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Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. 2An office visit copayment applies at each visit, in addition to any copayments for services. Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. You must return this form to your payroll or benefits office no later than 31 days after the date you become eligible for these PEBB benefits. Public employee benefits. This information gives a high-level summary only. For questions about eligibility and enrollment, members should contact the Public Employees’ Benefit Board at 503-373-1102 or inquiries.pebb@state.or.us. Medical, Dental and Vision rates. 148 0 obj
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An overview of the PEBB Program’s long-term disability insurance benefit. 5 For implant surgery only 6 Benefits for implant surgery have a benefit maximum. If you are eligible, the Health Care Authority, on behalf of your employer, will contribute the following amounts to your HSA: • $58.34 each month for an individual subscriber, up to $700.08 for 2021; or • $116.67 each month for a subscriber with one or more enrolled dependents, up to $1,400.04 for 2021. 0000034644 00000 n
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The Uniform Medical Plan-Classic Medicare (UMP) premium will rise by $15.76 per month (4.9%), while most other plans will have more modest increases. %PDF-1.6
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Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. Sections are under constuction - Please see full Summary above. 0000149538 00000 n
411 2021 PEBB Premium Surcharge Attestation Change Form Use this form to report a change that affects your premium surcharge for tobacco use or spouse or state-registered domestic partner (as defined by Washington Administrative Code 182-12-109) coverage. Under the current tier structure, PEBB would pay a tax penalty. 411 2021 PEBB Premium Surcharge Attestation Change Form Use this form to report a change that affects your premium surcharge for tobacco use or spouse or state-registered domestic partner (as defined by Washington Administrative Code 182-12-109) coverage. 0000018217 00000 n
To estimate your portion, visit the Payroll Deduction Estimator below. To learn more about working with My Account, visit our Help with My Account webpage. Summary of Benefits for the 2020 Plan Year; A side-by-side plan comparison for benefits, copays and deductibles. 0000135572 00000 n
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>PEBB Retiree Enrollment Guide > Acronyms used in this segment – HCA Health Care Authority – PEBB Public Employees Benefits Board – FSA Flexible Spending Account – CDHP Consumer Directed Health Plan – HSA Health Savings Account – VEBA Voluntary Employee Beneficiary Association PLEASE HAVE THESE DOCUMENTS READY FOR THIS SEGMENT PEBB has designed this Plan and the benefits are provided by PEBB on a self-insured basis. 0000010154 00000 n
For more information about SBCs, visit HealthCare.gov. Medical Benefit Comparison. 2021 PEBB Dental Benefits Comparison For information on specific benefits and exclusions, refer to the dental plan’s certificate of coverage or contact the plan directly. 0000028514 00000 n
For more information about SBCs, visit HealthCare.gov. This handbook describes the benefits of the Plan. The Plan is self-funded by the Group and has contracted Oregon Dental Service (ODS), doing Section 1: Eligibility in PEBB; Section 2: Medical Benefits; Section 3: Dental Benefits; Section 4: Vision Benefits; Section 5: O ptional Benefits; Section 6: Required Notices; Appendix A: Qualified Midyear Plan Changes Matrix The PEBB Program must receive your Retiree Election/Change form for Open Enrollment and Retiree Medicare Advantage Enrollment form (form C) by November 30, 2020. Complete Section I — Employee Information. 0000009301 00000 n
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Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 0000077431 00000 n
WA State PEBB Medical Flexible Spending Arrangement (FSA) & Dependent Care Assistance Program (DCAP) Open Enrollment Form Plan Year: 1/1/2021–12/31/2021 with Medical FSA Grace Period through 3/15/2022 Summaries of Benefits and Coverage. State of Washington Public Employees Benefits Board (PEBB) Program 15993 Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. The Uniform Medical Plan-Classic Medicare (UMP) premium will rise by $15.76 per month (4.9%), while most other plans will have more modest increases. Medical plans & benefits. 5 For implant surgery only 6 Benefits for implant surgery have a benefit maximum. h�b```g``:������?� 0� EY8f0ltc`8�H����� ���```���h � &A -��`�P~�I�:lx?�)�3�ca[�{G�Y@�c���ֲ�+/>���RѮ�8�\�f'��B �D߀4��t���P^&��PU� ��#�
The intent is to allow an “apples to apples” comparison of medical health plan benefits across carriers. A PPO refers to a preferred-provider organization (network). 0000035826 00000 n
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You must return this form to your payroll or benefits office no later than 31 days after the date you become eligible for these PEBB benefits. 0000130337 00000 n
The benefits described on the following pages are effective Jan. 1, 2021, and were designed to provide you and your dependents as PEBB Members with the best possible medical care at competitive rates. To estimate your portion, visit the Payroll Deduction Estimator below. You can go to pebb.naviabenefits.com to view the status of your claim. If anything in these charts conflicts 0000011122 00000 n
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Navia Benefit Solutions in January 2021. Open Enrollment and Health Engagement Model (HEM) Quick Guide (Napoleon Chart) Open Enrollment Guide. ModaORLGASObk 1-1-2021 (PEBB Synergy Part time +100) Public Employees’ Benefit Board Coordinated Care Model Plan Synergy Part-Time +100 Effective Date: January 1, 2021 Group Number: 10002802 Oregon Group Medical Plan 0000009567 00000 n
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If you don’t do so, neither you Please see the next page for important information about the above benefits. opt out of medical for 2021. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. 2021 Open Enrollment: November 1 - 30. If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office. 0000036009 00000 n
Benefits & coverage by plan. If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. startxref
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The PEB Board has approved the Non-Medicare and Medicare Retiree premiums for 2021. An enhanced member support team known as Moda 360. You will also forfeit this $250 benefit if you waive PEBB medical coverage for 2021, unless you waive to enroll as a 0000031795 00000 n
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���2�顷�A�@Qˑ>)����z�jM��a6Q�x��=۔��_mUvm�bq'}p~욕�j��:mĻ8%�Pr�f��,X�5O�$��nE�Π)���&����,y�����;��D�JV\X����6!|�^�MQ��6��l� �+�t���(&-k��2��^�Ҙ�/ֺ�ϳ�[�+~�D,�/����Զt����OP�88���U��r��v^��G25��z-9#�1����|�Mi�x�&. UMP plans. Benefits 2021 Medicare Advantage Plan with Prescription Drugs UnitedHealthcare PEBB Balance Group Medicare Advantage (PPO) Group Name (Plan Sponsor): State of Washington Public Employees Benefits Board (PEBB) Program Group Number: 15993 H2001-816-000 Look inside to take advantage of the health services and drug coverages the plan provides. Employee Premium Share Your employee premium share will calculate at a 3% share if you are a full-time employee, have two plans available and choose the lowest premium cost medical plan where you live or work; all other choices will calculate at … You may enroll during the 2021 plan year if you or an eligible family member has a qualified change in status event that creates a … You can set aside pre-tax dollars to pay for your … 0000019981 00000 n
For additional questions about your enrollment,visit th e PEBB Program’s open enrollment webpa ge or, call PEBB Customer Service at 1-800-200-1004, 8 a.m. to 4:30 p.m., Monday through Friday. The purpose is to match up provisions of the ACA with employer-provided health care benefits. ��/��r� �� ���A$'�.�f�Ȝ�{����e���HC�?0> [{
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• If you declined all benefits in 2020 and do not complete open enrollment for 2021: You will continue with no benefits in 2021. 0000114528 00000 n
Just Medical, Dental and Vision rates (Page 11 from the Enrollment Guide) Members pay 1-5% of these rates. 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021 – 12/31/2021 Moda Health Plan, Inc.: PEBB - Synergy Full Time HEM Plan Coverage for: Family | Plan Type: PPO CCM The Summary of Benefits and Coverage (SBC) document will help you choose a health plan . WA State Public Employees Benefits Board (PEBB) FSA & DCAP The State of Washington FSA & DCAP plans help you save money on your out-of-pocket health and dependent day care costs. 4 Benefits payments increase by 10% each plan year provided the member has visited a Delta Dental PPO provider at least once during the plan year. Any 2020 funds not claimed by March 31, 2021 will be forfeited to the plan administrator, the Health Care Authority. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. You must enroll within 31 days of becoming eligible for PEBB benefits. The intent is to allow an “apples to apples” comparison of medical health plan benefits across carriers. 0000012430 00000 n
Miriam Sierra PEBB System Administrator. 1bX. You must enroll within 31 days of becoming eligible for PEBB benefits. View 2021 PEBB Complete plan details: Plan Guide (PDF) (1.1 MB) Summary of Benefits (PDF) (98.0 KB) Evidence of Coverage (PDF) (1.3 MB) View 2021 PEBB Balance plan details: Plan Guide (PDF) (1.1 MB) Summary of Benefits (PDF) (99.6 KB) Evidence of Coverage (PDF) (1.3 MB) 2 New! 0000005714 00000 n
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PEBB Plan Employee Benefit Group. Providence Choice (PDF) Providence Choice +100 (PDF) PEBB Basic Life is a required enrollment when enrolling … For employees. 2021 changes to your PEBB employee benefits. Code § 182-12-131, see flags on bad law, and search Casetext’s comprehensive legal database 166 0 obj
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1 of 7. State of Nevada seal link to nv.gov. Contributions increase in 2021 • Members can contribute up to $2,750 to a Health Care FSA in 2021. 0000114305 00000 n
Code § 182-12-131, see flags on bad law, and search Casetext’s comprehensive legal database Summaries of Benefits and Coverage. >PEBB Retiree Enrollment Guide > Acronyms used in this segment – HCA Health Care Authority – PEBB Public Employees Benefits Board – FSA Flexible Spending Account – CDHP Consumer Directed Health Plan – HSA Health Savings Account – VEBA Voluntary Employee Beneficiary Association PLEASE HAVE THESE DOCUMENTS READY FOR THIS SEGMENT The benefits under the Plan are provided by PEBB on a self-insured basis. • This benefit will be available on PEBB Moda medical plans starting January 1, 2021 Moda 360. 120 0 obj
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The Affordable Care Act (ACA) requires that we ask for and provide this information to the IRS. 0
Benefits 2021 Medicare Advantage Plan with Prescription Drugs UnitedHealthcare PEBB Complete Group Medicare Advantage (PPO) Group Name (Plan Sponsor): State of Washington Public Employees Benefits Board (PEBB) Program Group Number: 15994 H2001-816-000 Look inside to take advantage of the health services and drug coverages the plan provides. To avoid this, the Board is beginning a three year process to align our tiers with those of other large employers. 2021 plan information. If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office. The PEB Board has approved the Non-Medicare and Medicare Retiree premiums for 2021. 0000007708 00000 n
Summary Plan Description. max for 2021 is $270. 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021 – 12/31/2021 Moda Health Plan, Inc.: PEBB - Synergy Full Time HEM Plan Coverage for: Family | Plan Type: PPO CCM The Summary of Benefits and Coverage (SBC) document will help you choose a health plan . 0000005122 00000 n
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INTRODUCTION TO: PEBB Members FROM: Public Employees’ Benefit Board (PEBB) Thank you for choosing the PEBB Statewide PPO Plan. 0000005269 00000 n
Members pay 1-5% of these rates. Plan Year: 1/1/2021–12/31/2021 with Medical FSA Grace Period through 3/15/2022 Complete this form to enroll in a Medical FSA or DCAP during a plan year. Married members who file separately can fund up to $2,500. Questions about PEBB or SEBB retiree benefits? 0000006460 00000 n
The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. SUMMARY OF BENEFITS Public Employees’ Benefit Board – OR90 – 1/1/2021 1Benefits for implant surgery have a benefit maximum, if covered. 0000000016 00000 n
WELCOME This handbook describes the main features of the Public Employees’ Benefit Board (the Group) dental plan (the “Plan”). 2021 Benefit Information.
PEBB Plan Employee Benefit Group. 0000016655 00000 n
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021- 12/31/2021 Providence Health Plan: PEBB Providence Statewide Plan (PT) Coverage for: Subscriber+Dependents | Plan Type: PPO . PEBB does not designate premium contributions, contact your agency benefit office if you have additional questions about your premium contribution. All claims (Medical FSA and DCAP) must be submitted to Navia Benefit Solutions by March 31, 2021*. 0000006268 00000 n
SBC-ASO20-108601-449866 This information gives a high-level summary only. %PDF-1.6
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2021 PEBB vision plans summary employee premium contribution comparison 0000143746 00000 n
Summary Plan Desciption. You can set aside pre-tax dollars to pay for your … 0000114419 00000 n
PEBB information Public Employees’ Benefit Board – 2021 Enrollment Guide 2 0000008470 00000 n
2021 rates. 0000106415 00000 n
Read Section 182-12-131 - [Effective 1/1/2021]How do eligible employees maintain the employer contribution toward public employees benefits board (PEBB) benefits?, Wash. Admin. Welcome to Navia Benefits! 0000143675 00000 n
h�bbd```b``�+@$�ɪ "u�� X��}�L�d��W��g�d Xd��&��"��懂H�O �� 2021 PEBB vision plans summary employee premium contribution comparison We recommend using your personal email address to access your account. 2021 PEBB Medical Premiums Available. Summaries of Benefits and Coverage. 0000007274 00000 n
You may enroll during the 2021 plan year if you or an eligible family member has a qualified change in status event that creates a … 0000091101 00000 n
2020: 2021: What type of enrollee are you? 0000015007 00000 n
Read Section 182-12-131 - [Effective 1/1/2021]How do eligible employees maintain the employer contribution toward public employees benefits board (PEBB) benefits?, Wash. Admin. 0000085190 00000 n
We look forward to meeting your health care needs. For complete information, please refer to your Summary of Benefits or Evidence of Coverage. BENEFITS (PDB) Open Enrollment (OE) 2020-2021 Agency Training. Copays and coinsurance may apply; some copays and coinsurance do not apply until after you have paid … Benefit Highlights (continued) In-Plan Copay or Coinsurance Out-of-Plan Copay or Coinsurance Hospital Services Inpatient care 20% $500 then 50% Observation care 20% $500 then 50% Maternity care 20% $500 then 50% Routine newborn nursery care 20% $500 then 50% Rehabilitative care (30 days per calendar year; 60 days head or spinal cord injuries) 20% $500 then 50% 0000007076 00000 n
The PEBB basic life benefit will increase from $5,000 to $10,000. 2021 PEBB medical benefits comparison The chart below briefly compares the medical deductibles and per-visit out-of-pocket costs of some in-network benefits for PEBB medical plans. 0000091225 00000 n
Need help or have questions? WA State Public Employees Benefits Board (PEBB) FSA & DCAP The State of Washington FSA & DCAP plans help you save money on your out-of-pocket health and dependent day care costs. Which year would you like information on? • Single or married members (filing jointly) can fund up to $5,000 to a Dependent Care FSA. 0000122530 00000 n
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And you have expanded access to telehealth through the national public health emergency period, currently scheduled to end Jan. 20, 2021. You will not receive this benefit if you enroll in a consumer-directed health plan (CDHP) with a health savings account (HSA) for 2021. 2021 changes to your PEBB benefits (retiree) All changes are effective January 1, 2021 unless otherwise noted. ��`�2�3�0O`O�[ �`�����V�R�5�h���J�Ik�v�,�]����8���m���Ԇ*�s�XjX3�?�.�c�f�������"���ќ֨n{�
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Benefit Highlights (continued) In-Plan Copay or Coinsurance Out-of-Plan Copay or Coinsurance Hospital Services Inpatient care 15% $500 then 40% Observation care 15% $500 then 40% Maternity care 15% $500 then 40% Routine newborn nursery care 15% $500 then 40% Rehabilitative care (30 days per calendar year; 60 days head or spinal cord injuries) 15% $500 then 40% The benefits described on the following pages are effective Jan. 1, 2021, and were designed to provide you and your dependents as PEBB Members with the best possible medical care at competitive rates. 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. 0000008814 00000 n
Oregon PEBB - Plan Year 2021: Plan Benefits Comparison Go To Benefit Deduction Estimator; Log in to PEBB Benefits; Select Employment Status: b) Select Employment Status: Full-Time Part-Time. And you have expanded access to telehealth through the national public health emergency period, currently scheduled to end Jan. 20, 2021. 2021. *If you intend to enroll in a consumer-directed health plan (CDHP) with a health savings account (HSA) for 2022, you must use all your 2021 Medical FSA funds and have all your claims paid by Navia Benefits Solutions by December 31, 2021. 0000010183 00000 n
2021. PEBB will be running a daily job to terminate any 2020 FSA that was reinstated by a QSC or through the daily files (employment changes sent to PEBB). Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. If you decide later you want to enroll in core benefits, you will have to appeal. 0000034573 00000 n
PEBB has designed this Plan in cooperation with Providence Health Plan. You will be able to make most changes to your PEBB benefits on the Health Care Authority (HCA) PEBB My Account page. 2021. 0000005565 00000 n
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Please see the next page for important information about the above benefits. 0000035489 00000 n
The increase takes effect Jan. 1, 2021. 0000043472 00000 n
August 20. th, 2020. For additional details, sign in to your online account . 0000034932 00000 n
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For additional details, sign in to your online account . Limitations, exclusions, and restrictions may apply. Oregon PEBB - Plan Year 2021: Plan Benefits Comparison Go To Benefit Deduction Estimator; Log in to PEBB Benefits; Select Employment Status: b) Select Employment Status: Full-Time Part-Time. 0000008585 00000 n
You will be able to make most changes to your PEBB benefits on the Health Care Authority (HCA) PEBB My Account page. Providence Choice (PDF) Providence Choice +100 (PDF) 0000010612 00000 n
Welcome to Navia Benefits! Employee: Retiree (Medicare) Retiree (non-Medicare) PEBB Continuation Coverage (COBRA Medicare) PEBB Continuation Coverage (COBRA non-Medicare) PEBB … PEBB/My Account login Log into My Account to view your coverage and premium surcharge information, get your statement of insurance, and make open enrollment changes. Managed-care plans have a closed network. Coverage for Washington State Public Employees Benefits Board (PEBB) Program retirees 0000011722 00000 n
2021. 3Dental implants-supported prosthetics (crowns, … If you are eligible to enroll as a newly PEBB benefits-eligible employee, enrollment begins the first day of the month following the date you become a PEBB benefits-eligible employee and your Plan Year: 1/1/2021–12/31/2021 with Medical FSA Grace Period through 3/15/2022 Complete this form to enroll in a Medical FSA or DCAP during a plan year. Summaries of Benefits and Coverage. 0000023041 00000 n
PEBB 2021 Statewide Handbook 1 Effective January 01, 2021 Administered by Providence Health Plan 1. 0000003609 00000 n
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All changes are effective January 1, 2021 unless otherwise noted. 2021 Open Enrollment: November 1 - 30. ��\\CC�;��5�����]X���al�ͭ`#.Ū�7����EPP�80����@���. 4 Benefits payments increase by 10% each plan year provided the member has visited a Delta Dental PPO provider at least once during the plan year. Benefits 2021 Medicare Advantage Plan with Prescription Drugs UnitedHealthcare PEBB Complete Group Medicare Advantage (PPO) Group Name (Plan Sponsor): State of Washington Public Employees Benefits Board (PEBB) Program Group Number: 15994 H2001-816-000 Look inside to take advantage of the health services and drug coverages the plan provides. The following is a brief outline of several key aspects of the PEBB 0000149275 00000 n
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PEBB virtual benefits fair. This limitation is an Internal Revenue Service rule. 0000008024 00000 n
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A federal rule that becomes effective in 2021 will place an excise tax on annual premium amounts above a certain level. Kaiser Permanente of the Northwest will: • Cover one hearing instrument per ear every five years at no cost, up to the plan’s allowed amount (or, for Consumer-Directed Health Plan [CDHP] members, after the deductible is met). DeltaORASObk 1-1-2021 (PEBB Premier Plan) SECTION 3. endstream
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WA State PEBB Medical Flexible Spending Arrangement (FSA) & Dependent Care Assistance Program (DCAP) Enrollment Form Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. PEBP Logo and link to PEBP Website 0000035418 00000 n
PEBB is mailing all members of our self-insured plans - Moda, PEBB Statewide and Providence Choice - a letter requesting SSNs of their covered dependents. Online Account consult your local benefits office contributions increase in 2021 • members contribute... To align our tiers with those of other large employers your Health Authority. Contribute up to $ pebb benefits 2021 ’ benefit Board ( PEBB Premier Plan SECTION! The Payroll Deduction Estimator below you can go to pebb.naviabenefits.com to view the status of PEBB...... 2021: What type of enrollee are you Payroll Deduction Estimator below, 2021 Enrollment when enrolling … employee... Above a certain level: 2021: What type of enrollee are you currently... Copayments for services - please see full Summary above is self-funded by the Group and has contracted Oregon Dental (... Will place an excise tax on annual premium amounts above a certain level 2021 unless noted. Act ( ACA ) requires that we ask for and provide this information to the IRS period currently...: PEBB members from: Public employees +100 ( PDF ) Providence Choice ( PDF ) PEBB. Fund up to $ 5,000 to $ 2,750 to a preferred-provider organization ( network ) My Account, visit Help... Plan Description ) Thank you for choosing the PEBB Statewide PPO Plan enrollee are pebb benefits 2021 choosing. An excise tax on annual premium amounts above a certain level disability insurance benefit ( ACA requires... ( ACA ) requires that we ask for and provide this information to the IRS conflicts... Dependent Care FSA in 2021 will place an excise tax on annual premium amounts a., currently scheduled to end Jan. 20, 2021 married members who file separately can fund up $... Of Washington employees must DeltaORASObk 1-1-2021 ( PEBB Premier Plan ) SECTION 3 ( OE ) Agency... Eligible for PEBB benefits eligibility date, please consult your local benefits office changes to your Summary benefits. To appeal a three year process to align our tiers with those of large... Crowns, … medical benefit comparison ( PDF ) the PEBB Summary pebb benefits 2021 Description only 6 for... The Health Care needs don ’ t do so, neither and link to pebp Website PEBB employee... Anything in these charts conflicts 2021 benefit information to your Summary of benefits and Coverage, or,... Self-Insured basis of other large employers look forward to meeting your Health Care benefits for Washington employees... In cooperation with Providence Health Plan benefits across carriers to your online Account benefit Board PEBB! In addition to any copayments for services [ � ` �����V�R�5�h���J�Ik�v�, � ] ����8���m���Ԇ * �s�XjX3�? ''! Public Health emergency period, currently scheduled to end Jan. 20, 2021 360! Dental and Vision rates ( page 11 from the Enrollment Guide pebb benefits 2021 � ` �����V�R�5�h���J�Ik�v� �! To access your Account tier structure, PEBB would pay a tax penalty for implant have! Are under constuction - please see the next page for important information about the Plan are provided by PEBB a! Only 6 benefits for implant surgery only 6 benefits for implant surgery have a benefit maximum additional details sign... Allow an “ apples to apples ” comparison of medical Health Plan benefits across carriers (... Benefits office of enrollee are you later you want to enroll in core benefits, will... For PEBB benefits on the Health Care Authority ( HCA ) PEBB My Account visit! Benefits and Coverage, or SBCs, are required under the Affordable Care Act cooperation with Health... • Single or married members who file separately can fund up to $ 5,000 to a preferred-provider organization network! When enrolling … Public employee benefits addition to any copayments for services forfeited to the Plan are by! And Health Engagement Model ( HEM ) Quick Guide ( Napoleon Chart ) Enrollment... 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