Mandatory PEBB Health Insurance Open Enrollment for 2020 Benefits

Takes place October 1 through October 31, 2019

PEBB Open Enrollment Guide Booklet

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 2020 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 2020.

What's new for 2020? 
  • Medically necessary varicose vein surgery added to Providence and Moda plans
  • Massage therapy coverage was added for Providence Choice, Kaiser and Moda plans but not for PEBB Statewide Plan.
  • Delta Dental will provide coverage for composite fillings. Willamette dental will add limited coverage for dental implants.
  • Moda will have a new Coordinated Care model called PCP 360. Summit and Synergy will be combined to one network called Synergy. 
  • Review will be required for PT services beyond 12 visits on all Providence Plans.
  • Kaiser requires referral for ophthalmology services. 
  • SunCare benefit added on both VSP plans.

* 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. Visit the “Midyear Changes to Health & Optional Benefits” website for additional information.

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.

2020 Plan & HEM Changes/Reminders

  • Medical
    • Opt Out requirements (reminder) - Employee MUST attest that all tax dependents have minimal essential health insurance coverage.
    • Moda has a new plan design/network called the PCP 360 Network. It replaces Synergy and Summit. Members who select a PCP 360 medical home get enhanced benefits, which include a lower individual deductible, lower individual out of pocket max and lower copays for office visits. Members who already had a medical home will need to make sure their current medical home provider is a PCP 360 provider. They will need to re-designate their medical home or name a new medical home that is considered a PCP 360 for the enhanced benefits. Look for more information about this in the Open Enrollment materials.
  • ASIFlex
    • The maximum contribution for medical flexible spending account has increased to $2,700.

Dependent Eligibility - verification of eligibility for added dependents (required)

PEBB will request verification of eligibility for dependents added during Open Enrollment and throughout 2020 for qualifying Midyear Changes (birth, marriage, etc.).

What does this mean? If you add dependents during Open Enrollment or through a Midyear Change Form during 2020, PEBB will send you a packet of information. PEBB will ask you to confirm that each of your dependents are eligible. To complete the process, you will simply:

  • Make copies of requested proof.
  • Mail, fax, or email the above to the PEBB Dependent Eligibility team. (NOTE: Email is not a secure method for sending documents.)

Read more about dependent eligibility on the Oregon Health Authority website. Make sure you have everything you need. Don't send anything now, wait until you receive your letter from PEBB later this year. NOTE: If you do not respond to PEBB's letter, PEBB will remove the dependents added to your coverage.

Adult Children Dependent Eligibility updates

  • Coverage for Adult Children will terminate at the end of the month the child turns age 26. This change was effective as of January 1, 2019. In previous years, children could remain on coverage until the end of the plan year in which the child turned age 26. This is no longer the case.

2020 Videos & Calculators

PEBB TOOL (available in September):  ALEX

  • ALEX is a virtual benefits counselor to explain your benefit options and help you choose the plan that's best for you and your family.
  • 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

  • Employee Premium Share - (monthly employee cost for health insurance premiums)
    • Select "University Employee"
    • Select Full-time Calculator for Unclassified (.50 to 1.0 FTE) and Classified (.75 – 1.0 FTE) employees
    • Select Part-time Calculator for Part-time Classified (.50 - .74 FTE) employees
  • Benefit Plan Comparisons – Compare plan coverages to help you decide which plan meets the needs of you and your family.

 

Open Enrollment & HEM Health Assessment Process - 2 Actions Required

  • Action #1: PEBB Open Enrollment Completion – October 1 - 31, 2019: Confirm your benefit elections, make changes, re-enroll in flexible spending accounts, AND indicate your HEM participation status for the 2019 plan year.
  • Action #2: HEM Health Assessment CompletionSeptember 1 - October 31, 2019:  If you have or will elect to participate in the HEM for 2020, you must complete the HEM Health Assessment again between September 1 and October 31, 2019.
  • REMINDER: Your spouse/domestic partner is no longer 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 2020 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 2020 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, 2019)

Confirm your benefit elections, make changes, re-enroll in flexible spending accounts, AND indicate your HEM participation status for the 2020 plan year.

ANSWERING THE HEM HEALTHLY ACTIVITIES QUESTION:  If you were eligible and elected to participate in the 2018 HEM program, you will be asked during the Open Enrollment process if you completed two healthy activities during 2019.

  • If you answer “YES”, you will be eligible to participate in 2020. 
  • If you answer “NO”, you will not be eligible to participate in 2020.
  • You do not need to record and/or report what healthy activities you completed during 2019.

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

  • Online Enrollment will take place on or after October 1, 2019 through midnight October 31, 2019.
  • Paper Forms – download: Forms will be available on October 1, 2019 on the PEBB website. Return completed forms to Employee Benefits:

Tips on Completing Action #2:  HEM Health Assessment Completion (Sept 1 – Oct 31, 2019)

Special Situations:

  • For new and newly benefit eligible employees that are hired and/or become benefits eligible between September 1 and October 31, 2019, you will need to call PEBB at 503-373-1102 or Employee Benefits at 541-737-2805 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 2019 plan year and are enrolling in health insurance during Open Enrollment will also need to call PEBB or Employee Benefits for an access code to complete the HEM Health Assessment. Call PEBB at 503-373-1102 or Employee Benefits at 541-737-2805 for the access code after completing the Open Enrollment process.
  • New Employee Last Year: If you were hired between September 1, 2018 – October 31, 2018 and completed the health assessment using the “Special Access Code”, you must create a new user account using your Providence ID number, MODA ID number, or your Kaiser ID number.

2020 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 2020.

To receive Medical Home level of benefits, you must choose a medical home in the plan and notify Providence or Moda of your choice before accessing services.

  • Moda Health
    • Members who select a PCP 360 medical home get enhanced benefits which include a lower individual deductible, lower individual Out of Pocket max, and lower copays for office visits.
    • Members who already had a medical home will need to make sure their current medical home provider is a PCP 360 provider. They will need to re-designate their medical home or name a new medical home that is considered a PCP 360 for the enhanced benefits.
    • To search for PCP 360 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.
    • Members can designate their medical home in their myModa portal or by calling Moda at 1-844-776-1593, Monday through Friday, 7:30 a.m. to 5:30 p.m. Pacific Time. TTY users, please call 711.

 

2020 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 & 3.0 – 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.
  • 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.
  • Virtual Lifestyle Management (Providence Choice & PEBB Statewide members only) - Live Healthier, Prevent Diabetes - an internet program designed to help you improve your health and lower your risk of developing diabetes
  • Preventive Health Services– list of preventive services covered by our medical plans as outlined in the Affordable Care Act.

 

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
  • Incarceration
  • 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

 

2020 Health Engagement Model (HEM)

  • Health Engagement Model (HEM) program for the 2020 benefit year 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. Reminder:  Your spouse/domestic partner is no longer 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 2019 HEM program, you will be asked during the Open Enrollment process if you completed two healthy activities during 2019.

  • If you answer “YES”, you will be eligible to participate in 2020. 
  • If you answer “NO”, you will not be eligible to participate in 2020.
  • You do not need to record and/or report what healthy activities you completed.

PARTICIPATION in the 2020 HEM program:

  • Elect to Participate & Complete the HEM Health Assessment:
    • Enroll in the HEM program during Open Enrollment, October 1 – October 31, 2019.
    • Complete of the online HEM health assessment between September 1 and October 31, 2019. 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 Assessment.
  • 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, 2019. The HEM incentive will begin on your December 2019 paycheck.
  • Complete two health related activities during 2020
    • 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.
    • Health Actions FAQs
    • Employees will attest to completing the requirements during Open Enrollment in 2019 (to be eligible to participate in 2020).
    • There are no additional deadlines and/or PEBB tracking of completion of HEM activities during 2020.

NON-PARTICIPATION STATUS in the 2020 HEM program:

  • You answered “NO” to the Open Enrollment question: “Did you do two health activities during 2019"; 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, 2019; 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, 2020, 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 2019 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 2020 Earnings Statement will reflect enrollment in the Flexible Spending Account(s) for 2020.

CORRECTIONS to Enrollments

  • If there is an error on your Earnings Statement contact Employee Benefits immediately at 541-737-2805 or send an email to employee.benefits@oregonstate.edu.
  • The corrections time period has been shortened. All corrections must be completed by January 31, 2020.

 

Employee Benefits Fairs in Corvallis, Bend and Portland

The 2020 OSU Corvallis Campus Benefit Fair is scheduled for Tuesday, October 1, 2019 from 10 a.m. to 1 p.m., in the Memorial Union Horizon Room (MU room 49). The OSU Cascades Campus Benefit Fair will take pace on Friday, October 4th from 10 a.m. to 1 p.m. in Obsidian Hall, room 210. OSU Portland Campus Employees are invited to attend the Portland State University (PSU) Benefits Fair in the Smith Ballroom at PSU on October 10 from 10 a.m. to 2 p.m. Meet with health and retirement providers and get all of your questions answered. Enter to win door prizes/drawings. 

Note: The Office of Human Resources also offers informative benefits workshops thoroughout the month of October. Visit this page to learn more and register. 

OSU Corvallis CAmpus benefits fair

Tuesday, October 1, 2019 from 10 a.m. to 1 p.m., in the Memorial Union Horizon Room. 

Register online for one or more of the following workshops also taking place October 1:

  • Pregnancy & Parental Leave 
    • Presented by the Office of Human Resources
    • 11 to 11:30 a.m., MU room 208
  • Short-term and Long-term Disability Insurance
    • Presented by The Standard
    • 9:30 to 10 a.m., MU room 208
  • Medicare Basics - A, B, C
    • Presented by SHIBA - This is a two-hour workshop on understanding Medicare and Medicare Supplemental Plan
    • 1 to 3 p.m., MU room 208
  • Moda Health Plan Changes
    • Presented by Moda - Explanation of their new PCP 360 Network
    • 1:30 to 2:30 p.m., MU room 206
Health Benefit & Insurance Providers:
  • Providence – PEBB Statewide & Providence Choice Plans
  • Providence Life Balance Program
  • Kaiser HMO & Kaiser Dental
  • Moda Health Insurance
  • VSP (vision plan)
  • Delta Dental (formerly Moda and ODS) Dental
  • Willamette Dental
  • PERS Health Insurance (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
    • ASI Flex
 Pension Plan & Voluntary Retirement Providers:
  • Optional Retirement Plan (ORP)
  • Fidelity
  • TIAA
  • PERS
  • Oregon Savings Growth Plan (OSGP)
Social Security & Medicare:
  • Social Security
  • Oregon Senior Health Insurance Benefits Assistance Program (SHIBA)
Other Benefit Fair Attendees:
  • Oregon College Savings Plan
  • Faculty/Staff Fitness
  • Orange Rewards
  • Family Resource Center
  • Office of Work-Life
  • Care.com
  • Office of Equal Opportunity & Access
  • Department of Public Safety
  • Office of Human Resources
  • PFLA - Professional Faculty Leadership Association
  • SEIU
  • United Academics
  • LifeMart - Employee Discount Program (information only)
  • Milk Stork
  • Corvallis Clinic
  • Samaritan Health Services
  • Fitness Over 50
  • KidSpirit
  • OSU Retirement Association

OSU Cascades Campus Benefit Fair

Friday, October 4th from 10 a.m. to 1 p.m. in Obsidian Hall, room 210

Vendors Attending:
  • Moda
  • Providence
  • PERS Health Insurance
  • SHIBA
  • OSU Retirement and Benefits Officers
  • OSU Protected Leave Officers
  • TIAA
  • Fidelity
  • VSP
Information and Resources Provided:
  • Lifemart, Worklife Balance, the Family Resource Center, PERS, and ORP.

  • Workshops Available 1-4 p.m. on Thursday October 3rd - see Campus flyer (PDF) for times and location)

  • Retirement Resources 
  • Open Enrollment Help
  • Saving and Investing with Optional Retirement Plans
  • OFLA/FMLA Leave for Employees and Supervisors

OSU Portland Campus Benefits Fair Option at PSU October 10, 2019

  • The OSU Portland Campus is invited to the Benefits Fair that Portland State University (PSU) holds with many of the same vendors who attend the Corvallis Campus fair. It will be held at the PSU Campus on October 10, 2019 from 10 am - 2 pm in the Smith Ballroom.

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.

  • Corvallis
    Help sessions will take place at Cascades Hall room 118 at OSU's Corvallis campus.
    • Oct. 3, 2019 - 10 a.m. to 1 p.m.
    • Oct. 9, 2019 - 1 to 3:30 p.m.
    • Oct. 14, 2019 - 8:30 to 11 a.m.
    • Oct. 17, 2019 - 10 a.m. to 1 p.m.
    • Oct. 24, 2019 - 6 to 7:30 a.m.
    • Oct. 25, 2019 - 1 to 3:30 p.m.
    • Oct. 29, 2019 - 10 a.m. to 1 p.m.
  • OSU-Cascades Campus
    • The Benefits Fair is scheduled for Oct. 4, 2019 from 10 a.m. to 1 p.m. in Obsidian Hall room 210.
    • Flu Shot Clinics are scheduled for Oct. 3, 2019 from 1:30 to 4 p.m. in Obsidian Hall, Room 207 AND Oct. 4, 2019 from 8:30 a.m. to noon in Tykeson Hall room 111.
    • Workshops and help sessions are scheduled for Oct. 3, 2019 from 1 p.m. to 3:30 p.m.
  • Newport, Oregon
    • Oct. 21, 2019 from 9:30 a.m. to 3 p.m. at the Lavern Weber Room at Hatfield Marine Science Center.
  • Portland Campus
    • October 16, 2019 from 10 a.m. to 2 p.m. - location TBD/ Help session and General Retirement Overview information session about PERS/ORP and Optional Retirement Plans.

 

Resources