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PEBB August 2006 Newsletter
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Article Content
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| Do You Have a Medical Home? |
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The Benefit Board will renew contracts with current healthcare plans for 2007, with no changes in plan designs. (See 2007 healthcare plan rates.)
This year, the Benefit Board created new, long-term partnerships with the Kaiser Permanente, Providence Choice, Regence BlueCross BlueShield of Oregon and Samaritan Select medical plans. These partnerships focus on achieving better health outcomes at costs that are affordable to PEBB members and the state.
Each of the Board’s partners is making progress to ensure every PEBB member has a “medical home.”
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“A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.”
American Academy of Pediatrics
In a medical home, teams of providers seamlessly integrate and coordinate care in response to each patient’s individual needs. The board wants PEBB members to have a medical home that includes the following elements:
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Electronic medical records to increase efficiency for both members and providers
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Health risk assessments that identify lifestyle risks and support for healthy behaviors
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Medical decision-making based on widely accepted guidelines
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Knowledge tools that help members make confident healthcare decisions
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Published safety and quality scores members can use to choose the best providers.
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Integrated Care in Kaiser Permanente
Kaiser Permanente is already the most integrated of PEBB’s healthcare plans. The HMO’s use of information technology tracks right in line with the medical-home concept. All patients’ tests, results, schedules, histories, prescriptions and diagnoses are available to all Kaiser providers electronically. The system cuts down on prescription errors, duplicate tests, waiting time, missed screenings, unnecessary office visits and other waste in the system.
Kaiser recently improved patient care by creating a new e-mail tool. Kaiser members who have symptoms, for example, that could be a cold – or might be flu – can e-mail their primary provider to ask for guidance. They’ll get a quick response and, in many cases, be able to get on with their lives without having to make an appointment and take time off work or school to see the doctor.
Continuity of Care in Providence Choice
A medical home in the Providence Choice plan gives members and their families continuity of care. Mindi Robinson, M.D., sees family practice patients at Providence Medical Group-Sunnyside in Clackamas, Oregon. “Because I see the same children, even the same families of children, I can see patterns in health issues and treat more effectively,” she says.
"Short-term problems, like an ear infection, may be part of a larger pattern that requires a different treatment approach to really get at the core health issue.”
Members using a Providence medical home may see a different provider in an immediate need, but that continuity still exists. “In our clinic, the patient’s history, medical reports and treatment notes are all available information.”
This continuity is good for kids, too. “Kids learn about the office - where the scale is to get weighed for example - and they feel comfortable coming here. That can make a big difference in how they talk to me as their doctor, and it reduces their anxiety about going to the doctor.”
Knowledge and Support in Regence BCBSO
Regence BCBSO offers PEBB members an array of health resources and wellness support online and in person. At MyRegence.com, members can quickly complete a health risk assessment. The site offers online programs for weight loss, stress relief, getting in shape and handling chronic conditions. The password-protected site also lets them create a personal health record and check the status of claims.
The plan’s 24-hour nurse-line connects members with registered nurses who can advise them when they have questions about seeking care. Members can also access a personal health coach who will provide support to start and maintain healthier behaviors.
Members with chronic conditions get help to manage their illness through Advicare. The range of support includes self-care goal setting, mailed reminders and personalized care plans. Advicare works with the member and member’s providers to make sure they get the right care at the
right time.
Community of Care in Samaritan Select
As a local, community-based health system, Samaritan Select helps members find preferred providers in their region who meet their medical needs. This community-based network of providers can access all members’ test results and current prescriptions for greater safety and efficiency.
Samaritan supports the use of widely accepted medical guidelines throughout its healthcare system. It works with plan providers to track results of treatments based on specific guidelines. Through the system, providers and patients can participate in clinical trials of new medications, equipment and techniques. The results help the providers and the system to continually improve the quality and outcomes of care.
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| Domestic Partner Affects Pay |
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PEBB allows you to add a domestic partner (and/or the partner’s children) to your benefit coverage. But if you do, you’ll see a change in your pay. Payroll will withhold more taxes, so you will have less pay to take home.
IRS Sees Coverage as Added Value
The IRS doesn’t view your domestic partner and children the same as a legal spouse and dependent children. The IRS sees partner coverage as a value added to your taxable income. This is called an imputed value on which you must pay taxes.
Imputed Value Means More Taxes
The imputed value is an estimate of the premium cost you would pay if you bought the coverage on the open market. It is not the same as the premium cost in your PEBB handbook. Each year, PEBB reviews the market cost for each of the plans and estimates an imputed value for each plan and coverage tier.
When you enroll a domestic partner or children in PEBB coverage, your payroll system adds the estimate of the imputed value to your taxable wages. Then it withholds taxes on the imputed value. Because the new taxable total is larger than your wages alone, you pay more taxes. The bottom line: you take home less money.
See How It Flows
Jane J Stateworker enrolled for medical and dental coverage on the employee-only tier. Payroll calculates her taxes based on her taxable wages of $3,515.39. After deductions, she takes home $ 2,665.35. (See Pay Stub A.)
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Pay Stub A
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DESCRIPTION
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HOURS
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RATE
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AMOUNT
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TOTAL –REG
GROSS PAY
FED TAX
STATE TAX
OASDI
MEDICARE
WCD TAX
EMPL DEDNS
NET DEPOSIT
NET CHECK
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184.00
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3,515.39
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3,515.39
3,515.39
237.04
210.00
217.68
50.91
2.76
131.65
2665.35
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YEAR TO DATE INFORMATION
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GROSS PAY
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TAX DEFER
INCOME
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OTHER
TAXABLE
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TAXABLE
INCOME
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31,638.51
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265.41
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31,373.10
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Jane adds her domestic partner to her PEBB employee-only tier. Payroll adds the imputed value of $456.59 to her taxable wages of $3,515.39. Payroll now calculates Jane’s taxes based on the total of $3,971.98.After deductions, Jane’s take-home pay is now $2526.94, for a net pay reduction of $138.41. (See Pay Stub B.)
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PAY STUB B
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DESCRIPTION
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HOURS
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RATE
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AMOUNT
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TOTAL –REG
DOMESTIC PARTNER
GROSS PAY
FED TAX
STATE TAX
OASDI
MEDICARE
WCD TAX
EMPL DEDNS
NET DEPOSIT
NET CHECK
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184.00
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3,515.39
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3,515.39
456.59
3,515.39
305.52
245.00
245.99
57.53
2.76
131.65
2,526.94
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YEAR TO DATE INFORMATION
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GROSS PAY
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TAX DEFER
INCOME
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OTHER
TAXABLE
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TAXABLE
INCOME
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31,638.51
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265.41
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456.59
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31,373.10
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The imputed value will increase if Jane adds coverage for her domestic partner’s children. Again, she will take home less pay.
Note: Even though the imputed value shows as a dollar amount on Jane’s pay stub, she does not receive any additional pay nor does she pay the imputed value as a premium.
More Information
Members and their domestic partners must meet PEBB eligibility. Check here for or more information. Or contact your payroll or benefits office or PEBB.
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| Benefit Statement on the Way |
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To help you get ready for Open Enrollment in October, you’ll receive an important notice in the mail next month — your PEBB benefit statement. The statement shows
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Your personal information, including your Benefit Number and contact information (see sidebar).
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The plans and coverage levels in which you are enrolled
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Information about your dependents, including their coverage in your plans.
Make sure it reflects your current benefit choices. If you see any errors, call your payroll, personnel or benefits office to make corrections.
If your address in pebb.benefits, the online benefit system, is not correct, you may not receive your benefit statement before Open Enrollment in October. Check it now to make sure it’s right.
Go to https://pebb.benefits.oregon. gov/members. If you haven’t registered, select the Register Here button, and follow the instructions on the new screen.
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If you have already registered, enter your user name and password; then select the Log In button.
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If you registered but have forgotten your user name or password, select "Forgot your User Name/Password?" and follow the instructions on the new screen.
Once in pebb.benefits, select "Update my personal information." If your address is wrong, you can correct it.
If you encounter any problems in the process or don’t have access to the online system, call PEBB at (503) 373-1102 in Salem or (800) 788-0520 statewide.
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| FREE Worksite Health Screening |
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PEBB is sponsoring free worksite health screenings for cholesterol, blood sugar, blood pressure and body mass index. Screening will take about 15-20 minutes, including consultation with a health coach to review your results and receive recommendations and referral. Watch the PEBB Web site for more information and schedules.
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| Know Your Numbers |
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Quick Quiz: What’s your fasting glucose level? Blood pressure? Total, “good” and “bad” cholesterol levels? Body mass index?
If you can’t answer, you need to find out.
These numbers are indicators for chronic conditions such as heart and vascular disease and diabetes. If your numbers aren’t in line, there are things you can do now to reduce the likelihood of developing these conditions - but you have to know your numbers first.
The next time you see your doctor, ask about each of these numbers. Work with your provider to make sure you know your health risks and what you can do to maintain and improve your health.
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| Praise for Healthy Worksites |
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Seven state agencies with about 9,500 employees are participating in the state’s Healthy Worksites Initiative pilot program. The initiative’s goal is to make the healthy choice the easy choice throughout Oregon workplaces.
During the first year, participating agencies sponsored contests and other activities that encourage walking and weight loss. They achieved success through the efforts of their wellness committees and agency wellness coordinators.
Congratulations to all employees who participate in the program. And thanks to the following agency wellness committees and wellness coordinators:
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Department of Administrative Services: Jerry Korson
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Department of Forestry:Deb Bogart
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Department of Human Services: Shannon Kraemer (Parkway Building); Jan Maddux and Julie Davie (Human Services Building), Sue Wimmer; (Oregon State Hospital)
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Department of Housing and Community Services: Larry Dillenbeck
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Oregon Liquor Control Commission: Gail Parnell
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Oregon State Treasury: Tina Barthlow
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University of Oregon: Kathy Cooks.
The following agencies will join the initiative this year:
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Department of Consumer and Business Services
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Employment Department (Central Office)
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Oregon Student Assistance Commission.
Watch for continued opportunities to make the healthy choice the easy choice at your agency or campus. Healthy worksites benefit us all.
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Oregon Healthy Worksites Initiative
The Department of Human Services Health Promotion and Chronic Disease Prevention Program is partnering with several public and private employers to make the healthy choice the easy choice at Oregon worksites. PEBB is collaborating with the Healthy Worksites Initiative to provide leadership in promoting healthy worksites among state agencies and universities.
Employers help make the healthy choice the easy choice when they create workplaces that support and promote healthy behaviors. Key elements include:
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Smoke-free campuses
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Easy availability of fruits, vegetables and other low-fat foods
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Support for bicycling and walking
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Policies that encourage healthy choices
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Assistance in identifying health risks and referral to disease management programs.
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| Keep Your Shots Up to Date |
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Vaccines are a key to a healthy life for people of all ages. August is National Immunization Awareness Month, and PEBB is asking all its members to check if they and their loved ones are up to date on their immunizations. Visit the National Immunization Program for recommended vaccination schedules.
All PEBB plans cover routine immunizations in full. But if you schedule an office visit for shots that is outside your plan’s preventive schedule, you may have to pay an office-visit co-payment or coinsurance amount. Call your plan’s customer service line for details. Access your plan's customer service information.
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| Call EAP for Help with Kids |
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EAP Offers Parenting Resources
As part of its broad menu of employee assistance choices, the Cascade Centers EAP offers many parenting resources. They help parents guide their children’s transitions from:
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Day care to early learning programs
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Grade to middle school
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Middle to high school
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High school to college.
The EAP can help you locate resources in your community, assist with family issues, and even point you to financial and legal resources. Go online to Cascade Centers, or call (800) 433-2320.
All your interaction with the EAP is completely confidential.
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| Eat Your Colors |
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Want your kids to like healthy foods?
Colorful fruits and vegetables provide the wide range of vitamins, minerals, fiber, and phytochemicals our bodies use to stay healthy and energetic.
Fruits and vegetables come in a big range of colors – blue or purple, green, white, yellow or orange, and red. The goal is to eat about one cup from each color group every day. So, keep color in mind – the more color you eat, the greater the benefit.
Visit the Healthy Worksites Initiative Web site for tips on getting color into your diet for better health.
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