No changes were made to the Health Engagement Model (HEM) program for the 2015 plan year.  The HEM program will provide a financial incentive in your pay if you elect to participate and a financial disincentive in your health plan if you choose not to participate.

Summary of 2016 HEM Program:

  • Complete the online HEM Health Assessment between September 1 – October 31, 2015.  Both you and your enrolled spouse/domestic partner MUST complete the online health assessment by the due date.  Your spouse/domestic partner will not receive separate notification of the requirement and/or due date.
  • Complete two health related activities during 2016 
    • Health Activities are individualized and can range from getting a physical, going to the dentist, starting and/or continuing an exercise program, walking at lunch time, to eating more fruits and vegetables.
    • For employees and/or spouse/domestic partners that use tobacco, one activity will involve trying to quit.
    • For employees and/or spouse/domestic partners that are overweight, one activity will involve trying to lose weight.
    • Additional list of PEBB approved activities is found at: http://www.oregon.gov/DAS/PEBB/Pages/HEMActivities.aspx
    • Required to be eligible to participate in the 2017 HEM program.
    • Employees will attest to completing the requirements during Open Enrollment in 2016 (for 2017 benefits)
  • There are no additional deadlines and/or PEBB tracking of completion of HEM activities during 2016.
  • If you PARTICIPATE in the HEM:  You WILL RECEIVE a taxable incentive in your monthly pay of $17.50 (employee only) or $35 (employee + spouse/domestic partner).  The HEM incentive will begin on your December 2015 paycheck.
  • If you DO NOT participate in the HEM: You will have an additional $100 per person deductible added to your medical plan’s deductible (family maximum of $300).  The additional deductible applies to both the In Network and Out-of-Network deductibles. 

Eligibility:

  • Eligible to Participate:
    • Employees that have PEBB health insurance coverage effective on/or before November 1, 2015.
    • Employees that participated in the 2015 HEM program and completed the two healthy activities during 2015.
    • Employees that did not participate in the 2015 HEM program, but elected to participate in the 2016 HEM during Open Enrollment.  This includes: employees that were not eligible to participate in 2015; employees that elected not to participate in 2015; and those that elected to participate in 2015 but did not complete the health assessment by the due date.
    • Employees that “Opted Out” or “Declined” health insurance during 2015, but enrolled in a health plan for 2016 plan year during Open Enrollment.
  • NOT Eligible to Participate:
    • Employees hired on or after November 1, 2015.
    • Employees that “Opt Out” or “Declined” PEBB Benefits for the 2016 plan year.
    • Employees that participated in the 2015 HEM program and did NOT complete the two healthy activities during 2015.  Answered “No” to the Open Enrollment question – Did you complete two healthy activities during 2015.

EXEMPTION from the HEM can be requested if:

  • Employees identifying as Transgender
  • Spouses in the military serving overseas
  • Members enrolled in Hospice or extended hospital stays preventing them from completing their HEM action requirements
  • Incarceration
  • Members who are out of the country from their plan year coverage effective date and their HEM action requirements.

How to Participate in the HEM – 2 Actions Required

Action #1:  PEBB Open Enrollment Completion

Confirm your benefit elections, make changes, re-enroll in flexible spending accounts, AND indicate your HEM participation status for the 2016 plan year.

If you want to participate in the 2016 HEM and your participation status in the 2015 HEM program was:

  • HEM Participant – you will be asked if you completed your two healthy activities during 2015.
    • If you answer “Yes”, you are eligible to participate in 2016 and you will default to HEM Participant for 2016.
    • If you answer “No”, you will not be eligible to participate in 2016 and you will default to Non-HEM Participant for 2016.
  • Non-HEM Participant – you will need to click on the “change” button next to the Medical Plan on the Core Benefits page.
  • Not-Eligible Participant – you will need to click on the “change” button next to the Medical Plan on the Core Benefits page.

HOW/WHERE to re-enroll and make changes during Open Enrollment –

Action #2:  HEM Health Assessment Completion

Complete the online health assessment between September 1, 2015 and October 31, 2015.* 

You and your enrolled spouse/domestic partner must complete the online HEM Health Assessment.  You are responsible for ensuring that your spouse/domestic partner completes the health assessment by the due date.  Your spouse/domestic partner will not receive separate notification of the requirement or due date.

Complete the health assessment under your current plan (PEBB Statewide/Providence Choice or Kaiser).

PEBB Statewide and Providence Choice members:

  • Log into myProvidence 
    • You should see “Welcome, PEBB member!” immediately after the blue "myProvidence" header.
    • Click on:
      • "Go Now" in the green box titled "Take your Personal Health Assessment" located in the center of the page; or
      • "Personal Health Assessment" under the "My Health” quick links located on the left hand side of the page

For assistance with access to your myProvidence website, call Providence customer service at:  877.569.7768, available 24 hours a day, seven days a week.

 Kaiser Permanente

For assistance logging into your kp.org account, contact Kaiser at 800.556.7677, Monday-Friday, 6am-7pm, weekends 7am-3pm

 

Special Situations:

  • For new and newly benefit eligible employees that are hired and/or become benefits eligible between September 1 and October 31, 2015, you will need to call PEBB at 503.373.1102 to get an access code to allow you AND your enrolled spouse/domestic partner to complete the HEM Health Assessment. You must first complete the initial new hire/newly eligible enrollment process before calling to get the HEM access code.  You will complete the HEM under the “myProvidence” account regardless of the health insurance plan you elect. 
  • If you add a spouse/domestic partner during Open Enrollment and benefits do not take effect until January 1, 2016, your spouse/domestic partner will NOT need to complete the HEM health assessment for 2016.  They will need to complete the HEM health assessment during Open Enrollment next year for 2017 benefits. 
  • Employees that opted out of health insurance during the 2015 plan year and are enrolling in health insurance during Open Enrollment will also need to call PEBB for an access code to complete the HEM Health Assessment once.  Call PEBB at 503.373.1102 for the access code after completing the Open Enrollment process.
  • New Employee Last Year:  If you were hired between September 1, 2014 – October 31, 2014 and completed the health assessment using the “Special Access Code” in 2014, you must create a new user account using your Providence ID number or your Kaiser ID number.  Your enrolled spouse or domestic partner will also need to complete the health assessment this year.

 

PEBB Determines Participation Status:

PEBB will determine your participation status in the 2016 HEM Program after the close of Open Enrollment, October 31, 2015.  You will be considered a HEM Participant or a NON-HEM Participant based on the following criteria:

  • HEM Participant* – you must complete the two actions below between September 1 – October 31, 2015
    • Action 1:  Enrolled in the HEM program during Open Enrollment
    • Action 2:  Completed the online health assessment. Both you and your enrolled spouse/domestic partner are required to complete the health assessment by the due date.  You are responsible to notify your spouse/domestic partner of the requirement.  Your spouse/domestic partner will not receive separate notification of the requirement and/or due date.

*If you participated in the HEM in 2015, you were required to complete two health activities during 2015 and attest to the completion of those activities by answering “Yes” to the Open Enrollment question. 

  • NON-Participant:
    • You answered “NO” to the Open Enrollment question: “Did you do two health activities during 2015; or
    • You elected not to enroll in the HEM program during Open Enrollment; or
    • You did not complete the Open Enrollment process (Action 1) and defaulted into Non-participant status; or
    • You elected to participate during Open Enrollment but you and/or your enrolled spouse/domestic partner did not complete the required health assessment (Action 2) between September 1 and October 31, 2015.

More information on the HEM: