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Public Employees' Benefit Board

March 2011
Download the Newsletter
 
Click here to download the March newsletter. 

   



Board Makes Midyear Plan-design Changes

To make up a projected $10.9 million shortfall to pay member health claims in 2011, the Benefit Board in February voted unanimously to make changes to plan design beginning April 1, 2011. Learn more.

 
 
Medical Services
 
In the PEBB Statewide and Providence Choice plans, the Board moved certain specialty procedures to an Additional-cost Tier. When members choose procedures on this tier, they will have higher costs. In most cases, these procedures involve more-aggressive treatments than alternatives that may offer equal or better outcomes at less cost. The additional cost encourages members to learn about, consider and discuss the alternatives with their providers.
 
Members in these plans also will have a $100 copay when they use an emergency department – the most expensive source of care. The additional cost encourages members to consider other sources of care in their plan for non-life-threatening circumstances.
 
Copays on the Additional-cost Tier are in addition to the standard coinsurance or copay. They will not apply to the annual out-of-pocket maximum. Learn more.  
 
Alternative Care Services
 
In the PEBB Statewide plan, the benefit for chiropractic, acupuncture and naturopathic services will be limited to 60 covered visits per year. In the Providence Choice plan, the benefit is limited to the lesser of $1,000 or 60 visits per year. These limits encourage members to consider the urgency and frequency of their need for this care. Learn more. 
 
Dental Care Services
 
In ODS dental plans, member coinsurance for crowns will increase from 25 percent to 50 percent. Cost share in dental plans can be an incentive to focus on preventive care. Learn more. 
 
Additional-cost Tier Beginning April 1, 2011
Procedure or Service
Providence-administered Plan
Current Member Cost
Additional Member Cost
In or out of network
In network
Out of network
Hip replacement surgery
Knee replacement surgery
Knee arthroscopy
Shoulder arthroscopy (not for cancer or traumatic injury)
Upper endoscopy
Bariatric surgery
Spine surgery for pain
Statewide Full-time
15%
30%
+ $500 copay
Statewide Part-time
20%
50%
Choice Full-time
$5
30%
Choice Part-time
$30
50%
Emergency department (member cost waived if patient is admitted for diagnosis or treatment)
Statewide Full-time
15%
15%
+ $100 copay
Statewide Part-time
20%
20%
Choice Full-time
$75
$75
Copay total of $100
Choice Part-time
$100
$100
 


Rural Subsidy to End
 
The rural subsidy will end April 1, 2011, in Baker, Crook, Curry, Gilliam, Grant, Harney, Jefferson, Josephine, Klamath, Lake, Malheur, Morrow, Sherman, Tillamook, Umatilla, Union, Wallowa and Wheeler counties.
 
The rural subsidy pays medical providers in 18 Oregon counties as if they were in the Statewide Plan’s network, whether or not they contract with the plan or comply with the plans’ quality requirements. It also allows members in these counties to access care from any provider without considering overall costs to the plan. These members have access to in-network providers.
 
The rural subsidy increases medical premiums for all PEBB members.
 
Link to questions and answers on the end of the rural subsidy.
 

New Report Scores Quality of Care in Oregon
GraphGuy
 
In February, PartnerForQualityCare.org posted new quality scores for doctors’ offices on diabetes care, asthma medication, heart disease care and preventive care for women’s health. Quality scores help Oregonians learn more about the health services they should be receiving so they can be informed partners in their own care.
 
The new scores come from the second statewide report on primary care performance. Information for a Healthy Oregon: Statewide Report on Health Care Quality summarizes primary care performance for doctors’ offices with four or more primary care practitioners. Ten Oregon health plans contributed data on care given to more than 1.8 million Oregonians.
 
The second report shows that measurable improvements have been made in many areas. But it also shows substantial variation in the quality of care delivered by providers across the state.

Go to the source
 
Benefits are like any insurance – they’re not "top of mind" until you need them. That’s why your Benefit Board tries to keep you up to date on your benefits; you never know when you’re going to need them.
 
The Board reaches out to you through
  • The Connection, this online monthly newsletter
  • PEBB_Benefits_Update, a monthly e-mail with benefits-related information
  • The PEBB Digest, a quarterly e-mail with links to news on health and the health care system
  • Live and recorded streams of Board meetings, along with links to meeting materials
You can give input through
  • Pebb.connect@state.or.us for feedback on Board policies and decisions
  • Public comment period during monthly Board meetings
  • Annual member survey, usually scheduled for after Open Enrollment

Questions are the Answer for Quality Care
 
Click here for a list of 10 questions to ask your health care provider the next time you talk about a test or treatment. Answers to these questions can help you make informed decisions about your care.
 
Your PEBB health plans also wants to aid you in making educated decisions about your care. Look through Providence’s interactive medical reference library or browse Kaiser’s health encyclopedia to learn more about your options.
 
Health care providers, government agencies and many other groups – including your Benefit Board – are working hard to improve health care quality, but it's a team effort. Join the team and the discussion. Click here for more materials on putting quality first.

Share Your Success
father and baby
 
Are you getting healthier? Share your success.
 
Your experience with exercise, eating better, dealing with stress or ending an addiction could help a co-worker succeed, too.
 
Send a note about what’s working for you to mystory.pebb@state.or.us. Include a photo, if you like. Your Benefit Board publishes these success stories in newsletters and online.

If you don’t want to share your name, that’s fine. Even an anonymous story could spur a co-worker toward a life-improving change

PEBB Resources

 
Public Employees’ Benefit Board 
1225 Ferry St. SE,
Salem, OR 97301
Phone: 503-373-1102
Fax: 503-373-1654
Web: www.oregon.gov/das/pebb 
E-mail: inquiries.pebb@state.or.us 
 
Medical Plans  
 
PEBB Statewide Plan 
1-800-423-9470
providence.org/healthplans/pebb/  
 
Kaiser Permanente 
1-800-813-2000
my.kp.org/nw/pebb 
 
Providence Choice 
1-800-423-9470
providence.org/healthplans/pebb/  
 
VSP (Vision Service Plan)
1-800-877-7195
www.vsp.com/home.html 
 
Dental Plans  
 
Kaiser Permanente 
1-800-813-2000
my.kp.org/nw/pebb

ODS Companies 
1-800-452-1058
www.odscompanies.com/pebb/ 
 
Willamette Dental 
1-800-460-7644
willamettedental.com/pebb 
 
Mail-order Prescriptions  
 
Kaiser Permanente kp.org
PPS ppsrx.com 
Walgreens walgreenshealth.com 
Wellpartner wellpartner.com  
 
Optional Plans  
 
Standard Insurance 
1-800-242-1888
standard.com 
 
UnumProvident 
1-800-227-4165
w3.unum.com/enroll/pebb/index.aspx 
 
Other Benefits  
ASIFlex (Flexible Spending Accounts) 
1-800-659-3035
orpebb.asiflex.com 
 
Employee Assistance Program (EAP)
1-800-433-2320
cascadecenters.com