The Benefit Board has renewed contracts with current carriers and made few changes to plan design for the 2013 plan year, which begins Jan. 1.
There are no changes to the design of dental, disability, accidental death and dismemberments or long-term care insurance plans.
Following are changes to medical plan designs, and to the optional life insurance plan and health-care flexible spending accounts. The total average premium rate increase for medical and dental plans is about five percent. Premium rates by plan will be published mid-July at www.oregon.gov/das/pebb.
Medical plans
Standard deductible: The standard deductibles in the PEBB Statewide and Providence Choice medical plans will be the same as this year – $250 per person for in-network services and $500 for out-of-network services, with a family (three-person) maximum of $750 in-network and $1,500 out-of-network. The deductible in the Kaiser Deductible plan will stay the same – $250 per person, with a family (three-person) maximum of $750. The Kaiser HMO has no standard deductible. However, your choice on HEM participation may add a HEM deductible to your plan.
HEM deductible: A $100-per-person deductible, with a family (three-person) maximum of $300, will be added to the health plan’s standard deductible for members who choose not to sign up for the HEM program or who sign up but don’t participate by completing their Step 1 health assessment as scheduled. This HEM deductible is in addition to the health plan’s standard in-network and out-of-network deductible.
Prescription drug coverage: Prescription drug coverage in both the full-time and part-time versions of the PEBB Statewide and Providence Choice medical plans will have a $1,000 out-of-pocket annual maximum per person. The full-time version of the Kaiser Deductible plan will limit the copay for exception-approved non-formulary brand drugs to $100.
Optional life insurance plans
Members who have used tobacco in the 12 months prior to Open Enrollment will have higher premium rates beginning 2013. Those who haven’t used tobacco in the 12 months prior to Open Enrollment will have lower premium rates. This rate differential will apply to existing, new and additional optional life insurance for employees and spouses or domestic partners.
Health-care flexible spending accounts (FSAs)
The maximum contribution an employee can make to a health care FSA in 2013 will be $2,500 – half of the current $5,000 maximum. This limit is set by federal regulations.
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