 Why do the 2012 health plans have deductibles? The plain answer is to contain costs.
The PEBB challenge for 2012 was to provide quality benefits while health care costs continued to skyrocket and state revenues continued to shrivel. Achieving this balance required many plan design changes, including deductibles.
Other changes help to offset this member cost. For example, value drugs, preventive services and the first four primary-care office visits aren’t subject to the deductible. Also, there’s no coinsurance, co-pay or deductible for chronic care visits for members with asthma, diabetes, cardiovascular disease or congestive heart failure.
Deductibles in PEBB plans apply:
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- Separately for prescription drugs and medical services
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- At lower levels for services from in-network providers
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- Separately for services from in-network and out-of-network providers
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- As out-of-network when not referred from the medical home in Providence Choice
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- As in-network for chiropractic, naturopathic and acupuncture services
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- Per covered individual to family of three in Providence, two in Kaiser Deductible
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- To higher annual levels in part-time plans
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- To both plans for dual-eligible members who both enroll as principal subscribers
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Deductibles in PEBB plans don’t apply:
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- To the first four visits with a primary care provider
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- To fully covered preventive services, Value drugs, office vistis for certain chronic conditions, and wellness support services
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- Toward the annual out-of-pocket maximum
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| An "explainer" video on this site shows how deductibles work in most health insurance plans:
Note: not every element in the video applies to PEBB plans, including pre-existing coverage exclusions and lifetime maximums.
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The Benefit Board continues to design quality, affordable plans by innovating in plan design, leveraging the power of PEBB’s size, demanding measurable quality, selecting patient-focused systems of care, designing coverage based on evidence, negotiating for the lowest possible rates and self-insuring.
The PEBB challenge going forward is to help members engage in having the best health possible as a way to help contain future costs.
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