| Answers to Questions about TriCare Coverage and Opt Out |
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Why did PEBB change its rules on opting out for members who have TriCare coverage?
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A
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In October 2007, PEBB changed its administrative rules in keeping with the new federal regulation and its status as an IRS 125 Cafeteria Plan.
Before 2008, PEBB members with TriCare received cash when they opted out of PEBB medical coverage. Federal law effective January 2008 precludes group plans such as PEBB from offering members with TriCare a financial incentive not to enroll in the group medical plans.(See Public Law No. 109-364.) The new law means PEBB could not continue to offer cash back to members who opted out against their TriCare coverage.
In considering this issue, the state's Attorney General office recommended that PEBB make no changes to its current rules that prohibit Medicare and TriCare members from opting out. If currently proposed federal rules become final, PEBB may want to revisit this issue.
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I have TriCare; what does PEBB's new rule mean to me?
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This rule means that you may no longer opt out of PEBB medical coverage because you have TriCare coverage. You must enroll in a PEBB medical plan. You will receive no cash back.
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Will my TriCare enrollment change?
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No, neither the federal regulation nor the PEBB administrative rule changes your TriCare enrollment. You don’t have to make any change in your TriCare coverage because of this rule.
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I didn’t know about this new rule, so I didn’t enroll for a medical plan during Open Enrollment; what do I do now?
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On April 25, PEBB sent a letter to PEBB members who had opted out. Information in the letter notes that these members have 60 days from the date they receive the letter to enroll in a PEBB medical plan without appeal or penalty. If this includes you, review the plans on the PEBB Web site: www.oregon.gov/das/pebb. Then complete and submit a Medical and Dental Update Form to your agency payroll or benefits office. Call that office if you have additional questions.
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How will my dual medical coverage be coordinated?
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In general, your PEBB medical plan will pay as your primary coverage; TriCare will pay as secondary coverage.
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Is enrolling in a PEBB medical plan my only option?
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No, you also have the option of declining to participate in PEBB. If you decline, you may not enroll in or continue any PEBB benefits, including medical and dental coverage, along with optional life, disability and long-term care insurance.
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