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Frequently asked questions on new medical plans for 2015

 

Who did the Board select as medical plans beginning 2015?

The Board selected eight plans:
  • AllCare PEBB - administered by Mid Rogue Health Plan
  • Balance by Trillium - administered by Trillium Community Health
  • Kaiser HMO and Deductible - administered by Kaiser Permanente Northwest
  • Moda Health Summit and Moda Health Synergy - administered by Moda Health
  • PEBB Statewide – administered by Providence Health Plan
  • Providence Choice - administered by Providence Health Plan
 
 
What are the premium rates for 2015?
The following charts show the 2015 premium rates for medical plans, the vision plan (except Kaiser, which has integrated vision coverage) and dental plans by family tier for PEBB-eligible employees. Currently, the agency typically pays 95% of the premium rate for core benefits (medical, vision, dental), and the employee typically pays 5%.
 
 
 
2015 Employee Medical Plan Monthly Premium Rates
 
Employee
Employee & Spouse/Partner
Employee & Children
Employee & Family
PEBB Statewide PPO1
$1,048.79
$1,405.24
$1,206.02
$1,436.68
Providence Choice2
913.67
1,224.29
1,050.73
1,251.70
Kaiser3
1,052.01
1,409.69
1,209.83
1,441.25
Kaiser Deductible3
967.26
1,296.11
1,112.36
1,325.16
Moda2
954.26
1,278.70
1,097.40
1,307.34
AllCare PEBB2
911.95
1,221.97
1,048.75
1,249.36
Trillium Balance2
916.94
1,228.66
1,054.48
1,256.17
PEBB Statewide Part-time PPO4
851.99
1,141.56
979.74
1,167.14
Providence Choice Part-time5
740.43
992.13
851.49
1,014.35
Kaiser Part-time6
890.59
1,193.38
1,024.17
1,220.09
Kaiser Deductible Part-Time6
841.14
1,127.11
967.31
1,152.34
Moda Part-Time5
773.24
1,036.15
889.22
1,059.34
AllCare PEBB Part-Time5
730.06
978.24
839.58
1,000.15
Trillium Balance Part-Time5
743.07
995.68
854.54
1,017.99
1 Available to PEBB eligible full-time and part-time employees.
2 Available to PEBB eligible full-time and part-time employees in plan service area.
3 Available to PEBB eligible full-time and part-time employees in plan service area. Kaiser routine vision services.
4 Additional option available to eligible part-time employees.
5 Additional option available to eligible part-time employees in plan service area.
6 Additional option available to eligible part-time employees in plan service area. Vision exam only.
 

 

2015 Employee Vision Plan Monthly Premium Rates
 
Employee
Employee & Spouse/Partner
Employee & Children
Employee & Family
VSP
$13.56
$18.16
$15.59
$18.59
2015 Employee Dental Plan Monthly Premium Rates
 
Employee
Employee & Spouse/Partner
Employee & Children
Employee & Family
ODS/Moda PPO1
$79.60
$106.64
$91.52
$109.05
ODS/Moda Premier 2
86.15
115.47
99.09
118.05
Kaiser Permanente 3
85.08
113.99
97.84
116.55
Willamette Dental
Group4
75.07
100.60
86.33
102.85
ODS Part-time5
62.01
83.08
71.30
84.95
Kaiser Permanente
Part-time6
63.37
84.92
72.87
86.84
1 Available to PEBB eligible full-time and part-time employees.
2 Available to PEBB eligible full-time and part-time employees.
3  Available to PEBB eligible full-time and part-time employees in plan service area.
 
 Available to PEBB eligible full-time and part-time employees in plan facilities.
5 Additional option available to eligible part-time employees in plan service area.
6 Additional option available to eligible part-time employees; in plan facilities.
 
 
Which plan has the lowest cost premiums in my county?
Click here to see the plans listed by county, with the lowest cost plan shaded.
 
Why is it important to know the lowest cost plan in my county?
According to collective bargaining agreements, where employees have a choice of medical plan, enrolling in the plan with the lowest premium cost will reduce the employees’ premium share from 5% down to 3%.
 
What will make these plans more accountable?
The plans will report a variety of quality measures throughout the year, not just claims for services. Examples include coordination of care for patients with chronic conditions such as diabetes and heart disease and for maternity care.  This will allow PEBB to establish methods of encouraging and compensating plans based on quality of care, not just number of services provided.
 
When did the Board conduct this request for proposals process?
The process began in early 2013. Proposals from 11 carriers qualified for consideration, which began in February of this year. The Board narrowed the field to eight apparent successful proposers in March and contracted with them in June. The Board anticipates it will issue contract addenda prior to the plans’ effective date, which is Jan. 1, 2015.
 
What are the plans’ deductibles and other out of pocket costs in 2015?
Deductibles will not increase from 2014. Detailed plan comparisons will be available prior to Open Enrollment, Oct. 1-31, 2014, showing copays and coinsurance amounts.
 
Why did the Board conduct this request for proposals process?
As the purchaser of health care benefits for more than 130,000 Oregonians, PEBB uses its buying power to get the best health care available from health plans that serve its members. PEBB, like other large health-care purchasers, has seen the cost of care almost double over the past 12 years. 
 
The state has struggled to cover these increases, and PEBB members have stepped up by paying a greater share of costs and taking greater responsibility for their individual health.  With this request for proposals (RFP), PEBB asked potential partners in the health care system to step up – to do their part in meeting our shared goals of better health and better care at a cost we can all afford.  
 
PEBB designed the latest RFP and resulting contracts to hold health plans accountable for the way they provide care; to offer more ways for members to improve their health; to seek new ways for members and providers to work together to achieve better health outcomes at lower costs; and to support primary care homes that can enhance care coordination for our members.