Plan Year 2010-11 Questions
|New for 2010-11|
|Who is providing the new Employee Assistance Program to OEBB educational entities? |
|Reliant Behavioral Health (RBH) has partnered with OEBB to provide an Employee Assistance Program (EAP) to OEBB educational entities starting Oct. 1, 2010. RBH will provide an affordable and comprehensive program that includes counseling, crisis response, supervisor resources and work-life balance services, all with a focus on wellness. Not all educational entities are offering this program. View the EAP Flyer or watch a video about the new program. |
|If I am using EAP services before Oct. 1, 2010, can I continue with my same provider after that date? |
|You can only continue if your provider is in the RBH network. If your provider is not, you can nominate them to join the network. Keep in mind, you have until September 30 to finish your counseling sessions and complete your goals with your current provider. Contact RBH to check if your provider is in-network, call 1-866-750-1327. |
|Does the new Employee Assistance Program have a comparable network across the state or Oregon? |
|Yes. Reliant Behavioral Health (RBH) has a robust network across Oregon. Feel free to call them with more details, 1-866-750-1327. |
|Who is providing Long Term Care Insurance to OEBB educational entities? |
|Starting Oct. 1, 2010, UNUM Life Insurance Company of America will be providing long term care insurance to 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 accidence, illness, or advancing age. Not all educational entities have chosen to offer this benefit. |
|I can now add my married daughter to the plan. Can I add my grandchild also? How about my daughter’s husband? |
|If you are legally responsible for the grandchild, you may add them to the plan. Your child’s spouse would not be eligible under your plan. |
|If I’m covering a child age 25, when will their coverage end? Do I need to notify anyone when they turn 26? |
|Covered dependents may remain on your plan through the end of the month in which they turn 26 years of age. You must notify your educational entity within 31 days of their 26th birthday requesting they be removed from the plan effective the first of the month following their 26th birthday. |
|When my covered dependent turns 26, is there any way to continue purchasing coverage for them? |
|After your dependent’s coverage is terminated in the MyOEBB system, BenefitHelp Solutions (BHS) will mail you COBRA information explaining the options and pricing for COBRA coverage, which is a continuation of the exact same coverage. Notifying your educational entity in advance of your dependent’s birthday will help you get this information sooner. Portability plans are also an option, which you can learn more about by calling your carrier directly. And of course, you can call any insurance provider to get a quote on an individual plan. |
|As an early retiree, can I add dependents to my plan? |
|Early retirees can only add dependents to their OEBB health plans within 31 days of a Qualified Status Change (QSC) event. For instance, if you adopted a child you may enroll your child by submitting a change form to your educational entity within 31 days of the adoption. View all the qualifying events. |
|As an early retiree, can I add my 24-year-old adult dependent child during Open Enrollment (Aug. 15 – Sept. 15, 2010)? |
|If your adult dependent child previously met eligibility requirements and you choose to not cover them, they are ineligible for coverage. However, you can enroll your adult dependent if they were ineligible for coverage prior to October 1, 2010, and now they meet the new dependent eligibility requirements. (See question below) You must contact your Educational Entity to add the dependent during Open Enrollment. |
|My child is attending college in another state. What doctors can they go to? |
|If a student/dependent lives outside of the service area, you will need to notify the insurance carrier and let them know that you have an out-of-area dependent. |
Be sure to contact your carrier before services are needed, so they have the correct information on file before a claim is submitted.
- ODS: Services will be processed as “in-network” as long as they go to a provider within a 30-mile radius of their residence. Fees charged by out-of-area providers (more than 30 miles from their residence) will be considered “out-of-network” and will be reimbursed at the maximum plan allowable for those services.
- Providence: Services will be processed as “in-network” if your dependent goes to one of Providence’s national network providers.
- Kaiser: Students dependents temporarily living outside the Kaiser Foundation Health Plan service area can see any health care provider. The benefit is limited to $1,200 per calendar year. You must pay 20% of the actually fee the provider, facility, or vender charged for the services. You must also complete and submit the student out-of-area benefit form annually.
|Is my doctor in-network with ODS Health Plans or Providence Health Plans? |
|Below are the links that will take you to the provider directory or search features on the carriers’ Web sites. |
ODS Health plans:
Providence Health Plans:
|Are there any pre-existing limitation conditions on the OEBB plans? |
|No, OEBB plans do not have any pre-existing condition limitations. Note: The ODS medical plans do not cover transplants during the first 24 months a person is enrolled in the plan, but this is true regardless of whether the condition began before or after the person enrolled and therefore is not considered a “pre-existing condition limitation”. |
|What is the difference between opting out and waiving benefits? |
|Opting-out of coverage is when an employee decides not to enroll in an OEBB medical plan and receives a financial incentive for doing so. You must have other group medical coverage for yourself and your eligible dependents if you choose to opt out of the OEBB medical coverage. Provide proof of your other coverage to your educational entity within five days of opting out of medical. |
Waiving coverage is when an employee decides they do not want benefits and they do not receive any financial incentive. However, please check with your educational entity to obtain further information regarding these options and requirements as they may vary.
|What will each plan cost me out of my paycheck?|
|Only your educational entity can provide your actual out-of-pocket cost for each of your benefit options. |
|You didn’t send the rates in my Open Enrollment packet, how can I find them?|
|Only your educational entity can provide the actual amounts you will pay out-of-pocket (see question 2 above). However, if you’d like to view the total premiums for each OEBB plan (which the entities will pay) you can click here to view the rates online. |
|Post-Open Enrollment |
|What happens if I previously chose not to enroll in dental and/or vision coverage, but now I want to enroll for 2010-11? |
|Members who do not enroll in the dental and/or vision plans when originally eligible and elect to enroll during Open Enrollment, will be subject to a 12-month waiting period. During the 12-month waiting period, dental coverage will cover only diagnostic and preventive services. Fillings, crowns, orthodontia, etc. will not be covered. Similarly, vision plans will only cover eye exams during the 12-month waiting period. Lenses and hardware will not be covered. After the initial 12-month waiting period has passed, full benefits will resume as long as you maintain your coverage. |
|What if I chose not to enroll in dental and/or vision coverage because I had other group coverage, but then I lose my other group coverage? |
|The 12-month waiting period for routine services does not apply due to loss of other group coverage. Loss of coverage is considered a Qualified Status Change (QSC) and you are allowed limited mid-year changes to your enrollment. If you experience a QSC, you must report it to your educational entity within 31 days of that event. Learn more about what qualifies as a QSC. |
If your loss coincides with Open Enrollment, you will need to provide your educational entity with proof of the loss of other coverage as soon as possible. Your educational entity can then contact OEBB, verify that the change is due to a Qualified Status Change (QSC) rather than Open Enrollment and OEBB staff can update your enrollment record so you won’t be subject to the 12-month waiting period. If you do not take these steps, the MyOEBB system will automatically apply the 12-month waiting period to anyone enrolling in dental and/or vision coverage who was previously eligible but not enrolled.
|Will my deductibles and out-of-pocket amounts start over on October 1? |
|Deductibles, maximum out of pocket amounts and benefit maximums will all be reset as of October 1, 2010 and will run through September 30, 2011. |
|What if I am (or one of my covered dependents is) travelling and needs medical attention? |
|Call your medical carrier to determine which providers and services will be covered at what level. They can also help you locate an appropriate facility for your situation. Depending on the location and availability of providers, you may need to pay cash and submit the receipt to the carrier for reimbursement. |
|What if I’m planning a long trip and need to stock up on prescriptions before I go? |
|Call your medical carrier as early as possible before your trip and explain the situation. Sometimes the logistics can be tricky, especially if your plan is changing mid-trip or if you’re travelling in a remote area with limited mail delivery. Whatever the details may be, the carriers hold your health as their top priority and can often come up with very creative solutions to get you the medication you need. |
|Which plans require a referral to see a medical specialist? |
|For Kaiser Permanente, members may self-refer for outpatient drug and alcohol treatment, outpatient mental health, cancer counseling, optometry, obstetrics/gynecology, occupational health, and social work. Generally, for other specialty services, a referral is needed to see a specialist for the first time. |
For Providence and ODS, you never need a referral to have a specialist visit covered; however, some specialists may require a referral before they will schedule your appointment. Authorizations may be required depending on the provider and the service.