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Public Employees' Benefit Board

March 2010
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Take the Direct Route
 
Members may find it easy to take questions on their health plan to PEBB and agency staff. But these staff members must refer most of these questions, because
  1. They shouldn’t have your personal health information
  2. They can’t influence contracts that govern the plans
  3. They must follow the Cafeteria Plan and administrative rules
It’s best to go directly to the source if you have a question. Here’s a guide to sources of information on care, coverage and eligibility.
 
Questions about your care
 
For questions about your care, start with your provider. He or she is the source for answers to questions like "Why do I need this test or medication?" and "Are there alternatives I could try?"
 
To understand more about conditions and treatments, try your plan’s online health tools. PEBB’s Web site has links.
 
Questions about your coverage
 
Your member handbook is the place to start if you have questions on coverage. The PEBB Web site links to each of them.
 
Each plan’s formulary details how the plan covers prescription drugs. Kaiser members see Kaiser’s formulary. Providence Choice and Statewide Plan members see the Providence formulary.
 
If you have questions on a claim, call the plan’s customer service.
 
Questions about your eligibility
 
PEBB’s Summary Plan Description (SPD) lays out rules on who is eligible to enroll in plans and when.
 
The SPD’s Midyear Plan Change Matrix details the benefit changes you can make with life changes like marriage, divorce or childbirth.
 

Coverage of Medical Equipment and Supplies
 
Your provider may prescribe medical equipment or supplies for an illness or injury. Examples are orthotics, oxygen equipment and diabetic test strips.
 
The Statewide Plan and Providence Choice cover part of the cost for most items needed for medical treatment. They may cover rental or purchase, depending on durability and overall expense. The plans may require prior authorization. These plans fully cover diabetic supplies.
 
Providence Home Medical Equipment (HME) is the principal supplier for these plans. HME has subcontracts with 120 suppliers around the state. The Statewide Plan also has contracts with suppliers in other states.
 
The member share of costs in the "full-time" plan is 15 percent through HME and network suppliers, and 30 percent out-of-network. The coinsurance levels in the "part-time" plans are 20 percent in-network and 50 percent out-of-network.
 
To find a source in your area, call Providence HME at 503-215-4663 in Portland or 800-762-1253.
 
Kaiser Permanente fully covers medical supplies in its "full-time" plan. The coinsurance is 50 percent in the "part-time" plan (20 percent for diabetic supplies).
 
For information on medical equipment and supplies, see your plan’s member handbook or call their customer service.

Success Stories
I was the typical yo-yo dieter until 2003, when I accepted I was just always doomed to be overweight and stopped the yo-yo habit.
 
When I returned to work after a leave of absence to care for my brother dying from cancer, a co-worker told me about the Weight Watchers opportunity.
 
At first I wasn’t interested, but I learned from my brother’s friends how worried he had been about my health and excess weight. In his honor, I joined Weight Watchers on Jan. 29, 2009. As of Feb. 18, 2010, I lost 98.2 pounds! Just 1.8 pounds to go for the big 100.
 
I ride my brother's 21 speed mountain bike an average of 20 miles at a time and usually log 50 to 80 miles per week, even in winter.
 
My doctor says that with the help of my brother's memory, I have given myself the gift of life. My husband too has benefited from my new lifestyle and is now off his blood pressure medication!
 
— PEBB Member JoAnne Boardman
 
I take medicine for chronic issues and needed more fiber in my diet. Using the Weight Watcher program, I have found ways to increase fiber in a tasty, healthy way and am feeling great!
 
— PEBB Member
 
 
PEBB plans cover the Weight Watchers fee for principal subscribers. Learn how you can join at no cost to you.
 
The program also offers special pricing for eligible spouses, domestic partners and dependents.
 
Call 866-454-2144 for more information.
 
 
 

No Judgement If You Use Tobacco
 
Join the Quit For Life® Program and get as little or as much support as you need to quit tobacco. Your Quit Coach® will develop a personalized Quitting Plan and provide the support you need without passing judgment. Knowing you are not alone can help make your quit a success.
 
PEBB health plans fully cover the Quit for Life Program through Free & Clear. Call 1-866-QUIT-4-LIFE (1-866-784-8454), or log on to www.quitnow.net today for more details. Kaiser members call 503-286-6816 or 1-866-301-3866 (toll free), select option 2 and tell them you’re a PEBB member.
 
 

New Board Members
 
Two new members took their place on the Board in February: Barney Speight and Fariborz Paskerest. They hold two of four positions on the Board that represent the state as an employer and management employees.
 
Barney is director of health care purchasing for the Oregon Health Authority. Fariborz is deputy director of the Oregon Youth Authority and the designee of the director of the Department of Administrative Services.
 
Read short bios of Board members 

Connect with Your Benefit Board
Voting members
Rich Peppers, Chair
Barney Speight, Vice Chair
Peter Callero
Rocky King
Diane Lovell
Paul McKenna
Fariborz Pakseresht
Jeanene Smith, MD, MPH
Advisory Members
Rep. Tina Kotek
Sen.William Morrisette

Resources

PEBB oregon.gov/das/pebb    
Benefit Questions: inquiries.pebb@state.or.us
Comments for the Board: pebb.connect@state.or.us   
(503) 373-1102, fax (503) 373-1654      
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