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| Did you Know? |
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Higher Cost May Not Equal Higher Quality Healthcare
When it comes to healthcare, higher cost may not mean higher quality. A recent Dartmouth Medical School study compared the cost of care for chronically ill Medicare patients in California hospitals. Findings show that care in Los Angeles costs as much as 69 percent more than in Sacramento. Yet LA hospitals produced no better results.
In 2006, the Benefit Board will focus on ways to measure the quality of care PEBB members receive in their medical plans. As costs continue to rise, PEBB and other healthcare purchasers want to know how costs tie to quality outcomes.
An Evolving Process
Measuring healthcare quality is an evolving process. The Office of Oregon Health Policy and Research made a start last year by posting 2004 hospital data on its Web site. There you can see how often certain procedures were performed at some of the state’s hospitals. (Higher volume may be tied to better outcomes.) You can also see the death rates for procedures at many hospitals and learn which of them had higher- or lower-than-average rates.
Quality and Chronic Care
The vast majority of PEBB members won’t be hospitalized in any given year. So how can the Board know the cost and quality of care it’s buying for PEBB members with high blood pressure, high cholesterol, diabetes, asthma and other chronic conditions? And how can you know the cost and quality of care you’re paying for if you have such a condition?
Throughout the year, the Board will work with the plans and other stakeholders to define performance measures. The goal is to allow all of us to compare cost and quality so we can all know the value of our healthcare dollars.
Online Resources
Go online to see other quality efforts:
- www.orpricepoint.org, posted by the Oregon Association of Hospitals and Health Systems, allows consumers to receive basic, facility-specific information about services and charges. (Charges are not the same as costs. Costs are determined by contracts between hospitals and health plans.)
- www.leapfroggroup.org, the Web site for the Leapfrog Group, lets you see how participating Oregon hospitals score on the Group’s quality initiatives.
- www.hospitalcompare.hhs.gov, sponsored by the U.S. Department of Health and Human Services, helps you compare how often hospitals in Oregon provide recommended treatments for certain medical conditions.
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| Check Your 2006 Benefits |
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Benefits are an important part of your total compensation. Make sure your selections are correct on your first pay stub or pay statement of 2006. You can also check your benefits online using pebb.benefits, the online benefit management system. "pebb.benefits" from the menu on the left. Follow the on-screen instructions.
You will have another chance to check your benefit selections in February, when PEBB mails a benefit statement to all members.
If you see an error on any of these materials, contact PEBB. We will help clear up any issues. You can also fill out an appeal form and fax it to PEBB at (503) 373-1654
Life, Disability and Long Term Care Insurance
If you requested a higher level of life or disability insurance during Open Enrollment, you were required to submit a medical history statement to the Standard Insurance Company. Your request goes into effect only with Standard’s approval. So, the increase will not show on the benefit statement if it was not approved prior to mailing. Standard will notify you on approval or denial.
In the same way, when you enroll for long term care insurance after the initial "new hire" period, you must submit an evidence of insurability form to UnumProvident. Your request goes into effect only with the carrier’s approval. So, your enrollment will not show on the benefit statement if it was not approved prior to mailing. UnumProvident will notify you on approval or denial.
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| Clues to Pay Codes |
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The following codes identify PEBB benefit deductions on pay stubs issued through the Oregon State Payroll System. Ages and amounts are examples. (K= maximum benefit in $1,000s.)
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Vendor
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Explanation
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Description
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Explanation
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BASIC LIFE
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Mandatory life insurance
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PRETAX/5K
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Premium deducted before pay is taxed;
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EMP LIFE/40+
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Employee life insurance; number denotes employee’s age group
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PRETAX/80K
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Premium for up to $45,000 deducted before pay is taxed;
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SP/DP LIF40+
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Optional spouse or domestic partner life insurance; number denotes age group
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POSTAX/60K
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Premium deducted after pay is taxed;
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DPNDT LIFE
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Optional dependent life insurance (a policy that covers all dependents)
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5K/DEPNDT
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Benefit per dependent; premium deducted after pay is taxed
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EMP AD&D
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Employee accidental death & dismemberment insurance
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POSTAX/100K
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Premium deducted after pay is taxed
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EMP/DEP AD&D
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Employee and dependent accidental death & dismemberment insurance
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POSTAX/100K
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Premium deducted after pay is taxed
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SHORTERM DIS
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Sort-term disability insurance, 7-day waiting period
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60% BENEFIT
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Replaces 60% of weekly salary; premium deducted after pay is taxed
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LONGTERM DIS
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Long-term disability insurance
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180DAY/60%
90DAY/60%
180DAY/662/3%
90DAY/662/3%
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Days denote waiting periods; percentages denote amount of salary replaced; premiums deducted after pay is taxed
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FSA/DEP CARE
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Dependent care flexible spending account
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Monthly deduction
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Amount deposited to account, deducted before pay is taxed
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FSA/HLTHCARE
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Healthcare flexible spending account
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Monthly deduction*
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Amount deposited to account, deducted before pay is taxed
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* Employees who switched from a PPO to the HMO during Open Enrollment and chose to have the $250 incentive for a healthcare flexible spending account will see the deposit on the February pay stub.
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Medical Plan Codes
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Vendor
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KAISER HMO
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Kaiser Permanente HMO
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KAISER P/T
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Kaiser Permanente HMO part-time plan
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| KAISER ADD |
Kaiser Permanente Added Choice POS |
| KAISER ADDPT |
Kaiser Permanente Added Choice POS part-time plan |
| PROVIDENCE |
Providence Choice PPO |
REGENCE PPO
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Regence BlueCross BlueShield PPO
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REG PPO P/T
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Regence BlueCross BlueShield PPO part-time plan
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| SAMARITAN |
Samaritan Select PPO |
| SAMARITAN PT |
Samaritan Select PPO part-time plan |
| VSP |
Vision Service Plan (for PPO members) |
OPT OUT
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Employee opted out of medical coverage
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Dental Plan Codes
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Vendor
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KAISER DENT
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Kaiser Permanente
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ODS TRD DENT
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ODS Traditional plan
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ODS PRF DENT
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ODS Preferred plan
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WILLMT DENT
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Willammette Dental plan
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Medical & Dental Descriptions
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EMP
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Employee only
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EMP&SPOUSE
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Employee & spouse
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EMP&PARTNER
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Employee & domestic partner
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EMP&CHILDREN
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Employee & child or children
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EMP&FAMILY
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Employee, spouse or domestic partner & children
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| Communication in January |
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Look for Communication from Your Plans
All PEBB members who enrolled in a new medical or dental plan for 2006 will receive a new ID card from the plan this month. All members enrolled in a Kaiser Permanente plan will also receive a new ID card, as will their eligible dependents. All PEBB members enrolled in a medical plan will receive a member handbook from the plan in January.
Group Numbers
Following are the medical group numbers for PEBB plans, beginning January 1, 2006:
- Kaiser Permanente HMO: 7029
- Kaiser Permanente Added Choice: 14029
- Providence Choice: 106528
- Regence BlueCross BlueShield: 015101XXX (XXX=first three numbers of the employee’s agency number)
- Samaritan Select: PEBB
If You Need Care Now
If you need to access healthcare services before you receive your ID card or handbook, call the plan to get the information you need before you receive care.
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| PEBB Resources |
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Kaiser Permanente
(Medical & Dental Plans)
http://my.kp.org/nw/pebb
Portland: (503) 813-2000
Outside Portland: (800) 813-2000 TTY: (800) 735-2900
The ODS Companies
(Dental Plans)
www.theodscompanies.com/pebb
Portland: (503) 265-5680
Outside Portland (877) 277-7280
Providence Choice
(Medical Plan)
www.providence.org/pebb
Portland: (503) 574-6620
Outside Portland: (800) 423-9470
Regence BlueCross BlueShield
(Medical Plans)
www.or.regence.com/pebb
Portland: (503) 220-3849
Outside Portland: (800) 826-9813
Samaritan Select
(Medical Plans)
www.samaritanselect.com
Corvallis area: (541) 768-6900
Outside Corvallis area: (800) 569-4616
The Standard Insurance Company
(Life & Disability Plans)
www.standard.com
Life Benefits (800) 242-1888
Disability Benefits (800) 842-1707
VSP
(Routine Vision Services except Kaiser)
www.vsp.com
(800) 877-7195
Willamette Dental
(Dental Plan)
www.willamettedental.com
Portland:(503) 644-6444, Option 8
Statewide :(800) 460-7644, Option 8
UnumProvident
(Long Term Care Plans)
www.unumprovident.com/enroll/pebb
(800) 227-4165
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