PEBB Health Insurance Open Enrollment
For 2017 BENEFITS
September 1 – October 31, 2016
Open Enrollment Summary & Plan Changes
Open Enrollment is MANDATORY. During Open Enrollment, you confirm your health insurance enrollments and select your participation status in the 2017 Health Engagement Model (HEM). If you elect to participate in the HEM, you must also complete the HEM Health Assessment by the due date.
This is also your once-a-year* opportunity to make changes to your benefit packages without having a qualifying family status change (marriage, birth, divorce, loss/gain of other insurance, etc.) and to re-enroll in the Flexible Spending Accounts (FSA) for 2017.
* If you incur or anticipate incurring a qualifying event during Open Enrollment, contact Employee Benefits at 541.737.2805 or email@example.com to complete the Midyear Change process before completing Open Enrollment. If you incur a qualifying event during the year, don’t wait until Open Enrollment to update your elections. Contact Employee Benefits or refer to our website on how to update you benefit elections. The “Midyear Changes to Health & Optional Benefits” website is located at: http://hr.oregonstate.edu/benefits/midyear-changes.
Surcharges and Optional Life Rates
- Tobacco Surcharge - $25/month if employee uses tobacco + $25/month if enrolled spouse/domestic partner uses tobacco.
- Spouse/Domestic Partner Surcharge - $50/month if spouse/domestic partner waives coverage in another employer’s group plan (non-PEBB plan) in favor of coverage through PEBB.
- Tobacco User Life Insurance Rates – The rates for optional employee life and optional spouse/domestic partner life insurance is higher for members that have used tobacco within the past 12 months.
2017 Plan & HEM Changes
- Opt Out requirements changed - Employee MUST attest that all tax dependents have minimal essential health insurance coverage
- Preimum tier structure is changing to avoid impending Federal Excise Taxes from the Affordable Care Act
- MODA Medical Home plan is expanding in 2017 to included: Coos, Crook, Curry, Deschutes, Douglas, Hood River, Jackson, Jefferson, Josephine and Klamath counties
- Providence Choice expaning in 2017 to: Grand, Harney, Morrow, Tillamook, Wasco, and Wheeler counties
- Providence Choice - pregancy and coronary artery bypass graft (CABG) care package programs at Providence Medical Groups only
- AllCare PEBB - Non-emergent medical transportation to tier one providers
- Kaiser HMO and Kaiser Deductible - $50 Specialty Drug Copay
- VSP will offer an additional vision plan - VSP Plus; which includes the Basic Plan benefits "PLUS" increaes in frame allowance and covers Anti-reflective coatings and Progressive lenses in full after a $30 copay for each. The employee pays the entire premium cost difference between the Basic Plan and the PLUS plan.
- Dental coverage:
- Athletic Mouth Guards - now covered by ODS and Kaiser dental plans
- Night Bite Guards - now covered by ODS and Willamette dental plans
- Kaiser Dental will now have a $5 copay for visits for non-preventive services
- StayFit Rewards will no longer be offered due to changes in IRS regulations.
2017 Videos & Calculators
PEBB Benefits 101 Videos:
- Learn about our range of benefits
- Learn about your health plan choices
- Learn How to Choose the Plan that is Right for You
Calculators: Employee Premium Share (employee cost) & Benefits Plan Comparisons
Open Enrollment & HEM Health Assessment Process - 2 Actions Required
- Action #1: PEBB Open Enrollment Completion – October 1 – 31, 2016: confirm your benefit elections, make changes, re-enroll in flexible spending accounts, AND indicate your HEM participation status for the 2017 plan year.
- Action #2: HEM Health Assessment Completion – September 1 – October 31, 2016: If you have or will elect to participate in the HEM for 2017, you must complete the HEM Health Assessment again between September 1 and October 31, 2016. CHANGE for 2017: Your spouse/domestic partner is not required to take the HEM Health Assessment; they may take it, but there is no HEM incentive for taking it.
Penalties for Not Completing Action #1 and/or #2:
If you do not complete Action #1:
- You will be charged a $25 monthly ($50 couples) Tobacco Surcharge
- You will be charged a $50 monthly Spouse/Domestic Partner Waives Other Coverage Surcharge (applicable only if spouse/domestic partner is enrolled)
- You will be charged the higher tobacco user rate on optional life insurance plans
- You will NOT participate in the 2017 HEM program
- An additional $100 per person deductible will be added to your plan’s standard deductible (family max of $300). The additional $100 per person deductible is added to both the In Network and Out-of-Network deductibles.
- You will not receive the HEM monthly cash back incentive. The cash back incentive is $17.50 per month.
If you do not complete Action #2:
- You will NOT participate in the 2017 HEM program and will have an additional $100 per person deductible added to your plan’s standard deductible (family max of $300). The additional $100 per person deductible is added to both the In Network and Out-of-Network deductibles.
- You will not receive the HEM monthly cash back incentive. The cash back incentive is $17.50 per month for employee.
Tips on Completing Action #1: PEBB Open Enrollment Completion (Oct 1-31, 2016)
Confirm your benefit elections, make changes, re-enroll in flexible spending accounts, AND indicate your HEM participation status for the 2017 plan year.
ANSWERING THE HEM HEALTHLY ACTIVITIES QUESTION: If you were eligible and elected to participate in the 2016 HEM program, you will be asked during the Open Enrollment process if you completed two healthy activities during 2016.
- If you answer “YES”, you will be eligible to participate in 2017.
- If you answer “NO”, you will not be eligible to participate in 2017.
- You do not need to record and/or report what healthy activities you completed during 2016.
HOW/WHERE to re-enroll and make changes during Open Enrollment –
Removing an Adult Child that is or will be age 26 by December 31, 2016 – Do not remove the child(ren) during the Open Enrollment process. PEBB will run an automated process to remove Adult Children (non-disabled)that are or will be age 26 as of December 31, 2016. Termination of coverage will be effective January 1, 2017.
Tips on Completing Action #2: HEM Health Assessment Completion (Sept 1 – Oct 31, 2016)
- Complete the online health assessment between September 1, 2016 and October 31, 2016.*
- You must complete the online HEM Health Assessment.
- CHANGE for 2017: Your spouse/domestic partner is not required to take the HEM Health Assessment; they may take it, but there is no HEM incentive for taking it.
Complete the health assessment under your current plan.
- PEBB Statewide, Providence Choice, and Trillium members:
- Moda Health
- Kaiser Permanente
- AllCare Health
- For new and newly benefit eligible employees that are hired and/or become benefits eligible between September 1 and October 31, 2016, you will need to call PEBB at 503.373.1102 to get an access code to allow you 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.
- Employees that opted out of health insurance during the 2016 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. 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, 2015 – October 31, 2015 and completed the health assessment using the “Special Access Code” in 2015, you must create a new user account using your Providence ID number or your Kaiser ID number.
2017 Medical Home Plans
If you select a “Medical Home” plan, remember to notify your plan of your Medical Home before you and any enrolled family members incur medical expenses in 2017.
To receive Medical Home level of benefits, you must choose a medical home in the plan and notify Providence of your choice before accessing services. All medical care must be received through providers in that medical home or through providers referred by that medical home.
- Moda Health:
- Medical Home Selection Form
- To search for Medical Home providers, visit: modahealth.com and log in to myModa.
- Click "Find Care" to search for a provider by location, gender or language spoken. When you search, be sure to choose your network and select "Medical Home Providers & Doctors" from the "Provider type" menu. For assistance in finding a medical home, call toll-free at 844-776-1593, Monday through Friday, 7:30 a.m. to 5:30 p.m. Pacific Time. TTY users, please call 711.
2017 Health & Wellness Programs
- Employee Assistance Program (EAP), Cascade Centers – confidential programs to assist you with dealing with work, home, and family life.
- Healthy Team, Healthy U 1.0 & 2.0– Is an individual or team-based wellness program and is available at no cost to employees and dependents age 18+. Participation is voluntary and activities are completed on “non-work” time.
- MoodHelper– The Kaiser Permanente Center for Health Research is looking for 500 PEBB volunteers to pilot this online program for managing depression. You do not need to be a Kaiser member.
- Better Choices, Better Health– workshops to assist you in relieving the symptoms of chronic conditions.
- Weight Watchers– program to help you achieve your weight loss goals and improve your overall health. Available to employee, spouse/domestic partners, and dependents ages 10 or older.
- Tobacco Cessation Programs– programs to assist you in quitting tobacco use.
Exemptions from the HEM Health Assessment
An EXEMPTION from the HEM Health Assessment can be requested if:
- Member identifies as Transgender (the health assessment does not take into account the needs of the member).
- Member is enrolled in Hospice or extended hospital stays preventing them from completing their HEM action requirements
- Member is out of the country from their plan year coverage effective date and their HEM action requirements.
- Medical condition(s) that would not allow an individual to complete the health assessment and/or the health activities
- Exemption Form
2017 Health Engagement Model (HEM)
- Health Engagement Model (HEM) program for the 2017 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. CHANGE for 2017: Your spouse/domestic partner is not required to take the HEM Health Assessment; they may take it, but there is no additional HEM incentive for taking it.
If you were eligible and elected to participate in the 2016 HEM program, you will be asked during the Open Enrollment process if you completed two healthy activities during 2016.
- If you answer “YES”, you will be eligible to participate in 2017.
- If you answer “NO”, you will not be eligible to participate in 2017.
- You do not need to record and/or report what healthy activities you completed.
PEBB Additional Information on the HEM Program
PARTICIPATION in the 2017 HEM program:
- Elect to Participate & Complete the HEM Health Assessment:
- Enroll in the HEM program during Open Enrollment, October 1 – October 31, 2016.
- Complete of the online HEM health assessment between September 1 and October 31, 2016. You MUST complete the online health assessment.
- An Exemption form the Health Assessment may be claimed in certain circumstances, see Exemptions from the HEM Health Assessement.
- You WILL RECEIVE a taxable incentive in your monthly pay of $17.50 if you elect to participate and complete the health assessment by October 31, 2016. The HEM incentive will begin on your December 2016 paycheck.
- Complete two health related activities during 2017
- Health Activities are individualized and may include getting a physical, going to the dentist, starting and/or continuing an exercise program, walking at lunch time, and 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
- Employees will attest to completing the requirements during Open Enrollment in 2017 (to be eligible to participate in 2018).
- There are no additional deadlines and/or PEBB tracking of completion of HEM activities during 2017.
NON-PARTICIPATION STATUS in the 2017 HEM program:
- You answered “NO” to the Open Enrollment question: “Did you do two health activities during 2016; 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 did not complete the required health assessment (Action #2) between September 1 and October 31, 2016; then
- 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.
Effective Dates, Verification of Changes, and Corrections to Enrollments
WHEN are Changes Effective – Changes made during Open Enrollment are effective January 1, 2017, except for policies and/or amounts that require the approval of underwriters (life/ long-term care).
VERIFY that Changes Have Been Processed – Review your Earnings Statement to confirm that your enrollments and deductions are correct.
- December 2016 Earnings Statement will reflect changes to Medical, Dental, HEM financial incentive, Life, Accidental Death, Short-term Disability, Long-term Disability, and Long-term Care. For policies that require approval of an underwriter the change will be on the Earnings Statement the month following approval (life/long-term care).
- January 2017 Earnings Statement will reflect enrollment in the Flexible Spending Account(s) for 2017.
CORRECTIONS to Enrollments – if you notice an error on your Earnings Statement contact Employee Benefits at 541.737.2805 or by email at firstname.lastname@example.org
Employee Benefits Fair
Tuesday, October 4, 2016, 10 am – 1pm, MU Horizon Room. Meet with health and retirement providers and get all of your questions answered. Enter to win door prizes/drawings.
- Protected Leave (FMLA/OFLA) for Pregnancy Disability/Child Bonding, 8am-9am, MU 213. Presented by: Office of Human Resources.
- Short-term and Long-term Disability Insurance, 9am-10am, MU 213 . Presented by: Standard Insurance.
- Medicare Basics. 1:00pm-3:00pm, MU Room 213. Presenter: Oregon Senior Health Insurance Benefits Assistance (SHIBA). Is a 2-hour workshop on understanding Medicare and Medicare Supplemental Plans.
Oregon Health Authority’s Patient Centered Primary Care Facilities in the Corvallis Area:
- Corvallis Clinic
- Corvallis Family Medicine
Health Benefit & Insurance Providers:
- Providence – PEBB Statewide & Providence Choice Plans
- Providence Life Balance Program
- Kaiser HMO & Kaiser Dental
- Moda Health Insurance
- AllCare PEBB Health Plan
- VSP (vision plan)
- Moda (ODS) Dental
- Willamette Dental
- BenefitHelp Solutions – COBRA/Retiree
- Cascades Centers – EAP (Employee Assistance Program)
- Weight Watchers – Information available only
- Healthy Team, Healthy U
- Optional Plans:
- Standard Insurance (Life, Short-term Disability, Long-term Disability, and MEDEX Travel Assist)
- Long-term Care – Information available only
Pension Plan & Voluntary Retirement Providers:
- Optional Retirement Plan (ORP)
- Oregon Savings Growth Plan (OSGP)
Social Security & Medicare:
- Social Security
- Oregon Senior Health Insurance Benefits Assistance Program (SHIBA)
Other Employee Services:
- Faculty/Staff Fitness
- Orange Rewards
- Childcare & Family Resources
- Student Health Center
- Free & Clear (Tobacco cessation information available)
- Office of Human Resources
- OSURA – OSU Retirement Association
Help Sessions: Open Enrollment & HEM “Drop-in” Help Sessions
Have questions or need assistance in completing the Open Enrollment online enrollment process and/or the HEM online health assessment, please attend one of the drop-in Open Enrollment & HEM Help Sessions at the Valley Library. Barnard Classroom (5th Floor, #5420):
- October 6th: 9am – Noon
- October 10th: 9am – Noon
- October 14th: 9am - Noon (reserved for Facility employees)
- October 17th: 1pm – 4pm
- October 27th: 1pm – 4pm