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Recent member questions
Week of Nov. 7
All employees must enroll

“Do I have to do anything if I just want the same benefits next year?”
PEBB Response: Yes, because if you don’t enroll, you won’t have the same benefits next year. The 2012 benefit program requires you to make specific elections that determine how much will be deducted from your pay starting Jan. 1, 2012.
Here’s an example.
Say you’re in the employee-only tier of the PEBB Statewide plan, and that’s the plan and coverage tier you want next year. If you don’t enroll, you will have that plan by default. But you’ll also have a monthly deduction for tobacco use because you didn’t state your tobacco-use status on enrollment. Plus, you’ll have a deduction for not participating in the Health Engagement Model (HEM) program because you didn’t elect to participate on enrollment.
Value of health assessments and e-lessons in HEM

I’m super healthy so what’s the value for me to take a health assessment and e-lessons in the HEM program?”
PEBB Response: Value lies in the awareness and knowledge you may gain about small changes that can mean an even healthier and more vital life.
Types of questions asked in health assessments

Why types of questions are asked in a health assessment?
PEBB Response: In general, health assessments ask questions about
  • Demographics (what is your age, sex, ethnicity, etc.)
  • Health history (have you ever had a baby, mammogram, prostate exam, etc.)
  • Biometrics (what are your cholesterol, blood pressure and glucose levels, etc.)
  • Safety (how often do you use a seatbelt, etc.)
Why health assessments include certain types of questions

Why do health assessments ask questions about demographics, health history, biometrics and safety?
PEBB Response: Your responses can help you determine your potential for health conditions that can result from everyday choices and actions.  Responses in aggregate (from the group as a whole) help the Board adjust and refine plan designs going forward.
Responses needed for health assessments to count as complete

What questions on the health assessments require input for the assessment to be counted as complete?”
PEBB Response: Both the Kaiser and Providence health assessments ask questions about demographics (age, sex, etc.), health history, physical status, (biometrics like cholesterol and blood pressure) and safety. Waist circumference is the only biometric question that requires input for the assessment to count as complete.
Differences between ODS Preferred and Traditional dental plans

What are the differences between the ODS Preferred and Traditional dental plans?”
PEBB Response: Most dentists in Oregon contract with the Preferred plan to accept the plan’s reimbursement rates. Members in this plan get a break on coinsurance for basic services if they stay with the plan (down from 20% to 10% to 0% over three years). Members have a waiting period for certain services when they choose this plan after they were initially eligible to enroll. See the plan’s member handbook for details.
Dentists in the Traditional plan are available nationwide. They participate through Delta Dental and accept the agreed upon reimbursement for services. Members in this plan don’t get a break on coinsurance rates over time.
Verifying correct enrollment

How can I verify that I have enrolled in my choice of plans?”
PEBB Response: Log in to your benefit record at https://pebb.benefits.oregon.gov. On the left menu, click “My Benefit Statement.” On your benefit statement, verify that
  • Enrollment in new plans or a new coverage tier shows a 2012 effective date
  • Enrollment to continue current plans does not have an end date
  • Dependents you want to cover show “yes” and dependents you don’t want to cover show “no”
  • Elections in the Tobacco-Use, HEM and Other-employer Group Coverage programs show a 2012 effective date
Correcting errors during Open Enrollment

What should I do if I made an error while enrolling?”
PEBB Response: Log in to your benefit record at https://pebb.benefits.oregon.gov and go through the enrollment process again to correct any previous errors. You can enroll until midnight Nov. 15

Weeks of Oct. 24 and Oct. 30
Example health assessments for participants in the Health Egnagement Model (HEM) program
“Can I see a copy of the health assessments that will be part of participating in the HEM program?”
PEBB Response: You can see examples of the online confidential health assessments.
  • Click here for an example from Providence for HEM participants enrolled in the PEBB Statewide and Providence Choice plans in 2012.
  • Click here for an example from Kaiser for HEM participants in the Kaiser HMO and Kaiser Deductible plans in 2012.
Please note that these are examples, only. HEM participants will complete the assessments online.

Deductible for alternative care services
“Since Providence doesn’t contract with alternative care providers as in-network providers, will I have to meet the $500 out-of-network deductible for their services?”
PEBB Response: No; in the Statewide and Providence Choice plans, the $250 in-network deductible applies for services provided by chiropractors, naturopaths and licensed acupuncturists. The standard coinsurance and copayments apply as do annual benefit limits.

Application of deductibles for dual-eligible, dual-covered state employees
“My domestic partner and I are both state employees and both cover each other in our medical plans. In which of our plans will payments apply toward the deductible?”
 PEBB Response:  For dual-eligible dual-covered employees, payment that goes toward a deductible applies to the individual’s deductible in both plans. Say you pay $250 for an office visit with an in-network specialist; that $250 payment would apply toward your individual deductible under your enrollment and under your domestic partner’s enrollment, and you will have met your in-network deductible in both plans.

Opportunity to complete health assessments and e-lessons now
“I enrolled in the Statewide plan and signed up for the HEM in 2012; where do I take my health assessment and e-lessons?”
PEBB Response:  Your opportunity to take your confidential online health assessment and two short e-lessons begins with the start of the new plan year – Jan. 1, 2012. The Statewide and Providence Choice plans will have a new health assessment questionnaire then, and you will be able to access it when you register as a new member for your myprovidence home page. If you are a current member of these plans, you can register for your myProvidence home page now at: https://www.providence.org/MyAccount/RegistrationPhpViewer.aspx.
That way, you'll be ready to take the health assessment as soon it's available, ja. 1, 2012.
The Kaiser health assessment will be the same as current. Members currently enrolled in a Kaiser plan can log in to their personal online member page to see the assessment now.

Exclusion of surgery for treatment of varicose veins
“Will all surgery for all varicose vein conditions be excluded in 2012?”
PEBB Response:  While surgery (including vein stripping) for varicose veins is on the list of exclusions in the Statewide and Providence Choice plans for 2012, providers may ask the plan for prior-authorization for varicose vein conditions that, without surgical treatment, may threaten life or limb. Providers are familiar with the process of presenting requests for prior-authorization in such cases.

Completing online enrollment successfully
“How will I know if I successfully completed online enrollment for 2012 benefits?”
PEBB Response:  When you have completed enrolling for 2012 benefits, you will see this message. If thought you had enrolled but don’t see this message, contact PEBB at 503-373-1102 or inquiries.pebb@state.or.us.

Medical providers in the Providence Choice plan
"How do I know if my current medical provider is in Providence Choice?"
  PEBB Response: Providence Choice is a medical-home plan, where teams of providers - led by a primary care provider - work with you to coordinate your care. This means you need to establish a relationship with primary care provider in a medical home clinic.
You can see the list of medical home clinics by city or you can search by provider name.
  1. Click here for medical home clinics by city.
  2. To see if a certain provider is part of a medical home, Click here to open the search tool for Oregon providers in Providence Choice From the "Specialty" drop-down menu on the right, select the type of provider you're looking for, type in your ZIP code, select distance, and click "Refine Search"
If you'll be new to Providence Choice in 2012, call the provider or clinic to see if they're taking new patients.
If you have questions about this plan or about which providers are part of the plan, call Providence customer service at 1-800-423-9470.

FSAs and premium payment

"I'm thinking about a health care flexible spending account for 2012; can I use it for reimbursement of premium share?"
  PEBB Response: No, you can't use a health care flexible spending account (FSA) for reimbursement of premiums. You can use these accounts for reimbursement of qualified health care expenses like these:
  1. Payments that apply to the deductible in your medical and dental plans
  2. Coinsurance and copayments for covered services and prescription drugs
  3. Certain expenses for routine vision care not covered in your vision plan
  4. Certain dental care expenses not covered in your dental plan
Be careful in estimating your expenses for 2012, because FSAs are "use it or lose it" accounts.
ASIFlex, PEBB's third-party administrator for these plans, offers help in understanding and using these accounts.
Click here for the ASIFlex website for PEBB members.
Click here for the ASIFlex estimator worksheet.
Week of Oct. 17
I got the following e-mail from donotreply@pebb.benefits.gov this weekend:
This automated message notifies you that your PEBB benefit record was modified today. If you did not modify your record, the change was made by an authorized person at your request. Type of Change: Enrollment Information - Your current plan enrollments have been changed. The change may include new enrollments, change in coverage or cancelation. View your current benefit record online by logging in at https://pebb.benefits.oregon.gov/members/!pb.main. Do not reply to this e-mail; it will not reach an actual person. If you have questions about this change or about your benefits, contact your Agency or Benefits Office.

Can you tell me what this message is supposed to mean? I didn't make any changes to my benefit record, nor to my enrollments, nor did I authorize anyone to make changes on my behalf.
PEBB Response: We apologize that the e-mail was not clear and that it generated concern.

The benefit management system is programmed automatically to prepare member records for Open Enrollment. This does not affect most members.

Members who received the e-mail notice have a 2011 flexible spending account or will move to a new premium rate based on their age for optional life insurance in 2012. The system prepped their records so they could enroll for a 2012 flexible spending account or to see their new optional life insurance rate for 2012.

In future, such e-mails will explain more clearly. Thanks very much.

"I have enrolled for 2012 will participate in the Health Engagement Model (HEM) program. I want to do my  health assessments and e-lessons. Where and how do I accesss them?"
  PEBB Response: The health assessments (HAs) for 2012 health plans are hosted on the plans’ websites.
Members who sign up to participate in the HEM program take the assessment within 45 days after their plan goes into effect. For members who enroll during Open Enrollment, that's between Jan. 1 and Feb. 15, 2012.
The HA in the Statewide and Providence Choice plans will be new in 2012. If you're in one of these plans now, you can register to see or take their current health assessment but it won't count toward HEM in 2012. The Kaiser HA will be the same as current. You can take the Kaiser HA now if you will be in that plan next year, and it will go toward your HEM participation in 2012.
Members who have not completed the HA or e-lessons prior to the deadlines will receive reminders to complete them.
Here are examples of e-lessons.
Here are examples of e-lessons in the Providence Choice and PEBB Statewide plans for the HEM program.
Getting Active: http://www.healthwise.org/Video/conversations/active.aspx
Healthy Eating: http://www.healthwise.org/Video/conversations/healthyeating.aspx
These are only examples. In 2012, members who sign up for HEM during Open Enrollment need to complete two e-lessons between Jan 1 and July 15.

"Do the Statewide and Choice plans exclude coverage of surgery for ALL neuromas and ganglion cysts? Are non-surgical treatments covered for these conditions?"
  PEBB Response: The plans exclude coverage for surgical treatment of Morton's Neuroma of the foot and ganglion cysts of the wrist. The list applies only to surgical procedures, not other methods of treatment.

"My wife has waived coverage through her non-state-agency employer, and she would like to take that coverage so we can avoid the "other coverage" surcharge. However, her employer doesn't hold Open Enrollment until June. Do we have to pay the surcharge until then?"
  PEBB Response: A different open enrollment period with a spouse's or domestic partner's non-Oregon-state-agency employer is a qualifying midyear event for PEBB members. If your spouse’s employer will not allow a change in enrollment now as a qualifying midyear event, then you, as the PEBB member, can fill out a midyear change form with proof of her other coverage after her open enrollment.  The surcharge would stop the first of the month following the date your spouse’s other employer group coverage goes into effect.