Open Enrollment Summary & 2022 Plan Year Changes
PEBB open enrollment is mandatory this year during. It takes place October 1-31, 2021.
What does that mean for you?
It means you must login to your PEBB portal and confirm your plans. (Failure to complete open enrollment could result in higher out of pocket costs or the loss of benefits).
This is the time that you can change any of your coverages, add eligible dependents, remove dependents, enroll, or re-enroll in a flexible spending account (FSA), change your Health Engagement Model (HEM) status, update your personal information, or update your beneficiaries. Open Enrollment is your once-a-year opportunity to make changes to your benefit packages without having experienced a qualifying life event or family status change (marriage, birth, divorce, loss/gain of other insurance, etc.).
The changes you make during Open Enrollment will be effective in the new plan year beginning January 1, 2022.
There are two (2) Actions required to complete both the Open Enrollment and the HEM:
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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 2022. If Opting Out, you MUST take action and affirm you and your dependents have minimal essential coverage.
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Action 2: (If planning to participate in the Health Engagement Model HEM) - Complete the HEM Health Assessment by October 31, 2021 at your current medical carrier’s website. The HEM program will provide a financial incentive in your pay of $17.50 a month if you elect to participate and an increased deductible on your health plan if you choose not to participate.
The Three easy steps to participate in both are:
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Enroll in a PEBB medical plan by October 31, 2021. (Be sure to say you plan to take part in HEM.)
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Take your health assessment on by October 31, 2021. Health assessments done after this date will not be accepted.
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Complete two healthy actions during the new plan year. You don’t need to report them. You just need to let us know you did them at open enrollment next year. Remember, spouses and partners don’t participate. When you participate, they get the advantage of your low family deductible.
Please refer to the Health Engagement Model landing page for links to the medical carrier’s websites, questions about healthy actions and health assessment related questions.
** Plan early to complete your Health Assessment. You may need to have your password reset which can take time. For example, Kaiser Permanente may require 10 business days to reset your password.
How do you complete open enrollment?
Employees can enroll online or use paper forms.
Go to: www.Pebbenroll.com to complete this process online.
To use Paper Forms to Complete Enrollment:
Download at: http://www.oregon.gov/oha/pebb/Pages/forms.aspx. Search for Open Enrollment forms.
Paper forms can be faxed, scanned and e-mailed or sent through mail.
Please return the forms to Employee Benefits by October 31, 2021, at:
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Campus Mail: 236 Kerr Administration Building, Corvallis OR
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US Mail: 236 Kerr Administration Building, Corvallis OR 97331-8578
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Fax: 541.737.0541
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Scan and send via e-mail to employee.benefits@oregonstate.edu
Life Events Outside of Open Enrollment: If you incur or anticipate incurring a qualifying life event during Open Enrollment such as birth, marriage, divorce, contact Employee Benefits at 541-737-2805 or employee.benefits@oregonstate.edu in order to complete the Midyear Change process prior to completing Open Enrollment. If you incur a qualifying life 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
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Tobacco Surcharge - $25/month if employee uses tobacco + $25/month if enrolled spouse/domestic partner uses tobacco.
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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.
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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.
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OEBB/PEBB double coverage Surcharge - You will have to pay a monthly $5 surcharge if you are an active full-time employee and:
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Someone in your family is covered as a member under their own PEBB or Oregon Educators Benefit Board (OEBB) plan, and
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That person is covered as a dependent (spouse, partner or child) on your PEBB medical plan.
2022 Plan Changes
Medical Plans
General/All Medical Carriers:
Fertility:
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Approved $35K annual maximum for Assisted Reproductive Technologies (ARTs)
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Includes artificial insemination [including intrauterine insemination (IUI)]
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No member cost share for services covered under the cap
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Normal cost share applied for basic treatment of infertility
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Includes diagnostic testing to determine underlying cause
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Coverage available at in-network and out-of-network providers to ensure provider access
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Infertility diagnosis no longer required for services
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Treatment offered to full-time and part-time employees
Moda Plans
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Moda will be moving their pharmacy benefit managers to Navitus Health Solutions starting 1/1/22.
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All Moda Health Medical members will receive a new ID card with the below information to share with their pharmacies.
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Bin: 610602
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PCN: NVT
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Rx Group: PEBB
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Walgreens will be an in-network pharmacy and CVS will be an out-of-network pharmacy. Members impacted by a pharmacy network change will be sent a letter in November with suggestions for in-network pharmacies and instructions how to search for in-network pharmacies.
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Members impacted by a formulary change will be sent a letter about the change in November.The letter will provider different alternatives and details.
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Members with a current pharmacy prior authorization on file will not need to seek a new prior authorization.
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Costco will be an in-network mail order pharmacy in addition to Postal Prescription Services (PPS).
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Pharmacy claims history
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If members would like to access to their pharmacy claims history after 1/1/2022, they must log in to their Member Dashboard before 12/31/21. Prescription claims history may be needed to request reimbursement from their health savings account or flexible spending account, or for tax purposes.
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Instructions to do so: They will need to select the Pharmacy tab on the top of the screen and click the MedImpact member portal link in the Resources box. By clicking the link to the MedImpact history, the system will then save their prescription history.
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Moda Health medical plans will no longer have the thousand-dollar limit that previously existed for Spinal manipulation Chiropractic and Acupuncture services.
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Spinal manipulation will have a 20-visit limit
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Acupuncture will have a 12-visit limit
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Massage Therapy will still be subject to the $1,000 benefit maximum
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Moda Health is expanding their current PEBB infertility services to include the Assistance Reproductive Technology Services (ARTs).
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These ART services will be covered at 100% up to the benefit maximum of $35,000 for both in and out-of-network providers. This means all medical and pharmacy related expenses to ART services would be covered at 100% up to the benefit maximum of $35,000.
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Services include the following:
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IVF – In-vitro Fertilization
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ZIFT – Zygote Intra-Fallopian Transfer
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GIFT – Gamete Intra-Fallopian Transfer
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PGSD – Pre-implementation Genetic Diagnosis
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ICSI – Intracytoplasmic Genetic Diagnosis
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Ovum microsurgery
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Artificial insemination (including IUI)
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Gender Confirming Facial Surgery (Male to Female; Female to Male) will now be covered at a preferred provider.
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Moda Health is adding Dental Integration to their Moda 360 program. This means if a member is enrolled in Moda Health and Delta Dental, they will be connected to a Moda 360 Health Navigator anytime they call. The Health Navigator will help dental members navigate billing issues, connect with providers, including those participating in Health through Oral Wellness®, and guide them to appropriate resources.
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Other changes
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Moda 360 enhancements, including access to a digital musculoskeletal program
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Aligning certain pharmacy copays to encourage biosimilar drug usage
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Adding coordinated specialty behavioral health programs to better address:
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Member needs, and
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Social determinants of health
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Phone numbers on the ID cards will also be changing for members with medical and dental:
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Dental members with a Moda medical plan: 833-681-2117
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Dental only members: 844-827-7100 (current dental phone number)
Kaiser Plans
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Physician referred Alternative Care benefits discontinued effective Jan. 1, 2022
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Updated alternative care co-pays and visits – Deductible and Traditional plans differ (see Summary of Benefits for greater detail)
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Naturopath
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Spinal manipulation
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Acupuncture
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Massage
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Deductible Plan Changes ($250 deductible incentive plan or the $350 deductible plan)
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Naturopath: copay equal to office visit ($5). Remove the annual dollar limit.
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Chiropractic: $10 copay with 20 visit annual limit. Remove the annual dollar limit.
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Acupuncture: $10 copay with 12 visit annual limit. Remove the annual dollar limit.
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Massage: $25 copay with 12 visit annual limit. Remove the annual dollar limit.
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HMO Plan (Full time Traditional HMO and $100 deductible)
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Naturopath: copay equal to office visit ($5). Remove the annual dollar limit.
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Chiropractic: $10 copay with 20 visit annual limit. Remove annual dollar limit.
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Acupuncture: $10 copay with 12 visit annual limit. Remove the annual dollar limit.
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Deductible Plan (Part Time $250 / $350 deductible)
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Naturopath: copay equal to office visit ($30). Remove the annual dollar amount.
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Chiropractic: $10 copay with 20 visit annual limit. Remove the annual dollar limit.
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Acupuncture: $10 copay with 12 visit annual limit. Remove the annual dollar limit.
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Massage: $25 copay with 12 visit annual limit. Remove the annual dollar limit.
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HMO Plan (Part Time Traditional HMO and $100 deductible)
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Naturopath: copay equal to office visit ($30), no annual limit.
Providence Plans
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Facial feminization surgery coverage for Male to Female gender reassignment.
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Other changes
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Providing wig coverage for drug-induced Alopecia
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Removing exclusion for neurofeedback within the Applied Behavioral Analysis (ABA) benefit
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Eliminating visit limitation for pain management under outpatient services
Providence Choice Plan: Alternative care can no longer have dollar limits on benefits. The benefit will now be:
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Spinal manipulation = 20 visit yearly limit.
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Acupuncture = 12 visit yearly limit
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Massage therapy = $1,000 benefit max per year
Dental Plans
Willamette Dental
Waiving 2022 office visit copays to encourage members back for cleanings and maintenance work.
Delta Dental: No 2022 benefit changes.
Kaiser Permanente Dental: No 2022 benefit changes
Vision Plans
VSP
Adding vision therapy coverage:
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Up to $85 for sensorimotor exam annually
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Up to $750 for orthoptic and/or pleoptic training (therapy session) annually
Optional Plans
Opt-Out or Decline? There is a difference
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Opt-out is a choice that results in PEBB membership. Employees that have other qualifying medical coverage can elect to opt-out of the PEBB medical enrollment and receive a cash payment in their monthly payroll checks. Employee’s MUST attest that all tax dependents have minimal essential health insurance coverage in order to qualify. To continue to opt out of medical benefits in 2022 you must:
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Complete open enrollment between Oct. 1 and Oct. 31, 2021.
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Attest that you still have other group (employer) coverage to receive the opt out incentive. If you don’t complete open enrollment you will remain without medical coverage and lose your monthly incentive.
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Opt out is allowed for medical only and employees must attest to having other employer group coverage to be eligible. This means all current enrolled opt out employees need to complete open enrollment to attest regarding other coverage. If employees who have opted out previously do not attest, they will be removed from opt-out cash back and will be defaulted into a medical plan.
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Decline is that an employee didn’t take an action to enroll in any PEBB option (including the opt-out cash payment option). You are not a PEBB member and receive no PEBB benefits.
Part-time Faculty Benefits
New this fall, related to SB 551, actively working part-time faculty working at least half-time at a single public institution of higher education or in aggregate at multiple public institutions of higher education in Oregon (Public Community College or University) during at least three of the four previous academic terms may be eligible for employee only, medical only insurance coverage. Please note current members and dependents in PEBB/OEBB plans are not eligible for this coverage. For more details regarding eligibility please visit the website here.
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