Frequently Asked Questions on 2013 Medical Plans
PEBB Statewide Plan
Where is the statewide plan available?
PEBB Statewide is available everywhere in the state (and nation). All eligible PEBB members can enroll in this plan wherever they live or work.
What’s the benefit of enrolling in the PEBB Statewide plan?
This plan gives you a very broad choice of providers for both primary care and specialty medical services. About 85 percent of medical providers in Oregon contract with Providence Health Plan, the plan’s administrator, to be in their network. The plan also contracts with a nationwide network to provide services at contracted rates. You have lower costs when you use in-network providers for both primary and specialty medical care. But the plan still pays a portion of the cost of covered services from out-of-network providers.
What’s the cost benefit of using a Patient-Centered Primary Care Home in PEBB Statewide?
When you get primary care services from a state-recognized Patient-Centered Primary Care Home (PCPCH), your coinsurance – the percent of costs you pay for care you receive – goes down by 5%. For in-network care in the full-time plan, it drops from 15% to 10%, and in the part-time plan it drops from 20% to 15%.
Why is the plan set up to offer lower costs from a PCPCH?
This plan encourages PEBB Statewide members to look for better health, better care and lower costs. PCPCH clinics have been recognized by the Oregon Health Authority for their potential to better coordinate your care to help get you the services you need, when you need them; listen to your concerns and answer your questions; offer after-hours help and alternatives to the emergency room; and help you play an active role in your health.
Where can I find a PCPCH in my area?
How can I get lower cost if my medical provider isn’t a state-recognized PCPCH?
You can encourage your medical provider to go through the process of becoming recognized by the state as a PCPCH. Give them this link: www.oregon.gov/oha/OHPR/pages/HEALTHREFORM/PCPCH/providers.aspx
Providence Choice Plan
Where is the Providence Choice plan available?
Providence Choice is available to members who live or work (at least 50% of the time) in the following Oregon and Washington counties: Clark, Washington, Multnomah, Clackamas, Yamhill, Polk, Marion, Linn, Benton, Lane, Deschutes, Jefferson, Hood River, Coos, Curry and Wallowa.
What’s the cost benefit of enrolling in Providence Choice?
You have low copays for health care services from the Providence Choice medical home you choose and register with Providence Health Plan, the third-party administrator. When you need services from specialists, you also have lower copays when the specialist is one referred by your medical home, but you can still choose to get care from providers outside your medical home and without referral.It's a good idea to double check with Providence customer services to see if a referred specialist is in the Providence Choice panel.
Why does this plan set up to offer members lower costs?
This plan encourages members to enroll in a plan whose providers contract to offer better health, better care and lower costs. These providers are contracted based on their potential to better coordinate your care to help get you the services you need, when you need them; listen to your concerns and answer your questions; offer after-hours help and alternatives to the emergency room; and help you play an active role in your health. They must also meet additional criteria related to technical capabilities and accountability to the plan, PEBB and the members.
How can I find a Providence Choice medical home?
Kaiser HMO and Deductible Plans
Where are the Kaiser Plans available?
Kaiser plans are available in Kaiser Zip code areas in the following Oregon and Washington counties: Washington, Multnomah, Hood River, Yamhill, Clackamas, Polk, Marion, Benton, Linn, Cowlitz, Columbia, Clark, Wahkiakum, Lewis and Skamania. For a current list of Zip codes, contact Kaiser member services.
What’s the cost benefit of enrolling in the Kaiser HMO plan?
You have low copays for health care services from Kaiser providers. When you need specialty services, your Kaiser primary care provider will refer you to and coordinate your care with a Kaiser specialty provider. If you choose to get medical care services from non-Kaiser providers, those services will not be covered by your plan.
What’s the difference between the Kaiser HMO plans and the Kaiser Deductible plans?
The essential difference is the monthly premium rate. It’s lower in the Deductible plans compared with the HMO plans because members in Deductible plans have to pay in full for covered services until they reach the deductible amount. At that point the plan begins to pay for services. Few Kaiser services are actually subject to the deductible.
Why is this plan set up to offer members lower costs?
This plan encourages members to enroll in a health care system that is organized to offer better health, better care and lower costs. Kaiser has long been recognized for its focus on coordinating care for members throughout their lifetimes and across the continuum of their medical needs. It’s also recognized for providing care based on evidence and outcomes. Like the medical-home model, the Kaiser care model focuses on prevention of health conditions and continuous coordination of care for chronic conditions.
FAQ on enrolling for 2013