PEBB Health Insurance Open Enrollment
For 2014 BENEFITS
September 1 – October 31, 2013
Mandatory Open Enrollment
Open Enrollment and selection of your participation status in the 2014 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 2014.
* If you incur or anticipate incurring a qualifying event during Open Enrollment, contact Employee Benefits at 541.737.2805 or firstname.lastname@example.org 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://oregonstate.edu/admin/hr/benefits/midyear-changes
Open Enrollment/HEM Health Assessment Process (2-steps) & Penalties
- Step 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 2014 plan year.
- Step 2: HEM Health Assessment Completion – If you elect to participate in the HEM for 2014, you and your enrolled spouse/domestic partner must complete the HEM Health Assessment again between September 1 and October 31, 2013. 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 Step #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 2014 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 Step #2:
- You will NOT participate in the 2014 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.
Step 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 2014 plan year.
If you want to participate in the 2014 HEM and your participation status in the 2013 HEM program was:
- HEM Participant – you will be asked if you completed your two healthy activities during 2013.
- If you answer “Yes”, you are eligible to participate in 2014 and you will default to HEM Participant for 2014.
- If you answer “No”, you will not be eligible to participate in 2014 and you will default to Non-HEM Participant for 2014.
- 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 –
HOW to remove an Adult Child that is or will be age 26 by December 31, 2013 – You do not need to do anything. PEBB will ran automated process to remove Adult Children (non-disabled) that are or will be age 26 as of December 31, 2013 prior to the start of Open Enrollment. Termination of coverage will be effective January 1, 2014.
Step 2: HEM Health Assessment Completion
Complete the online health assessment between September 1, 2013 and October 31, 2013.*
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.
- PEBB Statewide and Providence Choice members:
NEW! Click here for tips on taking the personal health assessment at myProvidence.org.
- Log into myProvidence
- You do not need an “activation code” to complete the health assessment (this is the red banner at the top of the page), you can ignore this banner if you do not want to use the site’s “enhanced” services.
- You should see “Welcome, PEBB member!” at the top of the page.
- Click on:
- “Go Now” found in the green box “Take your personal health assessment” located in the center of the page; or
- “Personal Health Assessment” quick link under “My Health” located on the left hand side of the page
For assistance with access to your myProvidence website, call Providence customer service at:
- 877.814.9909 (Assistance with user name, password or registration)
- 877.569.7768 or 503.216.6463 (How to associate a PEBB health plan membership with your account or other questions about using myProvidence) , Monday-Friday, 7am-6pm; Weekend hours on 10/26 & 10/27/13 8am-5pm; and extended hours on 10/31/13 7am-Midnight
For assistance logging into your kp.org account, contact Kaiser at 800.556.7677, Monday-Friday, 6am-7pm, weekends 7am-3pm
*For new and newly benefit eligible employees that are hired and/or become benefits eligible between September 1 and October 31, 2013, 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.
Employees that opted out of health insurance during the 2013 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.
Changes you can make during Open Enrollment and questions you need to answer
Open Enrollment is your once-a-year opportunity to make changes to your benefit packages without having a qualifying family status change (marriage, birth, divorce, loss of other insurance, etc). You also need to elect participation in the 2013 HEM program and answer a couple of specific questions related to PEBB surcharges.
Questions that will need to be answered
- Do you and your enrolled spouse/domestic partner elect to participate in the HEM program
- Have you and/or your enrolled spouse/domestic partner used tobacco within the last 12 months
- Do you and/or your enrolled spouse/domestic partner currently use tobacco
- Does your enrolled spouse/domestic partner waive other employer group coverage (non-PEBB) in favor of PEBB coverage
Changes you can make during Open Enrollment and/or re-enrollment in a flexible spending account
- Enroll or Re-enroll in Flexible Spending Account(s) – Medical and/or Dependent Care. Annual enrollment is required.
- Add and/or Drop Dependents
- Enroll, Opt-Out, or Make changes to your Core Benefits (Medical and Dental)
- Optional Insurances – Enroll, Terminate, Increase, or Decrease coverage (Life, STD/LTD, Long-term Care)
2014 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.
2014 Plan Changes
- Short-term & Long-term Disability Rates Increased. Short-term premium increased 17%; Long-term increased an average of 8.2%, but varies by plan selected.
- State of Oregon Flexible Spending Accounts (FSA): for Medical & Dependent Care expenses for a Registered Domestic Partner and their dependents
- ODS Name Change: ODS is now MODA Health and plan names are changing from:
- Preferred to PPO
- Traditional to Premier
- Kaiser Plans:
- Substance Abuse Treatment - is now fully covered at no cost to member
- Bariatric surgery – covered for those with BMI of 35 and higher and diagnosis of diabetes.
- PEBB Statewide and Providence Choice plans:
- Naturopathic Visits: No limit on number visits
- Acupuncture and spinal manipulation: PEBB Statewide plan – visits limited to 60 visits per year (combined); Providence Choice – limited to $1,000 per year
- Knee viscosupplementation is covered with additional $100 co-pay
- Treatment for Foot Ailments: bunionectomy and surgery for hammertoe and Morton’s neuroma are covered with additional $100 co-pay
Providence has added more medical homes in some areas of 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 our choice before accessing services. All care must be received through providers in that medical home or through providers referred by that medical home.
- OSU Program:
- Available Now! Fill your prescriptions at OSU Student Health Services Pharmacy. Employees with a valid OSU ID card can now have prescriptions for themselves and family members filled at the OSU Student Health Services Pharmacy.
- PEBB Programs:
- Gym Subsidy - $15 per month
- Effective October 1, 2013
- Employee and enrolled spouse/domestic partner may participate in this program and receive the $15 per month subsidy.
- Must workout at least 12 times per month to receive the subsidy for that month.
- Rewards check mailed within 30 days of the end of the calendar quarter for each month you worked out at least 12 times.
- Search for “In Network” facilities at Fitness Facilities. OSU Recreational Sports and the Faculty Staff Fitness Program are approved facilities but not “In Network”. Therefore, they will not be listed on this report.
- Register online at www.exerciserewards.com.
- Recreational Sports is an “APPROVED” gym.
- OSU Faculty Staff Fitness Program is an “APPROVED” program.
- Faculty Staff Fitness website
- Is an approved facility, you do NOT need to submit the Fitness Facility Member Verification Form PEBB has worked with the vendor so you do not need to submit this form.
- Submit for your rewards check quarterly using the Reward Submission Form/Log
- If your class meets twice a week, you will also need to workout at either an “Approved” or “In Network” gym to meet the 12 times per month requirement.
- Other Facilities:
- “APPROVED” facility -
- Submit the Fitness Facility Member Verification Form (submitted only once per year) – form attached
- Submit for your rewards quarterly using the Reward Submission Form/Log – form attached
- “IN NETWORK” facility –
- Show the facility the ExerciseRewards ID card (from the attached Exercise Rewards Program brochure)
- The facility will submit your exercise sessions directly to ExerciseRewards each month.
- You will automatically receive your rewards check (approximately 30 days after the close of the calendar quarter) for each month you worked out at least 12 times.
- Healthy Team, Healthy U:
- Effective October 1, 2013
- Only the principal subscriber (employee) can participate.
- If you are enrolled in a PEBB health plan as a dependent but opt out of medical coverage as the employee, you are not eligible to participate.
- Worksite wellness program. Team up with co-workers to complete the 12-week program.
- 30-minute sessions to be completed during “non-work” times (e.g., breaks, before/after work, during lunch).
- Additional Information: https://pebb.healthyteam-secure.com/public/
- Living Well with Chronic Conditions and Diabetes Prevention – These are tested, proven programs and will be available at no cost to PEBB members in a variety of locations around the state. Start time vary. Additional information will be posted when available.
- 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. Program begins October 1, 2013.
2014 Health Engagement Model (HEM)
No changes were made to the Health Engagement Model (HEM) program for the 2014 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 2013 HEM program, you will be asked during the Open Enrollment process if you completed two healthy activities during 2013.
- If you answer “YES”, you will be eligible to participate in 2014.
- If you answer “NO”, you will not be eligible to participate in 2014.
PARTICIPATION in the 2014 HEM program:
- Participation status (2 step process). Must be completed between September 1 and October 31, 2013:
- Step 1: Enroll in the HEM program during Open Enrollment
- Step 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, 2013. 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 2013 paycheck.
- Complete two health related activities during 2014 to be eligible for participation in the HEM program for the 2015 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://oregon.gov/das/pebb/pages/hemactivites.aspx
- Employees will attest to completing the requirements during Open Enrollment in 2014 (for 2015 benefits)
- There are no additional deadlines and/or PEBB tracking of completion of HEM activities during 2014.
NON-PARTICIPATION in the 2014 HEM program:
- You answered “NO” to the Open Enrollment question: “Did you do two health activities during 2013; or
- You elected not to enroll in the HEM program during Open Enrollment; or
- You did not complete the Open Enrollment process (Step 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 (Step 2) between September 1 and October 31, 2013; 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:
- Spouses in the military serving overseas
- Members enrolled in Hospice or extended hospital stays preventing them from completing their HEM action requirements
- Members who are out of the country from their plan year coverage effective date and their HEM action requirements.
- Exemption Form
- PEBB Statewide & Providence Choice (will be available after September 1, 2013)
- Kaiser (will be available after September 1, 2013)
2014 Employee Premium Share (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, 2014, 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 2013 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 2014 Earnings Statement will reflect enrollment in the Flexible Spending Account(s) for 2014.
*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 email@example.com
Employee Benefits Fair
Thursday, September 26, 2013, 10 am – 2pm, MU Ballroom. Meet with health and retirement providers and get all of your questions answered.
- Short-term and Long-term Disability Insurance, 9am-10am, MU 206. Presenter: Standard Insurance.
- PEBB Open Enrollment overview, Plan Changes, & HEM, 10:30am-11:30am & Noon-1pm, MU 206. Presenter: PEBB Representative.
- Medicare Basics. 1:30pm-3:30pm, MU 206. Presenter: Oregon Senior Health Insurance Benefits Assistance (SHIBA). Is a 2-hour workshop on understanding Medicare and Medicare Supplemental Plans.
*Seating is limited and is on a first come basis. These presentations will be streamed live the day/time of the event and also recorded/posted on the Benefits website for later viewing. To watch the event live on the day and time of the event, please visit: http://live.oregonstate.edu
**SHIBA provides Medicare workshops throughout the State of Oregon. For a time/location nearest you, please visit their website at: http://www.oregon.gov/dcbs/shiba.
Health Benefit & Insurance Providers:
- Providence – PEBB Statewide & Providence Choice Plans
- Providence Life Balance Program
- Kaiser HMO & Kaiser Dental
- 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:
- OUS – 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:
- Dixon Recreation
- Faculty/Staff Fitness
- Orange Rewards
- Healthy Campus Initiatives/BeWell
- Childcare & Family Resources
- Work/Life Balance
- 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):
- September 5th: 10am – Noon
- September 11th: 2pm – 4pm
- September 16th: 2pm – 4pm
- September 24th: 2pm – 4pm
- September 30th: 2pm – 4pm
- October 10th: 10am – 1pm
- October 16th: 2pm – 4:30pm
- October 24th: 2pm – 4:30pm
- October 28th: 2pm – 4:30pm