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SEBB Wellness Plan 2022WELLNESS PROGRAM PLAN DOCUMENTFOR THE WASHINGTON STATE HEALTH CARE AUTHORITYSCHOOL EMPLOYEES' BENEFITS BOARD PROGRAMContentsI. Wellness Programs. 3A. Comprehensive Wellness Program Established . 31. Washington Wellness Worksite Designation Program (also known as SmartHealthWorksite Wellness Roadmap) . 32. SEBB Health Insurance Wellness Plan . 33. Tobacco-Use premium surcharge . 3B. Structure . 3II. Effective Date . 3III. Comprehensive Wellness Program Design . 4A. General . 41. Requirements . 42. Components . 43. Administration of Worksite Wellness Programs . 4B. FMLA, PFML, and USERRA Leaves of Absence . 4C. Activity-Only Wellness Program . 41. Eligibility . 42. Incentive Deadlines . 53. Incentives and requirements . 64. Timelines for Incentives . 65. Alternatives . 66. Appeals Procedure . 77. Conditions for Incentives . 7D. Outcome-Based Wellness Program. 71. Eligibility . 72. Requirements . 73. Alternatives. 84. Appeals Procedure . 8E. Participatory Wellness Program . 91. Eligibility . 92. Design Requirements . 93. Incentive Requirements . 94. Incentive Limit . 95. Alternatives. 96. Appeals . 97. Worksite Wellness Incentives . 10IV. Record-keeping and Administration . 10V. General Provisions . 10A. Headings. 10B. Which Provisions Control. 10SEBB SmartHealth Wellness PlanDocumentEffective 01/01/2022Page 1 of 16
SEBB Wellness Plan 2022C. No Contract of Employment . 10D. No Contract of Continuous Coverage . 10E. Amendment and Termination . 11F. Governing Law . 11G. Reimbursement . 11H. Non-Assignability of Incentives . 11I. Severability . 11VI. Definitions . 12A. "Activity-Only Wellness Program" . 12B. "ADA" . 12C. "Administrator" . 12D. "COBRA". 12E. "HCA" . 12F. "Health-Contingent Wellness Program" . 12G. "Health Factor" . 12H. "HIPAA" . 13I. “Incentive” . 13J. “Medical Effective Date” . 13K. “Non-Spartner Dependent” . 13L. “Outcome-Based Wellness Program” . 13M. “Participatory Wellness Program” . 13N. “PEBB” . 13O. “RCW” . 13P. “School Employee” . 14Q. “SEBB” . 14R. “SEBB Organization” . 14S. “SEBB Program”. 14T. “SEBB Wellness Program” . 14U. “Spartner”. 14V. “Subscriber” . 14W. “Tobacco Product” . 14X. “Tobacco Use” . 15Y. “WAC” . 15Z. “Year” . 15VII. Entire Plan . 16SEBB SmartHealth Wellness PlanDocumentEffective 01/01/2022Page 2 of 16
SEBB Wellness Plan 2022Wellness ProgramsComprehensive Wellness Program EstablishedThis comprehensive wellness program is established. It is intended to comply with45 C.F.R. § 146.121. The comprehensive wellness program includes, but is not limited to,the following:Washington Wellness Worksite Designation Program (also known asSmartHealth Worksite Wellness Roadmap)SEBB Organizations may participate in the Washington Wellness Worksite DesignationProgram administered by the HCA. The Washington Wellness Worksite DesignationProgram provides structure and technical and training assistance to SEBB Organizationsdeveloping internal worksite wellness programs for employees. Internal worksitewellness programs are referred to as Worksite Wellness Programs.SEBB Health Insurance Wellness PlanThe SEBB health insurance wellness plan is known as SmartHealth or the SEBBWellness Incentive Program. This plan aligns with the Washington Wellness WorksiteDesignation Program. SmartHealth is intended to help employees and family membersachieve their personal health and wellness goals. This includes efforts to reduce smokingrates.Tobacco-Use premium surchargeThe Tobacco-Use premium surcharge is an element of the comprehensive wellnessprogram for School Employees. The surcharge is established by the Legislature in eachbiennial budget.StructureThe SmartHealth program and the Tobacco-Use premium surcharge are integratedcomponents of SEBB medical insurance coverage. The Worksite Wellness Programsadministered by SEBB Organizations are separate wellness programs that do not provideor pay for health or medical benefits.Effective DateThis plan document is generally effective beginning on January 1, 2022.Page 3 of 16
SEBB Wellness Plan 2022Comprehensive Wellness Program DesignGeneralRequirementsThe SEBB and HCA will determine the requirements for eligibility for SmartHealth andfor completion of requirements for SmartHealth Incentives. The SmartHealth wellnessIncentives are set in the State of Washington and School Employees’ Benefits Coalitionagreement (collective bargaining agreement). The Legislature will set the financial valueof the Tobacco-Use premium surcharge.ComponentsThe SEBB Wellness Program contains both an Activity-Only Wellness Programcomponent known as SmartHealth and an Outcome-Based Wellness Program componentthat is the Tobacco-Use premium surcharge.Administration of Worksite Wellness ProgramsIndividual SEBB Organizations administer Worksite Wellness Programs as ParticipatoryWellness Programs. SEBB Organizations must not offer Incentives that depend onmedical examinations or on inquiries related to disabilities. Worksite Wellness Programsare subject to the Incentives limit described in SEBB Program Policy 91-3.FMLA, PFML, and USERRA Leaves of AbsenceIf a Subscriber goes on qualifying leave under the Family Medical Leave Act ("FMLA"),Washington Paid Family and Medical Leave ("PFML"), or the Uniformed ServicesEmployment and Reemployment Rights Act of 1994 ("USERRA"), then, to the extentrequired by FMLA, PFML, or USERRA, as applicable, that Subscriber may continue toearn Incentives.Activity-Only Wellness ProgramThe Activity-Only Wellness Program component of the Wellness Program is calledSmartHealth. Under that component, Subscribers and Spartners enrolled in SEBBmedical coverage can access an online wellness portal to complete a Well-beingAssessment and track their involvement in wellness activities to earn points.Eligibility(a) Subscribers and Spartners are eligible to participate in the SmartHealthprogram. They may access the SmartHealth wellness portal, take a Well-beingPage 4 of 16
SEBB Wellness Plan 2022Assessment, and participate and track their involvement in wellness activitieson the SmartHealth wellness portal to earn points. However, only Subscribersare eligible to earn SmartHealth Incentives based on their participation.Subscribers who waive enrollment in a SEBB medical plan may access theSmartHealth portal but cannot earn Incentives. Spartners of Subscribers whowaive enrollment in a SEBB medical plan will only have SmartHealth portalaccess and will not be eligible to earn Incentives. Wellness activitiescompleted by an individual who is in waived status will count towardSmartHealth Incentives if the individual later becomes a Subscriber orSpartner in the same Plan Year.(b) Dependents other than Spartners are not eligible to access or participate inthe SmartHealth wellness program in any way.Incentive Deadlines(a) To receive the SmartHealth Incentive of a reduction to the Subscriber'smedical plan deductible or a deposit to the Subscriber's health savingsaccount for the following Plan Year, eligible Subscribers must completeSmartHealth Incentive program requirements as described in the SEBBSmartHealth webpage, bb-smarthealth, by the latest applicable date below:(i) For Subscribers continuing enrollment in SEBB medical from the previousPlan Year and Subscribers enrolling in SEBB medical with a MedicalEffective Date in January through September, the deadline is November 30of the current Plan Year (for example, if the Subscriber's Medical EffectiveDate is March 1, the Subscriber must complete the SmartHealth Incentiveprogram requirements by November 30 of that same Plan Year in order to beeligible for the Incentive for the following Plan Year); or(ii) For Subscribers enrolling in SEBB medical with a Medical Effective Datein October through December, the deadline is December 31 of the currentPlan Year (for example, if the Subscriber's Medical Effective Date isOctober 1, the Subscriber must complete the SmartHealth Incentive programrequirements by December 31 of that same Plan Year in order to be eligiblefor the Incentive for the following Plan Year).(b) Except as provided in (d) below, Subscribers who do not complete therequirements according to subsection III.C.2(a), or according to an alternativeas described in this Plan, within the time limits described in subsectionIII.C.2(a) above are not eligible to receive a SmartHealth Incentive thefollowing Plan Year.(c) If a Subscriber has a "termination" (such as a transfer between SEBBOrganizations, change in eligibility status (LWOP, COBRA), or retirement,etc.) in SEBB medical coverage for any reason causing a system terminationrecord to be initiated, and then the Subscriber re-gains eligibility for SEBBPage 5 of 16
SEBB Wellness Plan 2022medical coverage with a new Medical Effective Date, the deadline that applieswill be based on the new Medical Effective Date.Incentives and requirements(a) To be eligible for SmartHealth Incentives, Subscribers must meet therequirements explained on the SEBB SmartHealth nefits/sebb-smarthealth,within the time limits described in section III.C.2 (beginning on page 5) inthis Plan document. Subscribers who do not meet the requirements withinthose time limits cannot earn Incentives for the Plan Year.(b) For Year 2022 and thereafter, eligible Subscribers may qualify for a 125SmartHealth Incentive. To qualify for this, eligible Subscribers described inIII.C.1(a) must meet the requirements explained on the SEBB webpage iree-benefits/sebb-smarthealth, completethe SmartHealth Well-being Assessment, and earn at least 2,000 total points onSmartHealth by joining and tracking activities on SmartHealth. QualifyingSubscribers enrolled in a high-deductible health plan (HDHP) receive a onetime deposit of 125 into the Subscriber's health savings account the followingPlan Year. All other qualifying Subscribers receive a 125 reduction to theSubscriber's medical deductible the following Plan Year.(c) Only the Subscriber is eligible to receive SmartHealth Incentives, and theSubscriber must be enrolled (not waived or ineligible) in a SEBB medical planin the Plan Year in which the Incentive is distributed.(d) All Subscribers earn an Incentive, however, only if the Incentive isotherwise available under III.C.7 and other provisions of this Plan.Furthermore, a Subscriber cannot earn the Incentive more than onceeach Plan Year.Timelines for IncentivesIncentives provided by the Administrator are available to all similarly situatedindividuals once each Plan Year.Each Plan Year, the SEBB Program will determine whether a Subscriber completed therequirements to earn an Incentive during the previous Plan Year and whether theSubscriber met the other eligibility requirements in WAC 182-31-190.AlternativesEligible Subscribers described in section III.C.l(a) can earn Incentives. Subscribers forwhom the activities are unreasonably difficult due to a medical condition or are medicallyinadvisable may be able to earn the same Incentive by different means. The Administratorwill work with Subscribers to define an individual wellness program that provides thePage 6 of 16
SEBB Wellness Plan 2022opportunity to qualify for the same Incentive in light of the Subscriber's health status. Therecommendations of the Subscriber's personal physician will be accommodated. SEBBPolicy 91-1 explains the process for requesting an alternative. Policy 91-1 is available s Procedure(a) Subscribers may appeal a decision by the Administrator regarding theircompletion of the requirements for an Incentive offered under theSmartHealth wellness program, or regarding a request for an alternative to aSmartHealth wellness program requirement. Such appeals must be made tothe Administrator. After that appeal, Subscribers may appeal a decision bythe Administrator to the SEBB Program.(b) Subscribers may appeal a decision by the SEBB Program concerning eligibilityto participate in the SmartHealth wellness program or receive an Incentiveunder the program. Such appeals must be made to the SEBB Program.(c) Chapter 182-32 WAC explains the process for appealing these decisions,including deadlines.Conditions for IncentivesThe Administrator will provide a SmartHealth Incentive only if all the following apply:(a) The Subscriber is still eligible for the SmartHealth Incentive program in thePlan Year the Incentive applies;(b) The funding rate provided by the legislature is designed to provide aSmartHealth Incentive program or a SmartHealth Incentive, orboth;(c) Specific appropriations are provided for SmartHealth Incentives; and(d) The Subscriber meets all requirements for the Incentive.Outcome-Based Wellness ProgramEligibilityThe Tobacco-Use premium surcharge applies to all Subscribers, Spartners, and NonSpartner Dependents.Requirements(a) If a Subscriber attests to their own, their Spartner's, or their Non-SpartnerDependent's use of Tobacco Products, or if the Subscriber fails to provide anattestation in accordance with WAC 182-30-050(1), the Subscriber will pay theTobacco-Use premium surcharge. The surcharge will be collected fromPage 7 of 16
SEBB Wellness Plan 2022Subscribers during each month of the Year. The SEBB Program will chargeonly one Tobacco-Use premium surcharge per account, regardless of thenumber of people who use tobacco and are enrolled on the Subscriber'saccount.(b) A Subscriber may avoid paying the Tobacco-Use premium surcharge byattesting on the prescribed form that neither the Subscriber, nor the Spartner,nor any Non-Spartner Dependents use Tobacco Products, or attesting that allTobacco Products users have enrolled in a qualified tobacco-cessationprogram. Subscribers may submit attestations to the SEBB Program anytimeduring the Plan Year. An attestation is effective the month after the SEBBProgram receives it.(c) A Subscriber may also avoid paying the Tobacco-Use premium surcharge ifthe Tobacco User contacts the SEBB Program to request an alternative inaccordance with the provisions in section III.D.3 below, and complies with theagreed alternative.AlternativesA Subscriber may avoid paying the Tobacco-Use premium surcharge if the TobaccoUser joins a tobacco cessation program prescribed by the Program or ceases usingTobacco. In some cases, a Subscriber's, Spartner's, or Non-Spartner Dependent's primarycare physician might have health-related concerns about joining a tobacco cessationprogram or ceasing use of Tobacco Products. In that case, the Subscriber, Spartner, orNon-Spartner Dependent may submit to the SEBB Program documentation from thatphysician stating that a tobacco cessation program is not medically appropriate andcontaining a recommended alternative. The SEBB Program cannot independently seekthis information from the physician. The SEBB Program will provide a reasonablealternative standard that accommodates the recommendations of the physician withregard to medical appropriateness. The procedures are in SEBB Policy 91-1. The currentversion of that policy is available at les-and-policies/sebb-rules-and-policies. For more information, contact theSEBB Program at 1-800-200-1004.Appeals Procedure(a) Subscribers may appeal a decision by the Administrator regarding theTobacco-Use premium surcharge. Such appeals must be made to theAdministrator. After that appeal, Subscribers may appeal a decision by theAdministrator to the SEBB Program.(b) Subscribers may appeal a decision by the SEBB Program concerning TobaccoUse premium surcharge. Such appeals must be made to the SEBB AppealsUnit.(c) Chapter 182-32 WAC explains the process for appealing these decisions,including deadlines.Page 8 of 16
SEBB Wellness Plan 2022Participatory Wellness ProgramThe Participatory Wellness Program component of the comprehensive wellness programis the Worksite Wellness Program. SEBB Organizations administer this programinternally. The Washington Wellness Worksite Designation Program at HCA providesstructure and technical and training assistance to SEBB Organizations involved indeveloping a Worksite Wellness Program for employees.EligibilitySchool Employees employed by a SEBB Organization who are eligible under WAC182-31-040 or 182-31-130 can participate in the Worksite Wellness Program.Design Requirements(a) The program must provide eligible employees a reasonable chance ofimproving health or preventing disease.(b) The program must be available to all similarly situated employees.(c) Eligible employees with disabilities must have equal access to programbenefits and greater obligations cannot be imposed upon them in order toobtain equal benefits.(d) The program cannot be overly burdensome, cannot be a subterfuge forviolating the ADA or other laws prohibiting employment discrimination, andcannot be highly suspect in the method chosen to promote health or preventdisease.(e) The program cannot conduct medical examinations or disability-relatedinquiries.Incentive RequirementsSEBB Organizations may develop their own requirements for earning Incentives, exceptthat the requirements to earn the Incentive cannot be based on a participant's satisfactionof a standard related to a Health Factor and cannot require a participant to disclose resultsfrom medical exams or physical or mental capacity exams.Incentive LimitIncentives under the program are subject to the limit described in SEBB Policy 91-3.AlternativesSEBB Organizations must provide reasonable accommodations (modifications oradjustments) to enable employees with disabilities to have equal benefits and privilegesof employment, which includes participation in employee wellness programs. SEBBPolicy 91-1 contains more information on requesting reasonable alternative.AppealsPage 9 of 16
SEBB Wellness Plan 2022Any eligible employee may appeal a decision regarding the Incentive by followingthe appeals process established by his or her employing SEBB Organization.Worksite Wellness IncentivesSEBB Policy 91-3 states the requirements and standards for worksite wellness Incentives.Record-keeping and AdministrationThe SEBB Program owns and will maintain all records related to the SmartHealthProgram in accordance with appropriate state and federal laws, such as the WashingtonPublic Records Act and HIPAA. Each SEBB Organization owns and will maintain allrecords relating to the Worksite Wellness Program at that SEBB Organization.General ProvisionsHeadingsThe headings throughout this document are inserted for convenience of reference. Theyare not part of this Wellness Program. They do not indicate or control the meaning orconstruction of any provisions.Which Provisions ControlIf SEBB resolutions, SEBB Program policies, state law or rule, or federal law or ruleconflict with this document, those resolutions, policies, laws, and rules will control.No Contract of EmploymentNothing contained in this document is intended as a contract or other arrangementbetween a Subscriber, Spartner, Non-Spartner Dependent, or other dependent of aSubscriber and a SEBB Organization, guaranteeing employment or health benefits forany specific period. This document will not be construed as a guarantee of employmentand does not amend or modify any employment or other agreements between a SEBBOrganization and a Subscriber, Spartner, Non-Spartner Dependent, or other dependent ofa Subscriber whether entered before or after the effective date of the Wellness Program orthis document.No Contract of Continuous CoverageNothing contained in this document is intended as a contract or other arrangementbetween the SEBB Program and a Subscriber, Spartner, or other dependent of aSubscriber receiving coverage for any specific period. Moreover, a Subscriber, Spartner,or Dependent receiving continuation coverage (as defined in WAC 182-30-020) must stillcomply with any governing provisions of state and federal law.Page 10 of 16
SEBB Wellness Plan 2022Amendment and TerminationThe continuation of this Wellness Program is dependent on funding from theWashington State Legislature. The value of any Incentives under the WellnessProgram depends on funding from the Washington State Legislature. Only theWashington State Legislature may adjust the Incentive amounts under the WellnessProgram.Without providing prior notice to SEBB members, either the SEBB or theWashington State Legislature may change the terms and conditions for receiving anIncentive under the Wellness Program.Governing LawThis Wellness Program will be construed, administered, and enforced according to thelaws and regulations of the state of Washington, to the extent not superseded by theInternal Revenue Code of 1986, the Public Health Service Act of 1944, HIPAA, ADA,other federal law, or any rules promulgated under these authorities.ReimbursementIf a Subscriber receives any Incentives improperly from the Administrator throughthe SmartHealth program, the Subscriber must promptly reimburse the SEBBProgram for the improper Incentive.If a Subscriber believes he or she is entitled to an Incentive that was not provided, heor she may contact either the SEBB Program or the Administrator directly forassistance or appeal under chapter 182-32 WAC.If an eligible employee receives any Incentives improperly from the employing SEBBOrganization through the Worksite Wellness Program, the Subscriber must promptlyreimburse the SEBB Organization for the improper Incentive.Non-Assignability of IncentivesSubscribers or eligible employees under the Worksite Wellness Program may not assignIncentives to other people. Any attempt to assign an Incentive will not be recognized,except to the extent required by law.SeverabilityIf any court of appropriate jurisdiction declare any part of this
as described in this Plan, within the time limits described in subsection III.C.2(a) above are not eligible to receive a SmartHealth Incentive the following Plan Year. (c) If a Subscriber has a "termination" (such as a transfer between SEBB Organizations, change in eligibility status (LWOP, COBRA), or retirement,
