1. Public Employees' Benefit Board (PEBB)
2. Cost of CORE health insurance coverage (medical, vision, dental, employee basic life)
3. PEBB  Health Improvement & Cost Containment Programs (HEM, Tobacco, Other Group Coverage)
4. Benefits eligibility
5. Eligible Dependents
6. Enrollment options
7. Enrollment timelines
8. When does coverage go into effect?
9. Medical plans (Core benefit)
10. Vision plans (Core benefit)
11. Dental plans (Core benefit)
12. Employee basic life insurance (Core benefit)
13. Optional benefits (optional life, disability, long-term care, flexible spending accounts)
14. Health & Wellness Programs
15. How to enroll and/or Make Changes
16. Verify your benefit deductions on your earnings statement
17. Required notices


1. Public Employees’ Benefit Board (PEBB)

The Public Employees’ Benefit Board (PEBB) is a labor-management board that designs, contracts and administers benefits for Oregon state employees. These benefits meet IRS code requirements as a Cafeteria Plan, so they provide tax advantages.

2. Cost of CORE Health Insurance Coverage

Effective for 2015 Plan Year Coverage:

  • OSU employer contribution is 95% of the premium cost for the plan and enrollment tier you select.
    • Classified employees enrolled in the least costly plan in the county in which they work or live: OSU employer contribution is 97%.
  • Employee contribution is 5% of the premium cost for the plan and enrollment tier you select. 
    • Classified employees enrolled the least costly plan in the county in which they work or live: Employee contribution is 3%.
  • If your base* monthly salary rate is less than or equal to $2,828, OSU will pay an additional monthly premium subsidy of $40 toward your premium costs.  The monthly subsidy will stop if your base salary later increases above $2,828 per month. *Base salary rate is determined by the Salary Schedule Salary Range/Step and is the full-time equivalent.  Differentials, Overtime, etc. do not factor into the base.
  • Part-time Classified Employees receive a pro-rated employer contribution based on the number of hours worked or in a paid leave status during the pay period.  Part-time employees must pay the difference between their benefit amount and the cost of the premiums for their choice of medical and dental plans. Part-time employees may be eligible for a premium subsidy based on the medical plan enrollment.

Estimate your total Monthly premium costs:

  • PEBB Payroll Deduction Estimator - select your plans and answer a couple of questions and the calculator will calculate your monthly premium cost for you. 

3. PEBB Health Improvement & Cost Containment Programs:

If you enroll in a Medical plan, you must also select your participation status in PEBB’s Health Improvement & Cost Containment Programs.  You may be assessed additional monthly surcharges based on your participation status.

Health Engagement Model (HEM) Program

  • 2015 HEM program is available only to employees that had coverage effective on or before November 1, 2014.
  • Employees hired on or after November 1, 2014 are not eligible to participate in the 2015 HEM program.  You can participate in the HEM program for the 2016 plan year and will make that election during Open Enrollment in October 2015.
  • Elected to participate during Open Enrollment in September/October 2014.
  • Completed the online health assessment by October 31, 2014.
  • Complete two health actions before the next Open Enrollment (October 2015).  You will attest to completing these with a “Yes/No” question during Open Enrollment in 2015.
  • If you elected to participate in the 2015 HEM and you and your enrolled spouse/partner (if applicable) completed the online health assessment by the deadline, you will receive a monthly taxable incentive each month beginning with your December paycheck ($17.50 for employee only coverage or $35 for employee and spouse/partner coverage).
  • If you elected not to participate in the 2015 HEM or either you and/or your enrolled spouse/partner did not complete the online health assessment by the deadline, you will not receive the monthly taxable incentive and your medical plan’s deductible will be increased by $100 per person (family maximum of $300).
  • For additional information on the 2015 HEM Program

Tobacco Use– you will be assessed a monthly surcharge based on your and/or your enrolled spouse/domestic partner’s tobacco use.

  • If you or your spouse/domestic partner use tobacco, the surcharge is $25 per month.
  • If both you and your spouse/domestic partner use tobacco, the surcharge is $50 per month.
  • For additional information on the Tobacco Use Program

Spouse/Domestic Partner Other Non-PEBB Employer Coverage – If your enrolled spouse/domestic partner has other employer group coverage available and does NOT enroll in that coverage, you will be assessed $50 per month.

  • If your spouse/domestic partner does not have access to employer coverage, there is no surcharge.
  • If your spouse/domestic partner enrolls in their employer plan, there is no surcharge.
  • If your spouse/domestic partner has access to other PEBB employer coverage and enrolls,  opts out or declines, there is no surcharge.
  • Other Employer Group Coverage does NOT include:  Social Security, TRICARE, student insurance, individual coverage.
  • For additional information on the Spouse/Domestic Partner Waives Other Coverage Program

4. Benefits eligibility

Classified and unclassified academic and professional employees working at least half-time* on appointments of 90 days or longer are eligible for health insurance benefits. 

Benefit eligible employees must continue to meet eligibility requirements each month to earn health insurance coverage for the following month.  If you do not meet the hours eligibility requirement in a month, you will lose coverage the following month.  The monthly hours requirement is:

  • A classified employee must work or be in a paid leave status for at least 80 hours in the month.
  • An unclassified employee must work or be in a paid leave status for at least one half of the available work hours in the month.  For example if the month has a total of 22 possible work days, you must work or be in a paid leave status for at least 88 hours to earn health insurance coverage for the following month.

 *Eligibility can be through a single appointment or a combination of appointments.  Temporary Service (TS) positions are not eligible for benefits.

5. Eligible Dependents

  • Spouse
  • Domestic Partner (same sex/opposite sex)
    • Tax consequence per IRS regulations
    • Value of benefit is determined by PEBB and is subject to Social Security, Medicare, Federal  and State taxes
  • Qualifying dependent children and domestic partner’s dependent children through the calendar year in which they turn age 26 (tax consequences for domestic partner’s children per IRS regulations).  The term “child” will apply to any son, daughter, stepson, stepdaughter, foster child, adopted child, or child for whom a member is legally obligated.  Eligibility will not depend on marital, student, employment, residency or tax status.
    more

6. Enrollment Options

Enroll in benefits

  • Enroll in a Medical plan
  • Enroll or "Not Enroll" in a Vision Plan
    • There is no Cash Back for electing to "Not Enroll" in a Vision plan
    • Vision plans are also available to Part-time Classified employees enrolling in a Part-time Medical Plan
  • Enroll or "Not Enroll" in a Dental Plan
    • There is no Cash Back for electing to "Not Enroll" in a Dental plan
  • Enroll in Employee Basic Life Insurance
  • Enroll in any of the PEBB optional insurance coverage

Opt Out of Medical Coverage

  • Employees may opt out of Medical coverage
  • PEBB considers "Opt Out" as an enrollment option in a medical plan
  • To be eligible to opt out you must be covered by another employer sponsored health insurance program. Other group coverage does not include Medicare, Medicaid, Veterans Administration Health Benefits, Student Health Insurance, or an individual plan.
  • Provides a cash incentive for not enrolling in a medical plan or medical/dental plan
    • Cash back is subject to Federal, State, and Social Security taxes
    • Cash back is $233 per month less the cost of employee basic life insurance ($1.00) for a total monthly cash back amount of $232.
  • Enroll or "Not Enroll" in VSP vision plan
    • There is no Cash Back for electing to "Not Enroll" in a Vision plan
  • Enroll or "Not Enroll" in a dental plan
    • There is no Cash Back for electing to "Not Enroll" in a Dental plan
  • Enroll in any of the PEBB optional insurance coverage
  • Must enroll in employee basic life insurance
  • Must provide proof of other employer coverage
  • Additional information on Medical Opt Out

Decline Benefits

  • If you decline coverage, you are declining enrollment in the CORE benefits (medical, vision, dental and employee basic life insurance). You will also not be eligible to enroll in any of the other PEBB optional insurances (e.g., optional life, long-term care, etc.)

7. Enrollment Timelines

  1. Within 30-days of hire date
    • If you do not complete the enrollment process within 30 days, you will not have benefits and you will need to wait until Open Enrollment to enroll for the next calendar year. 
    • You may be eligible to enroll prior to Open Enrollment if you experience a Qualified Status Change during the year.
  2. During the year if you experience a Qualified Status Change
    • Must complete Mid-year Update Form within 30 days of the qualifying event and return to Employee Benefits.
    • Qualifying Mid-year events include, but not limited to:  Marriage, Divorce, Birth, Death, Loss of other Coverage, Gain Other Coverage, etc.
      more
  3. Open Enrollment each year
    • This is the time of year when you can make changes to your benefit elections, increase coverage, drop coverage, etc.
    • Open Enrollment is the month of October.
    • Changes and new elections take effect in January.  Plans that require a review of medical history before approving/denying coverage will take effect upon approval (optional life insurance and long-term care insurance).
    • Each year you must re-enroll in your Flexible Spending Accounts if applicable.
    • Each year you must select your HEM participation status.
    • Each year you and your enrolled spouse/domestic partner must complete the online Health Assessment if you elect to participate in the HEM program for the new plan year.

8. When does coverage go into effect

Generally, coverage goes into effect the first of the month following your online enrollment or receipt of enrollment forms by OSU. Exceptions are when a plan requires review of medical history before approving or denying coverage (Optional Life and Long-term Care insurance). Coverage in these plans goes into effect the first of the month after approval by the plan.

9. Medical Plans (Core benefits)

PEBB 2015 Medical Benefits Resources webpage

Comparison of PEBB Medical Plans (Full-time & Part-time Plans)

In 2015, all PEBB members will have two or more medical plans to choose from.  Plans available are determined by the county in which the employee works or lives and may include Preferred Provider Organization (PPO), Medical Home, and Health Maintenance Organization (HMO) plans.  Review the plans available in your area to determine which plan is the best for you and your family.  All plans offer both a “Full-time” and “Part-time” option. 

 “Full-time” plans are available to:  Unclassified employees (.50-1.00FTE); Classified employees (full-time and part-time); and Retirees

 “Part-time” plans are only available to:  Classified Part-time employees (.50-.99FTE) and Retirees

  • Plans are designed specifically for part-time employees in an effort to keep plans more affordable.
  • Part-time classified employees may choose from any of the plans offered:  Full-time or Part-time.
  • Part-time classified employees that enroll in a part-time medical plan receive an additional “part-time subsidy” to help cover the cost of the premium. Part-time employees that enroll in a full-time medical plan will receive an additional monthly premium subsidy of $40 if their base salary rate is less than or equal to $2,816.  The base salary rate is determined by the salary schedule (Step/Column) and is based on the full-time equivalent.

PEBB Resources

  • PEBB Enrollment Guide provides information on all health plans (medical, vision, dental) and optional plans; Health Engagement Model (HEM), Wellness Programs, service plan areas, and how to enroll.
  • PEBB Summary Plan Description
  • Map of Plan Service Areas
  • PEBB Videos – includes:  Medical Plans Overview, Medical Plans Comparison, Benefits Overview
  • PEBB Medical Plan Cost Estimator - use this medical expense estimator to compare your out-of-pocket medical costs and premium costs amongst the available plans in your area.  Your estmated out-of-pocket expenses is just one factor in determining which plan is best for your family.  Other items to consider include:  access to your current providers and specialists; provider network; family members living in other states; ability to self-refer; managed care vs. PPO; etc.  (Unclassified .50-1.0FTE  and Classified 1.0 FTE employees use the "Full-time" estimator; Classified .50-.99FTE employees use the "Part-time estimator).

PEBB Medical Plans - Overview

PEBB Statewide (Full-time & Part-time Plans)

  • PPO plan
  • You have lower costs when you use providers in the plan’s network (including specialists, facilities and pharmacies)
  • You may self-refer specialists
  • When you access primary care from a Patient Centered Primary Care Home (PCPCH), you have a lower coinsurance level
  • Service Area:  Statewide and Nationwide
  • PEBB Statewide website
  • Plan Summary and Member Handbooks

 Moda Health (Full-time & Part-time Plans)

  • Medical home plans built around the coordinated care model;
  • You select a medical home in the plan and a primary care provider;
  • Your primary care provider coordinates your medical care;
  • You may have higher costs when you access care outside your medical home and without a referral from your medical home.
  • Service Area – Summit:  Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wheeler.
  • Service Area – Synergy:  Oregon – Benton, Clackamas, Clatsop, Lane, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington, Yamhill; Washington:  Clark
  • Moda Health website
  • Plan Summary and Member Handbooks

 Providence Choice (Full-time & Part-time Plans)

  • Medical home plan built around the coordinated care model
  • You select a medical home from the plan’s network
  • You must  notify the plan of your selection
  • Access medical care through that medical home, including referrals to specialists
  • You have higher costs if you access care out of your medical home
  • Service Area:  Oregon – Baker, Benton, Clackamas, Clatsop, Coos, Crook, Curry, Deschutes, Douglas, Hood River, Jackson, Jefferson, Josephine, Klamath, Lane, Lincoln, Linn, Malheur, Marion, Morrow, Multnomah, Polk, Umatilla, Union, Wallowa, Wasco, Washington, Yamhill; Washington – Clark, Walla Walla;  Idaho – Payette.
  • Providence Choice website
  • Plan Summary and Member Handbooks

Balance by Trillium (Full-time & Part-time Plans)

  • Medical Home Plan built around the coordinated care model
  • You have lower costs when you establish a medical home with one of the plan’s primary care providers and get referrals to specialists from that provider.
  • You have higher costs when you access care out of medical home.
  • Service Area:  Lane
  • Balance by Trillium website
  • Plan Summary and Member Handbooks

 AllCare (Full-time & Part-time Plans)

  • Plan has three provider tiers:  Preferred, Participating and Out-of-Network
  • You have lower costs when you use a preferred provider
  • You are required to select a primary care provider from among the network of preferred providers
  • Your cost for specialist care is lower with a referral from your preferred primary care provider
  • Service Area – Curry, Jackson, Josephine, and Glendale and Azalea in Douglas County
  • AllCare PEBB website
  • Plan Summary and Member Handbooks

 Kaiser HMO & Kaiser Deductible (Full-time & Part-time Plans)

  • Facilities are located in the Salem and Portland areas
  • You access care only through Kaiser providers and facilities
  • The HMO plan has lower out-of-pocket costs than the deductible plan, which has a lower premium.
  • Both plans offer a medical home in which your primary care provider directs all your care, including specialist care.
  • Service Area – Zip Codes in:  Oregon – Benton, Clackamas, Columbia, Hood River, Linn, Marion, Multnomah, Polk, Washington and Yamhill; Washington – Clark, Cowlitz, Lewis, Skamania, Wahkiakum
  • Kaiser HMO & Kaiser Deductible website
  • Plan Summary and Member Handbooks

10.  Vision Plans (Core benefits)

PEBB 2015 Vision Benefits Resources webpage

  • Kaiser Permanente
    • Kaiser provides the vision coverage for all of the Kaiser plans
    • Kaiser “Part-time” plans offer a limited vision benefit limited to the exam only
    • Refer to your medical plan summary for details on the Kaiser vision benefits

11. Dental Plans (Core benefits)

PEBB 2015 Dental Benefits Resources webpage

Comparison of Dental plans

PEBB offers "Full-time" and "Part-time" dental plans.

  • “Full-time” plans are available to:  Unclassified employees (.50-1.00FTE); Classified employees (full-time and part-time); and Retirees
  •  “Part-time” plans are only available to:  Classified Part-time employees (.50-.99FTE) and Retirees
    • Plans are designed specifically for part-time employees in an effort to keep plans more affordable.
    • Part-time classified employees may choose from any of the plans offered:  Full-time or Part-time.

PEBB Dental Plans - Overview

ODS (Moda) Premier (Full-time & Part-time Plans)

  • Can use any licensed dentist
  • Maximum annual benefit per covered individual is
    • Full-time plan:  $1,750
    • Part-time plan: $1,250
  • ODS (Moda) will apply a one-year waiting period for some services if you and/or your dependents are not covered in a PEBB dental plan when you/they are first eligible
  • ODS (Moda) refers to the plan as “Delta Dental Premier”
  • ODS (Moda) Dental website

ODS (Moda) PPO (Full-time Plan ONLY)

  • Use Statewide Preferred Provider (PPO) Network for higher benefit level 
  • Maximum annual benefit per covered individual is $1,750
  • Progressively higher benefit level for basic and maintenance services if you visit your preferred dentist at least once per year
    • Plan pays:  1st year = 80%; 2nd year = 90%; 3rd year = 100%.
    • Failure to visit your preferred dentist will cause a 10% reduction in payment the following year, although payment will not fall below 80%.
  • ODS (Moda) will apply a one-year waiting period for some services if you and/or your dependents are not covered in a PEBB dental plan when you/they are first eligible
  • ODS (Moda) refers to the plan as “Delta Dental PPO”
  • ODS (Moda) Dental website

 Willamette Dental Plan (Full-time Plan ONLY)

 Kaiser Permanente (Full-time & Part-time Plans)

  • Must Live or work in the Kaiser Service Area (Willamette Valley – Salem & Portland areas)
  • HMO– must use Kaiser facilities located in the Salem/Portland area
  • Do not need to be enrolled in the Kaiser medical plan
  • Maximum annual benefit per covered individual is
    • Full-time plan:  $1,750
    • Part-time plan: $1,250
  • Do not need to be enrolled in the Kaiser medical plan
  • Kaiser Permanente website

12. Employee Basic Life Insurance (Core benefits)

  • $5,000 term life policy
  • Includes Frontier MEDEX Travel Assistance
  • You are automatically enrolled in the policy when you enroll in benefits or opt-out of medical or medical/dental coverage
  • Basic Life Insurance Additional Information
  • If you decline benefits, you do not have this policy

13. Optional Benefits

Optional benefits are voluntary choices you purchase on your own.  Below is a brief summary of the optional benefits available. Click on the benefit links for additional information (i.e., overview, rates, etc.).

  • Employee Life Insurance – You are eligible to enroll in a $40,000 guarantee issue policy (no medical history statement required), if you enroll within 30 days of eligibility (initial hire or benefits eligibility).  You may purchase up to $600,000 in term life coverage. A medical history statement is required for any amount above $40,000. 
  • Spouse/Domestic Partner Life Insurance – You are eligible to enroll in a $20,000 guarantee issue policy (no medical history statement required), if you enroll within 30 days of eligibility (initial hire or benefits eligibility). You may purchase up to $400,000 in term life coverage. A medical history statement is required for any amounts above $20,000.
  • Dependent Life Insurance – You may purchase a basic $5,000 policy on each of your dependents.
  • Short Term Disability – Provides income replacement if you are injured/disabled for a short period of time and not able to work. (Seasonal Employees are not eligible to enroll in short  term disability plans). Short term disability can also be used for pregnancy related disability and the recovery period after the birth.
  • Long Term Disability – Provides income replacement if you are injured/disabled for a period of time and not able to work. (Seasonal Employees are not eligible to enroll in long term disability plans)
  • Accidental Death & DismembermentCoverage available for employee only or employee and dependents.  Policy covers accidental loss of life, limb, hand, foot, hearing, speech, sight, or thumb and index finger on the same hand.
  • Long Term Care – Plans available for employee and eligible family members. You can enroll at any time during the year. Medical history statement and approval of provider is required. There is a guarantee issue policy for the employee if enrolled within 30 days of hire, coverage level of up to $4,000/month benefit with a duration of 3 to 6 years (no medical history statement is required for the guaranteed issue amounts).
  • Flexible Spending Accounts (FSA) – Allows you to use pre-tax dollars to reimburse yourself for qualified health care and dependent care expenses.  You forfeit any funds that you don’t use and claim for valid expenses by the deadline.  ASIFlex Additional Information on FSA accounts. Expenses for a domestic partner and/or domestic partner’s children is not an allowable expense in the Federal Flexible Spending program.  Expenses for a same sex domestic partner and/or same sex domestic partner's children can be covered under the State of Oregon Flexible Spending program.
  • Commuter Flexible Spending Accounts - Two types of Commuter accounts based on IRS codes are available to save you taxes on communter expenses:  1) Commuter Transportation Account; 2)Commuter Parking Account (for parking expenses that ARE NOT already taken out of your paycheck on a pre-tax basis).  ASIFlex Additional Informaton on Commuter Accounts 

RESOURCES:

14. Health & Wellness Programs

15. How to Enroll and/or Make Changes

New Employee – must enroll within 30 days of hire date

Midyear Changes – must complete Midyear Change form within 30 days of the qualifying event

  • Allows changes to your plan elections during the year if you experience a Qualified Status Change.
  • Qualifying Midyear events include, but are not limited to: Marriage, Divorce, Birth, Death, Loss of other Coverage, Gain Other Coverage, etc
  • Complete and return the Midyear Change Form within 30 days of the qualifying event to Employee Benefits.
  • For more information on Midyear Plan Changes

Open Enrollment

  • Is your once-a-year opportunity to make changes to your benefit packages (i.e., increase/decrease coverage, add/drop coverage, etc.) without experiencing a qualified status change.
  • Open Enrollment is the month of October with changes taking effect in January. Exception is when a plan requires review of medical history before approving or denying coverage (Optional life insurance and long-term care insurance).
  • Each year you must re-enroll in your Flexible Spending Accounts if applicable.
  • Each year you must select your HEM participation status.
  • Each year you and your enrolled spouse/domestic partner must complete the online Health Assessment if you elect to participate in the HEM program for the new plan year.

16. Verify your benefit deductions on your earnings statement

For additional information

17. Required Notices

For additional information