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2010-11 Plan Enhancements and Changes
Important Information
 

Health Care Reform
Federal health care reform legislation passed in March 2010 requires the following changes in the 2010-11 OEBB plans:
Dependent Eligibility Expanded
Effective October 1, 2010, all OEBB medical, dental and vision plans will extend coverage to dependents through age 25 with no residential, financial support, or student status requirements, regardless of marital status. Dependents no longer need to be “recertified” in the MyOEBB system.
 
No Lifetime Maximum on Medical Plans
Effective October 1, 2010, the lifetime maximum benefit on all medical plans will be removed. This is not to be confused with any annual maximum benefits, such as those on alternative care, dental, or vision benefits. Annual maximums still apply. See the plan summary for more details.
Guarantee Issue Coverage for Optional Life and Voluntary Disability Plans
The Standard is offering a one-time additional guaranteed issuance opportunity for Optional Employee and Spouse/Partner Life, Voluntary Short Term Disability (STD) and Voluntary Long Term Disability (LTD) during the 2010 open enrollment period.  This special enrollment is available to all eligible OEBB members, including those who were offered these plans last year.
  • Employees with amounts less than the guarantee issue, or none at all, have the opportunity to elect up to $200,000 of Optional Life insurance for themselves without providing proof of medical insurability.
  • Employees may elect up to $30,000 of Optional Spouse/Partner Life for their spouse or domestic partner without providing proof of medical insurability. (The Optional Spouse/Partner Life amount may not exceed the employee’s Optional Life amount.)
  • Employees may elect Voluntary STD without a Late Enrollment Penalty.
  • Employees may elect Voluntary LTD without providing proof of medical insurability.
During future annual enrollment periods (Fall 2011 and later), OEBB members will be required to provide medical evidence for any amounts of Optional Employee Life Insurance unless they have at least $10,000 of coverage in effect.  OEBB Members with at least $10,000 of Optional Employee Life Insurance on themselves may elect to increase that coverage by up to $30,000 during each future annual enrollment period without providing proof of good health until they reach the $200,000 guarantee issue. Any increase above $200,000 for 2010-11 or in the future will require proof of medical insurability.  For more information, please contact The Standard at (866) 756-8115.


 
Overview
 
Weight Management
  • Weight management benefits will be available on all OEBB medical plans effective October 1, 2010. Coverage includes educational resources, weight management classes/programs (employees/retirees only), health coaching and assessment by providers. For more details on how to access these benefits, click here. 
“Incentive Tier” Office Visits and “Value Tier” Medications
  • OEBB medical plans through ODS (plans 3-8) and Providence (plans 2 and 2A) will include lower copays for office visits and certain medications related to the management of asthma, heart conditions, cholesterol, high blood pressure and diabetes.
Additional Cost Tier
Both ODS (plans 3-8) and Providence (plans 2 and 2A) will cover certain treatment procedures under a separate tier with higher copays:
 
       ●   Outpatient upper endoscopy
       ●   Spine surgery for pain
       ●   Knee and hip replacement
       ●   Arthroscopies (knee and shoulder)
 
Educational Information about the Additional Cost Tier
 
       ●   ODS Health Plan 
       ●   Providence Health Plan 
 
 
New Plan Offerings
OEBB will offer two new benefits to educational entities for 2010-11:
Employee Assistance Program (EAP)
Reliant Behavioral Health (RBH) will be providing an affordable and comprehensive employee assistance program that includes counseling, crisis response, supervisor resources, and work-life balance services, all with a focus on wellness. If your entity elected the EAP benefit, you will see this listed on the enclosed benefit summary.  As this benefit is only available on an entity-wide basis, you do not need to enroll in this benefit.  For more details on how to use this benefit, visit the OEBB website.
 
 
 
Long Term Care Insurance (LTC)
Unum Life Insurance Company of America will be providing the long term care insurance for all OEBB members.  Long term care insurance (LTC) provides a monthly benefit amount when someone needs assistance with activities of daily living, such as bathing and dressing, due to an accident, illness, or advancing age. If your entity has chosen to make the OEBB LTC benefit available to you, you will see this listed on the enclosed benefit summary.
 
For more information about the LTC options available, click here.
For more information on the rates for LTC coverage, click here.
 

 
Medical Plan Design Changes

All OEBB Medical Plans
  • The annual benefit maximum for alternative care services will be reduced to $2,000 on all OEBB medical plans.
Kaiser Permanente 
Kaiser Medical Plan 1
  • Office visits with specialists will require a copay of $15.
  • The out-of-pocket maximum will be increased to $1,200 for individuals and $2,400 for families.
Kaiser Medical Plan 1A
  • The copay for primary care office visits will be reduced to $20.
  • Office visits with specialists will require a copay of $30.
Kaiser Medical Plan 2
Kaiser Medical Plan 2 has been eliminated for 2010-11. The last day coverage will be available under this plan is September 30, 2010.
Providence 
Note:  Providence Plan 2 from the 2009-10 plan designs will be eliminated Oct. 1, 2010.
 
Providence Medical Plan 2 (formerly Plan 1)
  • “Incentive Tier” office visits for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will remain at a $10 copay.
  • The copay for primary care and specialist office visits for all conditions other than those listed under the Incentive Tier category will increase to $15.
  • Covered lab work and x-rays will require a $15 copay.
  • Covered durable medical equipment will require a $15 copay and surgeries will require a $100 copay.
  • The deductible for out-of-network services will increase to $400/individual, $1,200/family.
  • The out-of-pocket maximum will increase to $1,200 per person for in-network services and $2,400 per person for out-of-network services.
  • Sleep studies and certain imaging services (CT scans, PET scans and MRIs) will require a $100 copay which will notapply toward the annual maximum out-of-pocket.
  • Outpatient upper endoscopies, spine surgery for pain, knee and hip replacements, and arthroscopies (knee and shoulder) will require a $500 copay which will notapply toward the annual maximum out-of-pocket.
Providence Medical Plan 2A (formerly Plan 1A)
  • “Incentive Tier” office visits for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will decrease to a $10 copay.
  • The copay for primary care and specialist office visits for all conditions other than those listed under the Incentive Tier category will remain at $25.
  • The maximum copay per admission will be removed for the hospital copays.
  • The deductible for out-of-network services will increase to $600.
  • The out-of-pocket maximum will increase to $1,800 per person for in-network services and $3,600 per person for out-of-network services.
  • Surgeries will require a $100 copay.
  • Sleep studies and certain imaging services (CT scans, PET scans and MRIs) will require a $100 copay which will notapply toward the annual maximum out-of-pocket.
  • Outpatient upper endoscopies, spine surgery for pain, knee and hip replacements, and arthroscopies (knee and shoulder) will require a $500 copay which will notapply toward the annual maximum out-of-pocket.
ODS 
ODS Medical Plan 3
  • “Incentive Tier” office visits for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will remain at the current $10 copay level for in-network providers.
  • The copay for in-network primary care and specialist office visits for all conditions not outlined under the Incentive Tier bullet above will increase to $15.
  • The annual deductible will increase to $200 per person and $600 per family.
  • The out-of-pocket maximum per person will increase to $1,200 for in-network services and $2,400 for out-of-network services.
  • Sleep studies and certain imaging services (CT and PET scans and MRIs) will require a $100 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
  • Outpatient upper endoscopies, spine surgery for pain, knee and hip replacements, and arthroscopies (knee and shoulder) will require a $500 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
ODS Medical Plan 4
  • “Incentive Tier” office visits for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will have a reduced copay of $10 for in-network providers.
  • The copay for in-network primary care and specialist office visits for all conditions not outlined under the Incentive Tier bullet above will increase to $25.
  • The annual deductible will increase to $200 per person and $600 per family.
  • The out-of-pocket maximum per person will increase to $1,500 for in-network services and $3,000 for out-of-network services.
  • Sleep studies and certain imaging services (CT and PET scans and MRIs) will require a $100 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
  • Outpatient upper endoscopies, spine surgery for pain, knee and hip replacements, and arthroscopies (knee and shoulder) will require a $500 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
ODS Medical Plan 5
  • “Incentive Tier” office visits for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will have a reduced copay of $10 for in-network providers.
  • The copay for in-network primary care and specialist office visits for all conditions not outlined under the Incentive Tier bullet above will increase to $25.
  • The out-of-pocket maximum per person will increase to $1,800 for in-network services and $3,600 for out-of-network services.
  • Sleep studies and certain imaging services (CT and PET scans and MRIs) will require a $100 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance. 
  • Outpatient upper endoscopies, spine surgery for pain, knee and hip replacements, and arthroscopies (knee and shoulder) will require a $500 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
ODS Medical Plan 6
  • Office visits are no longer covered with a copay, but require you to pay a percentage of the total charges.
  • “Incentive Tier” office visits for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will require you to pay a 20% coinsurance, but the deductible is waived for in-network providers.
  • Office visits with primary care providers and specialists for all conditions not outlined under the Incentive Tier bullet above will require you to meet the deductible and then pay a 20% coinsurance (they will no longer require a copay) and amounts paid as coinsurance apply toward the maximum out-of-pocket.
  • The out-of-pocket maximum per person will increase to $2,000 for in-network services and $4,000 for out-of-network services.
  • Sleep studies and certain imaging services (CT and PET scans and MRIs) will require a $100 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
  • Outpatient upper endoscopies, spine surgery for pain, knee and hip replacements, and arthroscopies (knee and shoulder) will require a $500 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
ODS Medical Plans 7 & 8
  • Sleep studies and certain imaging services (CT and PET scans and MRIs) will require a $100 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
  • Outpatient upper endoscopies, spine surgery for pain, knee and hip replacements, and arthroscopies (knee and shoulder) will require a $500 copay which will not apply toward the annual out-of-pocket maximum and is in addition to the plan deductible and coinsurance.
ODS Medical Plan 9
  • There will be no changes to ODS Medical Plan 9.
 

 
Pharmacy Plan Design Changes

Kaiser Permanente 
Kaiser Pharmacy Plan 1
  • The copay for preferred brand medications will increase to $25 (retail) and $50 (mail order).
Providence
Providence Pharmacy Plan 1
  • The copay for “Value Tier” medications for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will decrease to $4 (retail) and $8 (mail order).
  • The copay for generic medications not included in the Value Tier will increase to $8 (retail) and $16 (mail order).
  • The copay for preferred brand medications will increase to $25 (retail) and $50 (mail order).
ODS 
ODS Pharmacy Plan A
  • The copay for “Value Tier” medications for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will decrease to $4 (retail) and $8 (mail order).
  • The copay for generic medications not included in the Value Tier will increase to $8 (retail) and $16 (mail order).
 
ODS Pharmacy Plan B
  • The copay for “Value Tier” medications for the management of asthma, heart disease (including congestive heart failure), cholesterol, high blood pressure and diabetes will decrease to $4 (retail) and $8 (mail order).
  • The copay for generic medications not included in the Value Tier will increase to $8 (retail) and $16 (mail order).
  • The maximum will be removed from retail non-preferred brand medications. ($100 maximum still applies to mail order and specialty medications.)
ODS Pharmacy Plan C
There are no changes to ODS Pharmacy Plan C for 2010-11.
 

 
Dental Plan Design Changes

Kaiser Permanente
Kaiser Dental Plan 7
  • The copay for preventive and restorative services, major services and prosthodontics will increase to $10 per visit. (Additional copays for major services and prosthodontics still apply.)
Kaiser Dental Plan 8
  • The copay for preventive and restorative services, major services and prosthodontics will increase to $20 per visit.
ODS
ODS Dental Plans 1 - 3
  • A deductible of $50 will be added.
ODS Dental Plan 4
  • The deductible will increase to $50.
ODS Dental Plans 5 – 6
  • There are no changes to ODS Dental Plans 5 or 6.
Willamette Dental
Willamette Dental Plan 7
  • The copay for preventive and restorative services will increase to $10 per visit.
Willamette Dental Plan 8
  • The copay for preventive and restorative services, major services and prosthodontics will increase to $20 per visit.

 
No changes to Vision
There will be no changes to any of the OEBB vision plans for 2010-11.