MANDATORY
PEBB Health Insurance Open Enrollment
For 2015 BENEFITS
October 1 – October 31, 2014

 

 


 

Mandatory Open Enrollment

Open Enrollment and selection of your participation status in the 2015 Health Engagement Model (HEM) program is MANDATORY.  If you elect to participate in the HEM, you and your enrolled spouse/domestic partner 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 2015.

* If you incur or anticipate incurring a qualifying event during Open Enrollment, contact Employee Benefits at 541.737.2805 or employee.benefits@oregonstate.edu 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. 

Open Enrollment/HEM Health Assessment (2 Actions Required) & Penalties

  • Action #1:  Open Enrollment Completionto be completed between October 1 – 31, 2014: confirm your benefit elections, make changes, re-enroll in flexible spending accounts, AND indicate your HEM participation status for the 2015 plan year.
  • Action #2:  HEM Health Assessment Completionto be completed between September 1 – October 31, 2014:
    • If you have or will elect to participate in the HEM for 2015, you and your enrolled spouse/domestic partner must complete the HEM Health Assessment again between September 1 and October 31, 2014.  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.

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 2015 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 for employee only or $35 per month for employee plus spouse/domestic partner.

If you do not complete Action #2:

  • You will NOT participate in the 2015 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 only or $35 per month for employee plus spouse/domestic partner. 

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 2015 plan year.

If you were eligible and elected to participate in the 2014 HEM program, you will be asked during the Open Enrollment process if you completed two healthy activities during 2014.

  • If you answer “YES”, you will be eligible to participate in 2015. 
  • If you answer “NO”, you will not be eligible to participate in 2015.
  • You do not need to record and/or report what healthy activities you completed during 2014.

    Additional Information:

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

    Adult Child(ren) that is or will be age 26 by December 31, 2014 – 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, 2014.  Termination of coverage will be effective January 1, 2015.

    Action #2:  HEM Health Assessment Completion

    Complete the online health assessment between September 1, 2014 and October 31, 2014.* 

    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.

     

    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, 2014, 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, 2015, your spouse/domestic partner will NOT need to complete the HEM health assessment for 2015.  They will need to complete the HEM health assessment during Open Enrollment next year for 2016 benefits. 
    • Employees that opted out of health insurance during the 2014 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, 2013 – October 31, 2013 and completed the health assessment using the “Special Access Code” in 2013, 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.

     

    2015 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 will be higher for members that have used tobacco within the last 12 months.

    2015 Plan Changes

    • HEM status in the PEBB system will no longer be tied to a medical plan.  HEM status will be a separate question.
    • Medical Plans, additional medical plans will be available in 2015.  The County in which you live and/or work, will determine the medical plans available to you and whether new plans will be available in 2015.  All Counties will have at least two medical plans to choose from.  For additional information on the medical plans being offered, please visit the PEBB website at:  http://www.oregon.gov/DAS/PEBB/Pages/14FAQNewPlans.aspx
    • Vision Coverage:
      • No longer attached to the medical plan (except for Kaiser Full-time medial plans)
      • May elect to “Enroll” or "Not to Enroll" in the Vision plan.  If you elect to "Not to Enroll" in the vision plan, you will not receive any additional cash back.
      • Available to part-time Classified Employees enrolling in “part-time” medical plans.
    • Dental Coverage:
      • May now elect “not to enroll” in the dental coverage.
      • Do not need to provide proof of other dental coverage.
      • No cash back for not enrolling.
      • Previously you could only Opt Out of dental coverage if also Opted Out of Medical coverage AND you provided proof of other group dental coverage.
    • Commuter Flexible Spending Accounts.  Two types of Commuter Accounts based on IRS codes will be available to save taxes on commuter expenses. 
      • Commuter Transportation Account
      • Commuter Parking Account (for parking expenses that ARE NOT already taken out pre-tax).
      • For Additional Information, please visit ASIFlex at:  http://asiflex.com/commuter.html

     

    2015 Plan Comparisons

     

    2015 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 2015.

    Providence  Choice Plan*:

    Providence continues to add more medical homes throughout the state.  The service area has expanded into Clark County in southwest Washington and in Oregon along the I-5 corridor, into Deschutes County in central Oregon and Curry County on the coast. 

    For a listing of the available Medial Homes, refer to the Medical Home Selection Form located at: https://healthplans.providence.org/pdfs/pebb/documents/medical-home-selection-form.pdf

    To search for Medical Home providers, visit: https://healthplans.providence.org/pebb/pebb-providence-choice-plan/pages/find-a-medical-home.aspx

    *Note:  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 care must be received through providers in that medical home or through providers referred by that medical home. 

    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 2015.

    Moda Health Plan*:

    Depending on where you live or work, Moda Health offers physicians and Medical Homes through either the Synergy Network or Summit Network. 

    For a listing of the counties to determine the applicable network, please visit Moda Health's website at: https://www.modahealth.com/pebb/medical/ 

    To search for Medical Home providers, visit: https://www.modahealth.com/ProviderSearch/faces/webpages/home.xhtml 

    IMPORTANT:  There are many "In Network" doctors and facilities in both the Synergy and Summit Networks.  Therefore, you need to verify that your primary physician is part of a Medical Home.  If your physician is part of a Medical Home you will see the following teal icon by their name. 
                                                                                               

    *Note:  To receive Medical Home level of benefits, you must choose a medical home in the plan and notify Moda of your choice before accessing services.  All care must be received through providers in that medical home or through providers referred by that medical home. 

    2015 Health Programs

    • Gym Membership Subsidy – members and enrolled spouse/domestic partners who use a qualified exercise facility at least 12 times per month are eligible for a $15 per month membership subsidy. 
    • Healthy Team, Healthy U V.1 & V.2– Is a team-based wellness program and is available at no cost to employees and their enrolled family members age 18 or older.  Can be completed with a team or on an individual bases.  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.
    • Additional Information:

    2015 Health Engagement Model (HEM)

    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.

    If you were eligible and elected to participate in the 2014 HEM program, you will be asked during the Open Enrollment process if you completed two healthy activities during 2014.

    • If you answer “YES”, you will be eligible to participate in 2015. 
    • If you answer “NO”, you will not be eligible to participate in 2015.

    PARTICIPATION in the 2015 HEM program:

    • Participation status (2 Actions Required). Must be completed between September 1 and October 31, 2014:
      • Action #1:  Enroll in the HEM program during Open Enrollment (October 1 – October 31, 2014)
      • Action #2:  Complete of the online health assessment. Both you and your enrolled spouse/domestic partner MUST complete the online health assessment between September 1 and October 31, 2014.  Your spouse/domestic partner will not receive separate notification of the requirement and/or due date.
    • You WILL RECEIVE a taxable incentive in your monthly pay of $17.50 (employee only) or $35 (employee + spouse/domestic partner) if you complete Steps 1 & 2 above.  The HEM incentive will begin on your December 2014 paycheck.
    • Complete two health related activities during 2015 to be eligible for participation in the HEM program for the 2014 plan year. 
      • 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 
      • Employees will attest to completing the requirements during Open Enrollment in 2015 (for 2016 benefits)
    • There are no additional deadlines and/or PEBB tracking of completion of HEM activities during 2015.

    NON-PARTICIPATION in the 2015 HEM program:

    • You answered “NO” to the Open Enrollment question: “Did you do two health activities during 2014"; 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, 2014; 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. 

    EXEMPTION from the HEM can be requested if:

    2015 Employee Premium Share (estimated monthly employee cost for health insurance)

    *Spreadsheets were developed using current contract language and are subject to change to incorporate any changes to the negotiated bargaining contract.

    Effective Dates, Verification of Changes, and Corrections to Enrollments

    WHEN are Changes Effective – Changes made during Open Enrollment are effective January 1, 2015, 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 2014 Earnings Statement will reflect changes to Medical, Dental, HEM financial incentive, Life, Accidental Death, Short-term Disability, Long-term Disability, and Long-term Care.*
    • January 2015 Earnings Statement will reflect enrollment in the Flexible Spending Account(s) for 2015.

    *For policies that require approval of an underwriter the change will be on the Earnings Statement the month following approval (life/long-term care).

    CORRECTIONS to Enrollments – if you notice an error on your Earnings Statement contact Employee Benefits at 541.737.2805 or by email at employee.benefits@oregonstate.edu 

    Employee Benefits Fair

    Thursday, October 9, 2014, 10 am – 2pm, MU Ballroom. Meet with health and retirement providers and get all of your questions answered.

    Workshops:

    • Short-term and Long-term Disability Insurance, 9am-10am, MU Ballroom West. Presenter: Standard Insurance. 
    • PEBB Open Enrollment overview, Plan Changes, & HEM, 10:30am-11:30am and 12:30pm-1:30pm, MU Ballroom West.  Presenter:  PEBB Representative.
    • Medicare Basics. 2pm-4pm, MU Ballroom West.  Presenter:  Oregon Senior Health Insurance Benefits Assistance (SHIBA).  Is a 2-hour workshop on understanding Medicare and Medicare Supplemental Plans.

    Health Benefit & Insurance Providers:

    • Providence – PEBB Statewide & Providence Choice Plans
    • Kaiser HMO & Kaiser Dental
    • Moda Health Insurance (NEW Health Plan)
    • Trillium Health Insurance (NEW Health Plan)
    • Providence Life Balance Program
    • VSP (vision plan)
    • Moda (ODS) Dental
    • Willamette Dental
    • BenefitHelp Solutions – COBRA/Retiree
    • Cascades Centers – EAP (Employee Assistance Program)
    • Weight Watchers
    • Healthy Team, Healthy U
    • Optional Plans:
      • Standard Insurance (Life, Short-term Disability, Long-term Disability, and MEDEX Travel Assist)
      • Long-term Care

     Pension Plan & Voluntary Retirement Providers:

    • PERS
    • OUS – Optional Retirement Plan (ORP)
    • Fidelity
    • TIAA-CREF
    • Oregon Savings Growth Plan (OSGP)

      Social Security & Medicare:

      • Social Security
      • Oregon Senior Health Insurance Benefits Assistance Program (SHIBA)

      Other Employee Services:

      • Dixon Recreation
      • Faculty/Staff Fitness
      • Orange Rewards
      • Healthy Campus Initiatives/BeWell
      • Childcare & Family Resources
      • Student Health Center
      • Free & Clear (Tobacco cessation information available)
      • Public Safety - learn about the Stop Tag program for Laptops, enroll in the Emergency notification system, etc.
      • Office of Human Resources
      • OSURA – OSU Retirement Association
      • Oregon College Savings Plan (529 Plan) 

      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 Open Enrollment & HEM Help Sessions at the Valley Library.  Barnard Classroom (5th Floor, #5420):

      • October 2nd:  10am – 1pm
      • October 7th:  1pm – 4pm
      • October 14th:  10am – 1pm
      • October 20th:  1pm – 4pm
      • October 23rd:  1pm – 4pm
      • October 28th:  10am – 1pm

      Resources

        Employee Benefits Staff List

        Employee Benefits - 204 Kerr | 541-737-2805 | general email
        Donna Chastain Donna Chastain Director, Workplace Solutions 541-737-2806
        Heidi Melton Human Resources Officer
        Workers’ Compensation, Standard Insurance Claims (STD&LTD)
        541-737-2916
        Christina Schaaf Benefits Consultant
        Benefit Issues for Business Centers: HSBC, BEBC & AABC
        541-737-2835
        Jessica Dalziel Benefits Consultant
        Benefit Issues for Business Centers: UABC, FOBC & Chancellor’s Office
        541-737-3521
        Roshni Sabedra Benefits Consultant
        FMLA/OFLA/Military Leave
        541-737-5946
        Whitney Barstad Benefits Consultant
        Benefit Issues for Business Centers: ASBC & AMBC
        541-737-2269
        Patricia Young Benefits Consultant
        Retirement, Savings & Pension Programs
        541-737-8254