PEBB Health Insurance Open Enrollment for 2021 Benefits

Takes place October 1 through October 31, 2020

2021 PEBB Enrollment Guide
2021 PEBB Summary of Benefits
2021 PEBB Benefits Comparison Tool
2021 Payroll Deduction Estimator
Flu Shot 2020 Information

Open Enrollment Summary & Plan Changes

PEBB has decided for this year only to make open enrollment voluntary (passive).

What does that mean to you? It means you have some options this year:

  • If you are happy with your current coverages and insurance plans (including your current HEM participation), and your eligible dependents, beneficiaries and personal information have not changed, and you do not wish to enroll in an FSA, then you won’t need to complete open enrollment this year. Your 2020 plan choices will remain intact for plan year 2021.
  • If you want to 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 you should complete open enrollment and make changes as you did in other years.

Decision Matrix:

PEBB has identified some scenarios that may apply to you and help you in making the decision about participating in Open enrollment. Please see the Open Enrollment and Health Engagement Model Quick Guide for help deciding the best option for you.

PEBB Mailings:

PEBB will not be mailing the Sneak Peak Brochure or the Open Enrollment Guide this year. Both the brochure and guide will be emailed to PEBB members. PEBB will mail the Summary of Benefits tool that provides a side by side comparison of the Medical, Dental and Vision plans. 

Open Enrollment Opportunities:

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.).  It is also your opportunity to enroll or re-enroll in the Flexible Spending Accounts (FSA) for 2021.

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.

HEM during Open Enrollment: This year if you are new to participating in the HEM and wish to receive the incentive, you must also complete the HEM Health Assessment by October 31, 2020. Please refer to PEBB’s Open Enrollment and HEM Quick Guide for more 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.
  •   NEW: OEBB/PEBB double coverage Surcharge - In 2019 the Legislature passed a law that will affect some PEBB members. Beginning Jan. 1, 2021, you will have to pay a monthly $5 surcharge if you are an active full-time employee and:
    • Someone in your family is covered as a member under their own PEBB or Oregon Educators Benefit Board (OEBB) plan, and
    • That person is covered as a dependent (spouse, partner or child) on your PEBB medical plan.

2021 Plan Changes

Medical

Moda

Moda has a new plan design/network called the Moda 360 Network.  When members call Moda they will be connected with a health 360 Navigator who can assist with connecting to care, resources and programs that best fit the member and their family’s needs.

  • Moda 360 has a new Telemedicine app. where members can chat or text with their provider with no cost share.
  • There is also a new app for Diabetes support.  There is an extension of coverage for 90 day fills on specialty medications.
  • Viscosupplementation is discontinued.
  • Current Moda members do not need to re-designate their PCP 360.It will remain the same unless members change it. New members will need to designate a PCP 360. Look for more information about this in the Open Enrollment materials.
  • MyModa is now called the Member dashboard and has enhanced options.
Kaiser

On Kaiser Full Time plans, the vision allowance will be increased to $200 allowance/year and up to $100 of this allowance may be used for non-prescription sunglasses or non-prescription digital eyestrain glasses.  ​The change applies to full-time plans only.

Providence plans
  • Viscosupplementation (on the additional cost tier) is no longer a covered benefit
  • Adventist will be in-network on PEBB Statewide.
  • Mental Health/chemical dependency services will no longer have a separate phone number. Providence will be sending new ID cards to everyone in December so that the phone numbers can be updated.
  • Telehealth services will be expanded.
Dental

In the past, members (and covered dependents) wishing to enroll in the Delta Dental plans, but who didn’t enroll when they were first became eligible would have been subject to a wait period if the member enrolled after their initial enrollment period. To align with the PEBB’s other dental plans, the Board removed the wait for the 2021 plan year.

  • Delta Dental has removed the 12 month wait for basic and restorative dental services and the 24 month wait for orthodontia.
ASIFlex
  • The maximum contribution for medical flexible spending account has increased to $2,750.
  • The maximum contribution to a commuter/transportation FSA has increased to $270.
PEBB Basic Life Benefit: Standard Life Insurance
  • The PEBB basic life benefit will increase from $5,000 to $10,000. The increase takes effect Jan. 1, 2021.
  • PEBB Basic Life is a required enrollment when enrolling in any PEBB coverage (including the opt-out option)
Opt-Out or Decline? There is a difference
  • 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 checksEmployee’s MUST attest that all tax dependents have minimal essential health insurance coverage in order to qualify.
    • For Open Enrollment October 2020 only: employees currently enrolled in the opt-out plan and want to keep their opt-out plan and who don’t want to make any changes to their PEBB enrollments including enrollment or re-enrollment into a FSA are not required to re-attest that they have other qualifying coverage
  • 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.

Dependent Eligibility (required)

PEBB will request verification of eligibility for dependents added during Open Enrollment and throughout 2021 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 2021, 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.

Children Turning 26

  • Coverage for adult children will terminate at the end of the month the child turns age 26. The PEBB change was effective as of January 1, 2019.
  • PEBB completes the removal process for the overaged children.No action is needed by the Employee during open enrollment, or during the birthday month.
  • PEBB’s COBRA administrator Benefit Help Solutions (BHS) will send a COBRA packet to the child losing the PEBB coverage. The COBRA packet is mailed to the address listed in the PEBB system for child.

Password Security Requirements

There are new password security requirements this year for logging into complete Open Enrollment. Employees will want to read the requirements when prompted to re-set their password. Some tips include:

  • Your password must be 10-15 characters long.
  • The username and password must be different.
  • The password must contain both and uppercase and lowercase letters.
  • The password cannot end in Y.
  • You can use numbers 0-9.
  • Only some select special characters are allowed.
  • You cannot use a password that was one of your last four passwords.
  • The username must be 6-30 characters (you do not have to change the username unless you want to).

2021 Videos & Calculators & How/Where to Enroll

PEBB TOOLS

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.

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

  • Online Enrollment will take place on or after October 1, 2020 through midnight October 31, 2020.
  • Paper Forms – download: Forms will be available on October 1, 2020 on the PEBB website. Return completed forms to Employee Benefits:
HEM Health Assessment Completion (Sept 1 – Oct 31, 2020)

If you wish to newly enroll in the HEM this year you will need to complete the online health assessment between September 1, 2020 and October 31, 2020.*  If you are already a HEM member and do not wish to make any changes you do not have to complete the HEM  process this year.

For more information on the PEBB Health Engagement Model visit the website.

Special Situations:

  • For new and newly benefit eligible employees that are hired and/or become benefits eligible between September 1 and October 31, 2020, 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 2020 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, 2019  and October 31, 2019 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.

2021 Medical Home Plan - Providence Choice

Remember to register your Medical Home with the Plan before you and any enrolled family members incur medical expenses in 2021.

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

If you wish to keep your Medical Home the same you do not need to call and re-designate it.  It will remain the same.

2021 Primary Care Plan – MODA Health

  • Members must choose and use a PCP 360 for each covered individual for in-network primary care services.
  • Members who already have a PCP 360 selected do not have to re-select a PCP 360 unless they would like to change who they see for primary care services.
  • To search for PCP 360 providers, visit: modahealth.com/PEBB and use Moda’s online Directory Find Care –  Here
    • Click "Find Care" to search for a provider by location, gender or language spoken. When you search, be sure to choose your network (Synergy) and select "PCP 360" from the "Provider type" menu. For assistance in finding a PCP 360, 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 select their PCP 360 in their Member Dashboard (myModa) 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.

2021 Health & Wellness Programs

To learn more about these Health and Wellness programs available to you as a PEBB employee visit: https://www.oregon.gov/oha/PEBB/Pages/Wellness-Programs.aspx

  • Healthy Team, Healthy You: 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 A 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.
  • Quit For Life:  programs to assist you in quitting tobacco use.
  • Virtual Lifestyle Management, OMADA, Life Care  Diabetes prevention and management programs
  • Beyond Benefits EAP: OSU also has a new Employee Assistance Program called Beyond Benefits EAP.  Beyond Benefits provides resources across life events and seeks to provide impactful, holistic, no-cost solutions at the right time. Areas of focus include family needs, financial needs, mental/ emotional support needs and legal needs. Beyond Benefits consultants are available to create personalized action plans related to individual employee needs. Find out more information on the OSU Employee Benefits Website.

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

Health Engagement Model (HEM)

  • Health Engagement Model (HEM) program for the 2021 benefit year is operating differently for this year only. Employees already enrolled as a HEM Participant and are receiving the $17.50 credit on their monthly paycheck do not need to re-enroll or complete the Health Assessment this year. You will continue to be a HEM participant and continue to receive the $17.50 credit on your monthly paycheck.
  • For passive Open Enrollment October 2020:
    • New employees whose PEBB coverage began on or after 11/1/19 will need to decide how they want to proceed with the HEM program.
      • If you want to be a HEM participant you will need to elect to participate in HEM by logging on to your PEBB account during Open Enrollment October 2020 and selecting HEM participant *and* complete the health assessment by October 31, 2020.  If all steps are completed the HEM $17.50 cash incentive taxable benefit will begin on your December 2020 paycheck.
      • If you do not complete the Health Assessment but enroll in as a HEM Participant you will not receive the $17.50 a month and 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.
      • If you DO nothing during open enrollment (this year only) your current deductible plan will carry forward but you will not have the $17.50 incentive.

Please Note: The HEM credit shows on OSU earn statements as -17.50 (a credit to the employee).

  • PARTICIPATION in the 2021 HEM program:
    • Enroll in the HEM program during Open Enrollment, October 1 – October 31, 2020.
    • Complete of the online HEM health assessment between September 1 and October 31, 2020.  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.
  • Complete two health related activities during 2021
    • 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 that use tobacco, one activity will involve trying to quit.
    • For employees 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 2021 (to be eligible to participate in 2022).
    • There are no additional deadlines and/or PEBB tracking of completion of HEM activities during 2021.

Effective Dates, Verification of Changes and Corrections to Enrollments

WHEN are Changes Effective – Changes made during Open Enrollment are effective January 1, 2021, 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 2020 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 2021 Earnings Statement will reflect enrollment in the Flexible Spending Account(s) for 2021.

CORRECTIONS to Enrollments

Flexible Spending Accounts (FSAs)

Are you planning to enroll or re-enroll in an FSA for 2021?

Flexible Spending Accounts (FSAs) are a way use pre-tax dollars to reimburse yourself for qualified health care, dependent care and commuting/parking expenses. If you want to enroll or re-enroll in an FSA for 2021, you will need to complete the PEBB open enrollment process during October. You can learn more about FSAs here.

  • If you already have an FSA, PEBB has made it easy for you to re-enroll.  When you login at www.PEBBenroll.com, you can select “I just want to update my FSA Enrollment for 2021.” You do not have complete the rest of the enrollment process unless you want to make other changes. If you choose not to complete open enrollment this year, you cannot enroll in an FSA during the correction period ending on December 11, 2020.
  • All current FSA accounts will end on December 31, 2020. Remember that this money does not roll over into the next benefit year. You forfeit any funds that you do not use by the end of the grace period end date of March 15, 2021. The deadline for claiming any valid expenses is March 31, 2021.  Employees can find a list of eligible FSA expenses here. This link takes you to a list with four separate tabs organized by FSA type including health care, dependent care, parking and transit.

Make sure you have selected the correct duration for your employment type:

  • Academic Year Employees 9 month – Salaried
    • Select a 10 month FSA
    • Select Jul and Aug as the months in which you don’t have a paycheck.
  • Academic Year Employees 9 month – Salaried on deferred pay (9 over 12)
    • Select a 12 month FSA
  • Academic Year Employees 9 month – Hourly
    • If your positon will be on summer leave 06.16.2021 - 09.15.2021 then select a 9 month FSA.
  • 12 month Employees – Salaried and Hourly
    • Select a 12 month FSA
  • Do you have split appointments: Academic Year 9 month 50% FTE and 12 month 50% FTE?
    • Select a 12 month FSA

If you need to change your duration you still have time to log onto www.pebbenroll.com and change your duration.

If you don’t see your appointment type listed or if you have questions about what duration to select please contact us at employee.benefits@oregonstate.edu

Employee Virtual Benefits Fair October 5-9, 2020

All benefit eligible employees are invited to participate in our first Virtual Benefits Fair October 5-9, 2020. Extensive benefits information content is available now for employees to explore! Check back during the week of October 5-9 for live webinars, door prizes and vendor activities. To participate go to: https://hr.oregonstate.edu/virtual-benefits-fair-2020

Door prizes include:

  • Drawstring Beaver Backpack
  • OSU roll up blanket
  • OSU Stainless Steel Tumbler
  • OSU Mini Umbrella
  • Gray, Black and Orange OSU T-shirts

Over 25 Health, Wellness and Retirement Plan Vendors are participating including:

  • Providence – PEBB Statewide & Providence Choice Plans
  • Providence Life Balance Program
  • Kaiser HMO & Kaiser Dental
  • Moda Health Insurance and Delta Dental
  • VSP (vision plan)
  • Willamette Dental
  • PERS Health Insurance
  • Beyond Benefits – EAP (Employee Assistance Program)
  • Weight Watchers
  • Healthy Team, Healthy U
  • Standard Insurance (Life, Short-term Disability, Long-term Disability, and MEDEX Travel Assist)
  • ASI Flex

Pension Plan & Voluntary Retirement Providers:

  • Optional Retirement Plan (OPURP)
  • Fidelity
  • TIAA
  • PERS
  • Oregon Savings Growth Plan (OSGP)

Social Security & Medicare:

  • Oregon Senior Health Insurance Benefits Assistance Program (SHIBA)

Other Benefit Fair Attendees:

  • Oregon College Savings Plan
  • Faculty/Staff Fitness
  • Orange Rewards
  • Family Resource Center
  • Ombuds
  • Office of Work-Life
  • Care.com
  • Office of Human Resources
  • Sam Fit
  • Fitness Over 50
  • AHP Home Mortgage Program

Many of the vendors are hosting webinars during the Virtual Benefits Fair week. To find and register for a webinar, click here or go to their virtual booth at https://hr.oregonstate.edu/virtual-benefits-fair-2020.

Open Enrollment Webinars/Topics

Register for PEBB Webinars: https://www.oregon.gov/oha/PEBB/Pages/PEBBWebinars.aspx

Resources

Have questions or need assistance in completing the Open Enrollment? Contact employee.benefits@oregonstate.edu or call 541-737-2805 to set up an appointment time for individual assistance.