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March 2011
Download the Agency Update and Attachments
 

 PEBB seeks to support agency and university administration of benefits. These periodic newsletters keep you updated on plans and changes. We look forward to your ideas and feedback.
 
Download the March Agency Update (pdf) 

 


Board Actions
 
To make up a projected $10.9 million shortfall to pay claims for member health care in 2011, the Benefit Board in February voted unanimously to make changes to the design of current plans. The changes go into effect April 1, 2011. The changes affect members in the PEBB Statewide Plan, Providence Choice, and ODS dental plans.
 
Additional-cost Tier. In the PEBB Statewide and Providence Choice plans, the Board moved certain specialty procedures to an Additional-cost Tier. When members choose procedures on this tier, they will have higher costs. In most cases, these procedures involve more-aggressive treatments than alternatives that may offer equal or better outcomes at less cost. The additional cost encourages members to learn about, consider and discuss the alternatives with their providers.
 
Members in these plans also will have an additional copay when they use an emergency department – the most expensive source of care. The additional cost encourages members to consider other sources of care in their plan for non-life-threatening circumstances.
Copays on the Additional-cost Tier are in addition to the standard coinsurance or copay. They will not apply to the annual out-of-pocket maximum.
 
Additional-cost Tier Beginning April 1, 2011
Procedure or Service
Providence-administered Plan
Current Member Cost
Additional Member Cost
In or out of network
In network
Out of network
Hip replacement surgery
Knee replacement surgery
Knee arthroscopy
Shoulder surgery
Upper endoscopy
Bariatric surgery
Spine surgery for pain
Statewide Full-time
15%
30%
+ $500 copay
Statewide Part-time
20%
50%
Choice Full-time
$5
30%
Choice Part-time
$30
50%
Emergency department (member cost waived if patient is admitted for diagnosis or treatment)
Statewide Full-time
15%
15%
+ $100 copay
Statewide Part-time
20%
20%
Choice Full-time
$75
$75
Copay total of $100
Choice Part-time
$100
$100
 
Alternative Care Services. In the PEBB Statewide plan, the benefit for chiropractic, acupuncture and naturopathic services will be limited to a combined total of 60 covered visits per year. In the Providence Choice plan, the benefit will be limited to the lesser of $1,000 or 60 visits per year. These limits encourage members to consider the urgency and frequency of their need for this care.
 
Dental Services. In ODS dental plans, member coinsurance for crowns will increase from 25 percent to 50 percent. Cost share in dental plans can be an incentive to focus on preventive care.
 
Board Policy on Rural Subsidy. The Board voted to end the rural subsidy currently applied in 18 counties. Members in these counties have access to in-network providers, including access in Idaho, Washington and other states. Ending the policy of subsidizing out-of-network provider payments for medical services for members in rural counties saves costs for all PEBB members.
 

Communications
 
Member Communications. PEBB will mail a letter to members (copy attached) from Board Administrator Joan M. Kapowich on the midyear plan-design changes. Mailing begins March 4 and should be completed by March 8. The letter will include a link to the March edition of The Connection, PEBB’s online newsletter, which will be posted online this evening. The newsletter will focus on the changes and will include links to sets of topical questions and answers.  The full set of questions and answers (copy attached) will be posted in PEBB’s “Questions?” web section this evening. The link to this section is the last item in the left-side menu on PEBB’s home page.
 
Stakeholder Communications. The Oregon Health Authority will distribute a news release (copy attached) on the midyear plan design changes to Oregon media today. Ms. Kapowich will share information with agency heads and legislators.
 
Plan Communications. PEBB staff will prepare and post an addendum to the Plan’s Summary Plan Description by April 1. Providence Health Plans and ODS, which administer PEBB’s self-insured medical and dental plans, will publish updated information in their benefit summaries and member handbooks by April 1.
 
 

Eligibility Update
 
Beginning March 1, agencies and PEBB can automatically enroll only those dependents who meet requirements for an eligible midyear change event. The employee must submit a midyear change form to the agency within the 30-day window. Going forward, employees who request correction to enrollment made during Open Enrollment (e.g., “I didn't know I could,” “I forgot.”) will need to appeal to PEBB.  As with all appeals for late enrollment, employees must state why they did not enroll a dependent child in the provided time frame. Per administrative rule, PEBB will deny enrollment except for employees whose demonstrated circumstance prevented them from enrolling the eligible dependent.

Resources


Suggest topics for future editions of the Agency Update via e-mail to pebb.hottopics@state.or.us. 
 
Agency Resources: User Access Form  
                                 Agency, University & PEBB Contacts 
 
Public Employees' Benefit Board   
1225 Ferry St SE Salem, OR 97301  
E-mail: Eligibility and Enrollment
E-mail:Comments for the Board   
(503) 373-1102, fax (503) 373-1654  
Medical PlansDental Plans
       ●   Kaiser Permanente        ●    Kaiser Permanente 
       ●   Providence Choice         ●    ODS 
       ●   PEBB Statewide Plan         ●    Willamette Dental 
       ●   VSP (Vision Service Plan)   
Mail-order PrescriptionsOptional Plans
       ●    Kaiser Permanente        ●    The Standard 
       ●    PPS        ●    UnumProvident 
       ●    Walgreens Other Benefits
       ●    Wellpartner       ●    Flexible Spending Accounts (FSA) 
        ●    Employee Assistance Program (EAP)
              (800) 433-2320