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Public Employees' Benefit Board

PEBB September 2006 Newsletter
Open Enrollment Oct. 1-31
Open Enrollment for 2007 Benefits starts October 1 and runs through October 31. This will be a voluntary enrollment period. If you don't want to change your benefits for 2007, you don't have to do anything (with the exception of flexible spending accounts which require annual enrollment).
 
The Benefit Board wants you to become familiar with your medical plan choices to make sure the one you have really fits your and your family's healthcare needs. So, during October, come back to the PEBB Web site to review what's offered.

Choose Your Best Medical Plan
doctor at computer
 
Dear PEBB Member:
 
In 2006, the Benefit Board created new, long-term partnerships with its medical plans. These partnerships focus on achieving better health outcomes at costs that are affordable to PEBB members and the state. Among other things, the Board asked the plans to offer every PEBB member:
  • A medical home where teams of providers seamlessly integrate and coordinate care
  • Health risk assessments that identify lifestyle risks and support healthy behaviors
  • Providers whose practices follow widely accepted guidelines for the best outcomes
  • Knowledge tools that help members work with their doctors to make confident healthcare decisions
  • Electronic medical records to increase efficiency for both members and providers
  • Published safety and quality scores members can use to choose the best providers.
Each of our medical plan partners made progress toward these goals in 2006. So, the Board made no changes to medical plan designs or carriers for 2007.
 
With your benefits in the balance, we urge you to be an active partner in making your medical plan choice for 2007. Before you choose, we encourage you ask yourself these important questions:
  • What are my own and my family’s current healthcare needs? Do we have special needs caused by chronic illness?  Which plan will best meet those needs?
  • How can we change our behavior to reduce our risks for illness? Which plan provides the most support to achieve those changes?
  • What can we do to lower the cost of our care? Which plan makes the most economic sense for us, now and in the future?
  • How will we know the quality of the care we get? Which plan shows us the quality of care it offers?
  • If we develop a physical or mental health issue, how can we decide on the care we need? Which plan supports our role in making those decisions?
  • When we’re not sure if we need medical care, how do we know whether to seek treatment? Which plan gives us guidance?
The Benefit Board is your advocate in the healthcare delivery system. We’re asking the system to change how it provides care – to focus less on just providing services and more on making sure you and your family always get the right care at the right time. No accidents, no mistakes, no waste – in dollars, time or outcomes.
 
Please take time to consider how you fit into the value equation: quality divided by cost. When you review your medical plan choice during Open Enrollment, make sure you've selected the fit that’s right for you.
 
Public Employees’ Benefit Board

Voting Members
Diane Lovell, Chair
Rocky King, Interim Vice Chair
Peter Callero
David Hartwig
Paul McKenna
Sue Nelson
Rich Peppers
Jeanene Smith
Advisory Members
Representative Jeff Kropf
Senator William Morrisette
 
Administration
Jean Thorne, Administrator
Lydia Lissman, Operations Director

Go Online to Save Trees
Everything "PEBB" is Online for Open Enrollment

During Open Enrollment this October, you won’t be loaded down with a packet full of paper. Instead, you can handle all your benefits online.
 
PEBB contacted all state agencies this fall to find out how many employees don’t have access to the Web at work. These employees will have access to a printed benefit handbook from their payroll, personnel or benefit office.                  
 
All other employees can review their current benefits and enroll online at https://pebb.benefits.oregon.gov/members. All 2007 benefit information will also be available online during Open Enrollment on the PEBB Web site. 
 
 
 


NOTE: If you don’t have access to the Web at work and don’t receive a 2007 benefit handbook by October 1, contact your payroll, personnel or benefits office.

Check Your Benefits Now
You don’t need to wait until Open Enrollment to check your benefits. Employees have easy access to their benefit record on pebb.benefits, the online benefits tool.
 
Go to https://pebb.benefits.oregon.gov/members to:
  • Verify your current plans and coverage
  • Update your personal information (including address, phone and e-mail) and your dependents’ personal information
  • Verify or make changes to your beneficiary designations.
Register or Log In
  • If you haven’t registered yet, select the Register Here button and follow the instructions on the new screen.
  • If you have registered, enter your user name and password and select the Log In button. Reminder: Your password must be a combination of at least seven characters and must include at least one upper-case letter and one number.
  • If you have forgotten your password, select “Forgot Your User Name/Password?”, and follow the instructions on the new screen.
Benefit Statements in the Mail
 
It’s a good idea to check that your address is correct in your online record. That’s the address used to mail your benefit statement this month. The statement will show your current plans, dependents and coverage levels. If you see a discrepancy on your statement or don’t receive it by September 29, contact your payroll, personnel or benefits office.
 
More Information to Come
 
Employees will receive more information about Open Enrollment throughout the month of September. Watch for e-mails from PEBB_Benefits_Update.
 
NOTE: This year's Open Enrollment will be a voluntary -- not mandatory -- enrollment period. So, if you don't want to make changes to your benefits for 2007, you won't have to do anything. The exception is flexible spending accounts (FSAs), which are annual accounts; if you want an FSA for 2007, you will need to enroll for that option.
 

Open Enrollment Q&A
 
What’s new for 2007 benefits?
The Board added a new part-time and retiree PPO plan offered by Providence Choice. The plan is available to part-time employees and retirees who live or work in Multnomah, Clackamas, Washington and Yamhill counties. The Board made no additional changes to plans or plan designs for 2007.
 
Do I have to re-enroll for any benefits?
If you want to have a flexible spending account in 2007, you will need to enroll for that benefit. If you don’t want to add or change any other benefits for 2007, you do not need to re-enroll.
 
If I change medical or dental plans during Open Enrollment, when will the benefits go into effect?
The benefits become effective January 1, 2007.
 
If I enroll in or increase my life insurance coverage, when will the benefit go into effect?
If you enroll in or increase your life insurance coverage (for you, your spouse or your domestic partner) during Open Enrollment, you will need to complete and submit a medical history statement to the Standard Insurance Company. The benefit will go into effect after Standard’s approval, but no earlier than January 1, 2007.
 
I’m a new hire who enrolled in August; do I need to re-enroll during Open Enrollment?
Only if you want to have a healthcare or dependent care flexible spending account in 2007. If you don’t want to change any of your benefits for 2007, you don’t need to re-enroll.
 
If I have opted out of PEBB medical coverage, do I have to do anything for that to continue in 2007?
If you have opted out of PEBB medical coverage and will continue to have other group medical coverage for 2007, you don’t have to re-enroll. But the amount of opt-out cash you receive in your paycheck may change, depending on the dental plan you are enrolled in. Check the dental rates for 2007 to see if you will receive less cash.

2007 Healthcare Premium Rates
 
Overall premium rates for PEBB's 2007 healthcare plans will increase less than 10 percent. Under existing collective bargaining agreements, this means the state contribution to state agency employees will continue to fully cover medical and dental premium costs for full-time employees beginning January 1, 2007. OUS and Judicial Department Employees: look for your contribution notice from your university or department
 
During Open Enrollment, full-time employees may enroll in the full-time plans available according to service area.*  Eligible part-time employees may enroll in any of the healthcare plans (including the part-time and retiree plans not available to full-time employees) available according to service area.*
 

2007 Employee Medical Plans Monthly Premium Rates
 
Employee
Employee & Spouse/Partner
Employee & Children
Employee & Family
Kaiser Permanente HMO 1
$674.07
$903.24
$775.17
$923.47
Kaiser Permanente Added Choice POS 2
707.39
947.90
813.50
969.13
Providence Choice PPO 3
659.57
883.82
758.52
903.62
Regence BCBSO PPO 3
734.83
984.58
845.01
1006.61
Samaritan Select PPO 3
664.34
890.22
764.00
910.16
Kaiser Permanente Part-time & Retiree HMO 4
572.03
766.50
657.84
783.65
Kaiser Permanente Added Choice Part-time & Retiree POS 4
573.04
767.87
658.99
785.06
Providence Choice Part-time & Retiree PPO 5
526.45
705.44
605.41
721.23
Regence BCBSO Part-time & Retiree PPO 5
590.19
790.76
678.68
808.49
Samaritan Select Part-time & Retiree PPO 5
534.81
716.64
615.03
732.69
1   Kaiser Permanente HMO routine vision services.
2   Kaiser Permanente HMO Tier 1 routine vision services.
3   Routine vision services through VSP.
4   Vision exam only.
5   No vision benefit.
 
* Medical Plans Service Areas
  • Kaiser Permanente HMO and Added Choice POS plans: live or work (at least 50 percent of the time) in the following ZIP Codes:
Oregon Counties
Benton: 97330, 97331, 97333, 97339, 97370
Clackamas: 97004, 97009, 97011, 97013, 97015, 97017, 97022, 97023, 97027, 97034, 97035, 97036, 97038, 97042, 97045, 97049, 97055, 97067, 97068, 97070, 97086, 97222, 97267, 97268
Columbia: All
Hood River: 97014
Linn: 97321, 97322, 97335, 97355, 97358, 97360, 97374, 97389
Marion: 97002, 97020, 97026, 97032, 97071, 97137, 97301, 97302, 97303, 97305, 97306, 97307, 97308, 97309, 97310, 97311, 97312, 97313, 97314, 97317, 97325, 97342, 97346, 97352, 97359, 97362, 97373, 97375, 97381, 97383, 97384, 97385, 97392
Multnomah, Polk, Washington, Yamhill: All
Washington Counties
Clark, Cowlitz: All
Lewis: 98591, 98593, 98596
Skamania: 98639, 98648
Wahkiakum: 98612, 98647
  • Providence Choice PPO plans: Live or work in Multnomah, Clackamas, Washington, Yamhill counties
  • Regence BlueCross BlueShield of Oregon PPO plans: Statewide and nationwide
  • Samaritan Select PPO plans: Live in Linn, Benton or Lincoln counties.
 

2007 Employee Dental Plans Monthly Premium Rates
 
Employee
Employee & Spouse/Partner
Employee & Children
Employee & Family
Kaiser Permanente
$88.53
$118.64
$101.81
$121.28
ODS Preferred
61.40
82.27
70.60
84.11
ODS Traditional
66.47
89.07
76.44
91.06
Willamette Dental Group
61.99
83.07
71.29
84.93
ODS Part-time & Retiree
47.83
64.09
55.01
65.53

Worksite Health Screenings
Employees Benefit from Worksite Health Screenings
 
Employees in Southern and Eastern Oregon are learning their numbers and how to improve them at free worksite health screenings. They’re finding out if their blood pressure, blood sugar level and body mass index are all in the “good” range. After the screening, health coaches go over their numbers and how they affect overall health.
 
PEBB is now scheduling screenings in eastern and southern parts of the state. Other regions will be scheduled for September and October. Find out more about the screenings and check the schedule, which is updated weekly.

 "It was great. Gave me new knowledge about my numbers and what to watch. It motivated me to do better!" - Screening Participant

Dependent Care FSAs
father and daughter reading
Good News from the IRS!
 
PEBB members with a dependent care flexible spending account (FSA) can now claim the following expenses that were previously denied because of IRS rules:
  • Application fees and deposits for pre-kindergarten and day camp-programs
  • Expenses for transportation provided by a day care provider.
It gets better. If you pay for day care on a weekly or monthly basis, and you have short-term absence from work, you can request reimbursement for the entire week or month. This means if you take a few days vacation or are sick for a couple of days, you can still file a claim for the entire time period.

Not-so-Good News from the IRS
 
Some people with dependent care FSAs pre-pay their day care providers monthly and submit a claim for reimbursement as soon as they pay. Under IRS rules for dependent care FSAs, you can be reimbursed only after eligible dependent care services are provided. So, if you pre-pay monthly, you may want to ask your provider to give you four “weekly” receipts and submit them with your claim form at the end of each week.
 
Remember that you can be reimbursed only the amount of funds in your dependent care FSA. If you submit a claim for $500 for a month and you only have $300 in the account, you won’t get the additional $200 until it has been deducted from your pay and put in your account.

For More Information
 
BenefitHelp Solutions (BHS) administers FSAs for PEBB members. For more information, contact BHS at (800) 556-2230. Or visit the BHS Web site.

Free Worksite Flu Shot Clinics
man wearing hard hat
 
PEBB is working with its medical plans to ensure that employees can get free flu vaccinations at worksites this fall. View the schedule here beginning September 18. The schedule will be updated through the end of the season.
 
All PEBB plans cover routine immunizations in full. But if you see your doctor for shots outside your plan’s preventive schedule, you may be charged for an office visit. So take advantage of the convenience and savings of a flu-shot clinic at your worksite.

Back to School Physicals
grade school boy
 
Summers fly by. If you have kids, your September plans may include back-to-school physicals. PEBB medical plans differ in coverage levels for such exams based on the type of provider you see. They also have different schedules. Here’s a summary. Call your plan’s customer service line if you have questions or need more information.
 
Kaiser Permanente HMO
Kaiser HMO providers work with each member to determine the need for and timing of preventive exams. The plan’s recommendation is every two years after the age of six. The services are fully covered in the HMO. If you see a provider who is not in the HMO, you pay the full cost. Member Services: (503) 813-2000 (Portland) or (800) 813-2000.
 
Kaiser Permanente Added Choice
This plan covers preventive exams in full if you see a provider in the Kaiser HMO (Tier 1) or a CNN Network Preferred Provider (Tier 2). If you see an out-of-network provider, you will pay 30 percent of the cost. On Tiers 2 and 3, coverage for preventive exams is capped at $300 per member per year. After that, you pay 100 percent of charges. Member Services: (503) 813-2000 (Portland) or (800) 813-2000.
 
Providence Choice
This plan covers preventive health exams in full if you see a Providence Network Preferred Provider. If the provider says more frequent exams are needed, they will be covered, too. If you use a non-preferred provider, you will pay 30 percent of the cost. The plan’s schedule covers one exam per year for children age two through six and one exam every two years for children age seven through 19. Customer Service: (503) 574-6620 (Portland) or (800) 423-9470
 

Regence BCBSO
Regence covers preventive health exams in full for dependents age two through 18 once every three years if you see a preferred provider. If you see a non-preferred provider, you pay 30 percent of the cost. Customer Service: (503) 220-3849 (Portland) or (800) 826-9813.
 

Samaritan Select
This plan covers preventive health exams in full if you see a Samaritan Network Preferred Provider. If you use a non-preferred provider, you pay 30 percent of the cost. The plan’s schedule covers one exam per year for children age two through six and one exam every two years for children age seven through 18. Customer Service: (541) 768-6900 or (800) 569-4616.

Just 13 minutes with kid's doc
mom and daughter
Did you know you have just 13 minutes to talk with your child's doctor?
 
The average time spent talking with a doctor during a visit is now about 13 minutes. When your child is sick – or even if it’s a visit for a checkup – can you get all your questions answered in a 13-minute time frame? What can you do to make sure you’re getting the most out of that visit?
 
One thing you can do is come prepared to ask questions. Here are some examples of questions to ask if your child has symptoms.
 
Ask about the diagnosis:
  • What is wrong with my child?
  • What do we need to do to get better?
  • Where can I get more information about the condition?
 
If your child needs any type of test, ask the doctor:
  • How will the test be done?
  • How accurate will the results be?
  • What are the benefits and risks of the test?
  • When and how will I receive the results?
  • What should I do if I don't receive the results?
 
If the provider prescribes a new medicine for your child:
  • What is the name of the medicine?
  • What is it supposed to do?
  • Is it on my health plan’s preferred drug list?
  • If not, is there an alternative available that is equally effective at less cost?
  • When should I give my child the medicine; how much; how long; with or without food?
  • What side effects should I watch for?
 
This is not a complete list. You may have many other questions. Keep asking questions until you understand your child’s needs and how you and the doctor will meet them.

This newsletter as a PDF
Print a copy of this newsletter to share with your family. September 2006(pdf)