1. Open Enrollment Training Plan Changes, Eligibility & Enrollment, Rules, Regulations, Policy

2. Open Enrollment
Open Enrollment is mandatory and is October 1 through October 31, 2017
Health Assessment is September 1 through October 31, 2017
PEBB Office Hours:
8:00 AM to 5:00 PM Monday – Friday during September 2017
8:00 AM to 5:00 PM Monday, Tuesday, Thursday and Friday – Oct. 2017
8:00 AM to 8:00 PM every Wednesday in Oct. 2017
8:00 AM to 8:00 PM October 31, 2017

3. Open Enrollment PEBB Teams
Member Services Staff- Assistance for Agency Staff, Members, Plans – Eligibility & Enrollment, Rules, Regulations, Policy
Telephone: Fax:

4. Providence Health Assessment New Vendor
Providence Health Assessment is under a new vendor – Cerner and has a new look.
This year members are able to take the assessment as many times as they want.
Members must go through all the screens to get to the completed certificate. If the member does not go through the entire assessment it will not count as completed.
Some answers can be left blank if the member does not have the information.
PEBB will only accept a copy of the Personal Health Assessment Certificate of Completion for Providence verification

5. PEBB Forms and PEBB Website
PEBB Open Enrollment Forms have been combined and have a new look.
The PEBB website will be updated to include only PEBB forms and have links to the plans for plan forms.
Once open enrollment is complete PEBB will update remaining PEBB forms.

6. PEBB Administrative Rules Update
A number of rules were reviewed in which language and references were updated. Changes in policy were made to the following rules.
Dependent Child (updated eligibility on child by affidavit)
Correcting Enrollment and Processing Errors
Employee errors are now all prospective same as core corrections
Open Enrollment corrections till January 31st of the new plan year for OSPS and OUS employees. Only exception is OUS FSA corrections which are open till Feb. 28th. All Open Enrollment corrections will be prospective if received in January.

7. What’s new for 2018 Medical plans
AllCare no longer available for 2018
Kaiser Permanente – no plan changes
Moda Copays for primary and specialty office visits will be $10 in 2018
Will have a closed drug formulary
Out of Network coinsurance increased from 30% to 40%
Providence Choice – Copays for primary and specialty office visits will be $10 in 2018
Providence PEBB Statewide – Out of Network co-insurance increased from 30% to 40%
Members will pay more for out-of-network hospitals than they did last year. Emergency situations will be treaded the same as they are now.
Full time Medical coverage-Family subsidy- $18.11

8. MEDICAL COVERAGE
Employee Only
Employee & Partner
Employee & child(ren)
Employee & Family
PEBB Statewide
$ x 5%= $37.85
$1, x 5%=$75.71
$1, x 5%= $64.35
$2, X 5%-$18.11= $84.10
2017 Rate
$ x 5% = $45.53
$1, x 5% = $75.12
$1, x 5% = $63.74
$1, x 5%-$10.31 = $80.74
Providence Choice
$ x 3%=$19.41
$1, x 3% = $38.81
$1, x 3% = $32.99
$1, x 3%-$18.11= $34.29
$ x 3% = $22.90
$1, x 3% = $37.78
$1, x 3% = $32.05
$1, x 3%-$10.31 = $35.78
Moda
$ x 3%=$20.16
$1, x 3%=$40.31
$1, x 3%= $34.27
$1, x 3%-$18.11=$36.31
$ x 3% = $23.72
$1, x 3% = $39.14
$1, x 3% = $33.21
$1, x 3%-$10.31 = $37.13
Kaiser
$ x 5%= $37.30
$1, x 5%= $74.59
$1, x 5%= $63.40
$2, x 5%= $100.70
$ x 5%= $44.16
$1, x 5%= $73.68
$1, x 5%= $62.52
$1, x 5%= $89.31
Kaiser Deductible
$ x 3%= $20.44
$1, x 3%= $40.88
$1, x 3%= $34.75
$1, x 3%=$55.19
$ x 3%= $24.49
$1, x 3%= $40.40
$1, x 3%= $34.28
$ x 3%= $48.97

9. What’s new for 2018 Dental and FSA
Delta Dental (Moda) – Preventive care costs no longer go towards annual
maximum.
Kaiser Permanente – New facility in Lane county
Willamette Dental – mouth guards are covered
ASIFlex – Health Care FSA increase to a maximum yearly total of $2,600

10. DENTAL COVERAGE
Moda Premier
$54.44 x 5% = $2.72
$ x 5% = $5.44
$92.55 x 5% = $4.63
$ x 5% = $7.35
ODS ( Moda) Premiere-2017
$66.85 x 5% = $3.34
$ x 5% = $ $5.51
$93.59 x 5% = $4.68
$ x 5% = $6.69
Moda PPO
$50.31 x 5% = $2.52
$ x 5% = $5.03
$85.51 x 5% = $4.28
$ x 5% = $6.79
ODS (Moda) PPO-2017
$61.77 x 5% = $3.09
$ x 5% = $5.10
$86.46 x 5% = $4.32
$ x 5% = $6.18
Willamette
$50.79 x 5% = $2.54
$ x 5% = $5.08
$86.33 x 5% = $4.32
$ x 5% = $6.86
Willamette Dental Group-2017
$61.70 x 5% = $3.09
$ x 5% = %5.09
$86.37 x 5% = $4.32
$ x 5% = $6.17
Kaiser Permanente
$61.68 x 5%= $3.08
$ x 5%= $6.17
$ x 5%= $5.24
$ x 5%= $8.33
Kaiser Permanente 2017
$75.92 x 5%= $3.80
$ x 5%= $6.26
$ x 5%= $5.31
$ x 5% = $7.59

11. What’s new for 2018 Vision VISION COVERAGE VSP Basic $8.66 x 5% =$.43
VSP Plus
$ $8.66 =$4.34
$ $17.32 = $8.66
$ $14.72 = $7.37
$ $23.38 = $11.70
2017 Plus Plan
$ $10.72 = $5.91
$ $17.69= $8.84
$ $15.01 = $7.51
$32.16-$21.44 = $10.72

12. Open Enrollment Reminders
Open Enrollment is mandatory for all PEBB subscribers (includes all employees even those on an approved leave, temporary employees, retirees, COBRA and self-pays).
Employees intending to retire before January should complete OE
New employees through October 31, including Opt Out or Decline moving to 2018 medical without medical ID need to contact PEBB for the Access Code
Seasonal Employees actively working with an active PEBB enrollment – no termination dates in PEBB system can complete OE
Retiree, COBRA, Self-Pays with dental enrollment only do not have to complete open enrollment
Retiree, COBRA, Self-Pay do not participate in HEM
Affidavits or legal documents are due to agencies by November 7, 2017.
Subscribers with qualified midyear change should submit a Midyear Change form along with the open enrollment form to agency/university office
Tax dependent status for DP or DP’s child must be submitted to agency before January 1, 2018
Open Enrollment corrections through January 31, 2018 for OSPS and OUS exception is FSA corrections for OUS which is February 28, 2018.

13. HEM Reminders 2018 HEM enrollment requires employees to participate.
Steps to Participate:
Complete health assessment on current medical plan. Sept. 1 – Oct. 31, 2017
Enroll in HEM during October 2017 while completing open enrollment
Complete two health actions before October 2018
Opt Out enrollees do not participate in HEM
HEM status does not change during the plan year and is not correctible.
Tobacco, Other Coverage Waived Monthly Surcharges and optional insurance premiums are correctible.
After October 31 newly eligible employees cannot enroll for the HEM however they are in the standard deductible plan.
HEM appeal close date February 28, 2018

14. PEBB UPDATES SSN Letters –
Mailings scheduled for November and December (IRS) requirements are three times a year
If member already submitted SSNs and have not added a new dependent in the last year disregard the letter.
If user name and password do not work members can call PEBB and a new letter will be sent out
Voluntary members do not have to provide SSNs.
Senate Bill 1067
Proposed legislation that was voted on and passed by the 2017 Oregon State Legislature and signed into law by the Governor.
The Boards must comply with the directives in SB 1067 as law and implement them by the 2020 Plan Year for PEBB and the Plan Year for OEBB.
For additional information you can contact Cindy Bowman at:
Dependent Eligibility Review (Verification)

15. PEBB Dependent Eligibility Review
Presented by: Sheila Clausen, Sandy White-Gallardo

16. Why is PEBB conducting a Dependent Eligibility Review?
The intent of this “Dependent Eligibility Review” is to make sure only those who are eligible are receiving PEBB benefits.
As a Section 125 Cafeteria Plan, PEBB has the responsibility to manage health care costs and to ensure that health plans offered through PEBB cover only those who meet the eligibility criteria.
This helps keep health care costs down.
Why is PEBB conducting a Dependent Eligibility Review?

17. All active enrolled subscribers who have a dependent(s) enrolled in the PEBB benefit management system will be required to complete and return the required verification documents when selected for the review.
PEBB will begin mailing letters requesting documentation in mid to late- November.
Members who added dependents during Open Enrollment. They will be asked to provide documents for all active dependents who are covered under their medical, dental or vision plans.
The Dependent Eligibility Review will be an annual process starting this year with an expanded scope in corresponding years.
Newly hired employees
Members adding dependents using the Mid-Year Change Form
All other members not previously reviewed
Who must complete the Dependent Eligibility Review and when does it start?

18. What about the privacy of the members information?
Our members information and privacy is very important to us.
All information that the member provides for the dependent eligibility review will be kept confidential.
Copies of documents submitted to PEBB will be destroyed following verification of the members dependent(s).
No documents will be retained! That is why it is especially important that members provide PEBB only copies of the documents.
What about the privacy of the members information?

19. Member will receive the Dependent Eligibility Packet
Letter
Dependent Eligibility Worksheet
Documentation Requirements
Eligibility Definitions
Review Worksheet and Documentation Requirements
Mail or Fax copies of the required documents
How will the member know if they need to send in their dependent(s) information?

20. Members will have 60 days to make photo copies of the required documents and submit them to PEBB.
Mail or Fax
A reminder letter is sent approximately 30 days after the Dependent Eligibility Packet is sent.
A confirmation letter that confirms the eligibility status of the members dependent(s) will be mailed approximately two weeks after all of the documents are processed.
Dependents identified as ineligible or who have not complete the review process will have their benefits coverage ended.
Effective the last day of the month in which the determination was made and no later than the last day of the month in which the review is completed.
Dependents who's coverage has ended will receive COBRA information.
What happens if the member doesn’t complete the review process by the deadline or PEBB determines some dependents to be ineligible?

21. How can the member add their dependent(s) back on?
If the dependent(s) lost their eligibility (coverage ended) due to not responding to the dependent review the member can:
1. Complete an Appeal form
2. Submit it to PEBB, along with their requested eligibility documentation for each dependent
3. Within 30 days of the coverage end date
Note: Submitting the above information is still not a guarantee that the dependent(s) will be added back on. If the dependent(s) are added back on there is also no retro enrollment.
How can the member add their dependent(s) back on?

22. Questions about the Dependent Eligibility Review Process?
If you have questions about the Dependent Eligibility Review Process, Eligibility Requirements, or Forms of Acceptable/Required Documentation:
PEBB Member
Website Info: Eligibility-Review.aspx
Questions about the Dependent Eligibility Review Process?

23. Default process
Members with current employment and actively enrolled in a Medical plan (including Opt out) must complete the Open Enrollment process by 10/31/17. Agencies have until 11/3/17 to input any OE forms received no later than 10/31/17.
Members who do not actively enroll* during Open Enrollment will:
Move from the current standard deductible medical plan to the higher deductible medical plan as a HEM Non-Participant. All enrolled dependents will follow.
This action is: Not Correctable
If enrolled in an Optional life plan, move from the current optional life plan tier to the “Tobacco” user Optional life plan tier (both Employee and Spouse/Partner are affected).
This action is: Correctable
Tobacco use status will be changed to: Both my Spouse/Partner and I currently use tobacco.
Other Employer Group coverage will be changed if the member has an existing Spouse or Partner enrolled in the Medical plan to: My Spouse/Partner has other employer group coverage available and waives that coverage

24. Default process cont’d
Employees who are enrolled in Opt Out during 2017 and intend to continue in 2018:
Must attest to having essential coverage for self and tax dependents.
If they have active optional life insurance and intend to keep it, they must actively enroll or they will default to the tobacco user tier (the higher premium cost for the coverage).
If they do not have optional life coverage, PEBB will not default them.
Employees who are enrolled in Decline for 2017 and intend to continue for 2018 do not need to complete the Open Enrollment process. These members will not be part of the default process.