Text Size:   A+ A- A   •   Text Only
Find     
Public Employees' Benefit Board

The PEBB Connection, August 2012
Download The PEBB Connection for August 2012

Click here to download a PDF (may take time to load) 


 
  
 
Mandatory Open Enrollment Oct. 1-31
 
All PEBB members need to actively enroll for 2013 benefits during Open  Enrollment, Oct. 1-31. Otherwise they’ll default to the following enrollment status with associated costs:
  • tobacco user
  • spouse or domestic partner waives other coverage
  • HEM Non-Participant (see article below).
 
We’ll post information on the PEBB website to help you enroll and send it to  your address on record in early September.
 
 
2013 HEM offers wellness incentive
 BikingCouple.jpg
You’ll get a taxable health incentive in your monthly pay in 2013 when you  become a Health Engagement Model (HEM) Participant during Open Enrollment.
 
The incentive is $17.50 for employee and $35 for employee and spouse or  domestic partner (both must participate to qualify for the incentive).
 
You become a HEM Participant when you sign up for HEM during Open Enrollment and complete your confidential, online health assessment in your current plan Sept. 1-Oct. 31 -- even if you completed one for the 2012 HEM.
 
Exception for certain Kaiser members: Kaiser locks access to your health assessment for 201 days after you take it. If you completed your assessment after Feb. 13 and before Sept. 1, it will count for 2013 HEM participation.
 
HEM Non-Participants are eligible  employees who don’t sign up during Open Enrollment, or who sign up but don’t complete the health assessment Sept. 1- Oct. 31. They’ll have an additional $100-per-person deductible (family maximum of $300) added to their medical plan’s standard deductible.
 
Click here for more on HEM in 2013.
More medical homes now available in Providence Choice
 
/DAS/PEBB/PublishingImages/2010/doctor2.jpgMore physician groups and clinics are becoming medical homes in PEBB’s Providence Choice plans. Click here to see the current list.
 
In a Providence Choice medical home you have:
  • Lower costs for care and premiums
  • Quick access to practitioners who know you
  • A team of providers who work to coordinate your care
  • Smooth referrals to specialists when needed
    •  
When you enroll in Providence Choice, you must register your choice of medical home with Providence before you access care.
 
During Open Enrollment for 2013, members in Jefferson County can enroll for Providence Choice and register their choice of medical home with Providenc
 
​​
 
PEBB Statewide members will get cost break from primary care homes
 
Members in the PEBB Statewide plan will get a break on coinsurance costs when they access care from a Patient-Centered Primary Care Home (PCPCH) in 2013.
 
You’ll pay just 10% of the cost of a primary care visit, rather than 15%. In the part-time plan you’ll pay just 15%, rather than 20%.
 
PCPCH providers are recognized by the Oregon Health Authority for focusing on prevention and management of chronic conditions.
 
By meeting quality-of-care criteria, these providers are eligible for better pay, and – just as important – you’re eligible for lower cost.
 
Click here to learn what you can expect from a PCPCH (includes a short video).
 
Providers and practices around the state are already applying to be recognized. Click here to see if the clinic you use is already on the list.
 
If your provider or clinic isn’t listed, ask them about it on your next visit. There’s still time for them to apply before the 2013 plan year. Click here for information for providers on the recognition process.
 
Prescription coverage update
 New out-of-pocket maximum to help with high drug costsRxBottlesSized.jpg
Members in the PEBB Statewide and Providence Choice plans will have an out-of-pocket maximum for prescription drugs next year.

 

Your share of costs for covered prescriptions in these plans will be limited to $1,000 per person after you meet your prescription deductible. The family maximum will be $3,000 ($1,000 per person times three family members).

 

This is good news if you or a family member is taking many brand-name medications at the $30 co-pay tier – or even one specialty drug, which have a $100 co-pay.

 

Specialty drugs are typically high-cost injectable, infused, oral or inhaled drugs that require close supervision and monitoring.

 

Even if you don’t take a specialty drug, you can still see costs add up when you use brand-name drugs on the formulary. Ask your provider if there are alternatives that would work as well for you at lower cost.

 

Keep in mind that Value drugs in the PEBB Statewide and Providence Choice formulary have  no co-pay. They include most generic and some brand drugs that are typically used to treat the most common chronic conditions in the population. Click here for more on Value drugs.

 

Clearing up confusion on coverage of non-formulary drugs

 

There has been some confusion about the process for determining coverage exceptions for non-formulary drugs in the PEBB Statewide plan.

 

Non-formulary drugs are prescription medications that are not on the plan’s list of covered drugs.

 

Click here for a fact sheet that clarifies the process for seeking coverage of non-formulary drugs in PEBB Statewide.

 

Click here to see the formulary in the PEBB Statewide and Providence Choice Plans.

 

Click here to see the formulary in Kaiser Permanente plans.

 
Weight Watchers for kids in 2013
If you’re concerned that your child may suffer from health BeachRedBalloonsSized.jpgaffects of being overweight, look to Weight Watchers in your 2013 health plan.
 
Children 10 and older can join Weight Watchers at no cost beginning January 2013. Provider approval will be required for children age 10-16.
 
Details will be available before the start of the year. 
 
Don't miss life's winning moments
winning moments
Tobacco users often miss out on life’s special moments because they are giving in to urges to smoke.
 
If you’re ready to take a step toward a better quality of life and make a positive change for your health, the Quit For Life Program can help you quit tobacco today.
 
 
 Call 1-866-QUIT-4-LIFE (1-866-784-8454),
or log on to www.quitnow.net/pebb today for more details
 
.

Sanchez offers tips on summer allergies
​
winning moments
Most of us bask in the beauty of Oregon summers, but for some it’s a season  of discomfort caused by airborne allergens, including dust and pollen.
 
Melissa Sanchez, FNP, from Providence Health eXpress, notes that allergy symptoms can easily be confused with a simple cold. “These symptoms may include: ear pressure, sore throat, post nasal drip, nasal congestion, cough, itchy eyes and red eyes.” Click here for more from Melissa on dealing with allergies during the summer.
 
Providence Health eXpress, in the lower level of the Labor and Industries building in Salem, offers free, same-day appointments for state employees with workday health issues. Click here to learn more about this telehealth pilot project.
 
​