The Oregon Educators Benefit Board approved a 12-month waiting period for dental and vision plans in June 2008.

 

This waiting period applies when an OEBB-eligible member does not enroll in dental or vision coverage offered by their employer during one plan year, and enrolls in dental or vision during a following plan year.

 

Coverage for previously OEBB-eligible employees or a previously OEBB-eligible dependent enrolling in the dental or vision plans during an open enrollment period will be limited to routine and preventive care for the first 12 months and subject to a 24-month waiting period for orthodontia coverage, the Board decided.

 

Dental exams, cleanings and x-rays, as well as routine vision exams on the vision plan are still covered during the 12-month waiting period. Once the 12-month waiting period ends, a member who continues their dental or vision coverage will be eligible for all the benefits in the plan.

 

The 12-month waiting period was created to minimize risk to the overall pool. Without the 12-month waiting period, a member could get major work or glasses by enrolling and paying premiums one year and then disenrolling and not have to pay premiums until a future plan year when they need to get more dental work or glasses again. This creates adverse selection and causes premiums to increase for all members.

 

To view this administrative rule visit http://www.oregon.gov/OHA/OEBB/docs/DivisionRules/Division40/Division40Aug2009.pdf.

 

Examples of non-participation in the dental or vision plans include the following:

 

If you had a Qualified Status Change (QSC) during the Open Enrollment period (August 15 through September 15) and added the new coverage or dependents along with your other open enrollment changes, the 12-month waiting period may not apply. A QSC consists of the following events:

 

If you feel you qualify for one of the above mentioned QSCs, please use the link below to complete an Appeal Form with OEBB:

http://oregon.gov/OHA/OEBB/docs/Forms/AppealForm.pdf.

 

OEBB will review your appeal and communicate a decision to you in writing within 30 days of receipt of your appeal. Please submit your appeal by October 30, 2009. 

For prevention facts about the flu, the most trusted sources of information are the Oregon Department of Human Services Public Health Division and the U.S. Centers for Disease Control and Prevention. The Oregon Public Health Division is in the process of conducting a huge educational effort to provide the facts about seasonal and H1N1 influenzas to all Oregonians. OEBB is partnering with them to assist in their educational efforts.

 

Public health experts continue to advise the public to take the following basic precautions to help slow the spread of all influenza:

 

Vaccine for H1N1

Although it is recommended that everyone get the H1N1 vaccine, the following people are most at risk for getting sick and should make it a priority of getting the vaccine: healthcare workers, pregnant women, people aged 6 months through 24 years, people aged 25 though 64 with chronic health conditions such as asthma and immune deficiencies and front-line public safety personnel.

 

Currently, there is a limited supply of the H1N1 vaccine -- which is why people in the high-risk group should get the vaccine first -- but it will eventually be available for everyone. States will receive the vaccine as soon as it is available. If you are in one of the priority groups mentioned above, you may be able to find a location for the vaccine at http://flu.oregon.gov/DHS/ph/acd/flu/locations.shtml.

 

For more information on where to get the vaccine when it becomes available, visit the Oregon Department of Human Services Web site, www.flu.oregon.gov, or call the Oregon Public Health Flu hotline at 800-978-3040.

 

Seasonal Flu Vaccine

Regular seasonal flu shots, which do not protect against H1N1, also are recommended. Information about where you might find a flu shot is available on the Public Health Flu Web site, www.flu.oregon.gov, or from the state hotline at 800-978-3040.

 

Flu Symptoms

The symptoms of seasonal flu include fever, cough, sore throat, body aches, headache, chills and fatigue. Symptoms of H1N1 flu are the same as those found in seasonal flu except for reported cases of diarrhea and vomiting.

 

Stay Hydrated

The flu virus causes the body to lose water through fever and sweating. Signs of dehydration include weakness, fainting, dry mouth, dark concentrated urine, low blood pressure or a fast pulse when standing or sitting down. To prevent dehydration, it’s very important for a person with the flu to drink lots of fluids, even as much as eight to 12 glasses per day.

 

Rest and Over-the-counter Medication

Be sure to get plenty of rest when you are sick. In some cases you may find some relief by taking over-the-counter cold and flu medications. According to the Oregon Department of Public Health you can treat fever with acetaminophen, Tylenol® is the name brand, but generic acetaminophen works just as well and can save you money.

Save Time and Money -- use one of the following services to get quick answers to your health questions; all are available through your health plan.

 

Getting your non-critical medical questions answered is as simple as sending an e-mail or picking up the phone. Each of OEBB’s carriers provide physician or nurse consultations to their members. Following is information about how to access these services through your medical plan carrier.

 

Kaiser Pemanente -- My Health Manager

"My Health Manager" is a one-stop online resource on www.kp.org that makes managing your health easier and more convenient. Through "My Health Manager," you are able to e-mail your doctor’s office; view most lab results as soon as they become available; order prescription refills; schedule, cancel, or review appointments; see a list of your recent immunizations and allergies and review notes from recent office visits that include recommended follow-up steps. These features help save you time, are offered at no additional cost and can save you a trip to the medical office, which means fewer co-payments, fewer phone calls and less time waiting for results.

 

If you have an urgent health concern, but aren’t sure if you need to be seen, call a Kaiser advice nurse. During weekday hours, just call your medical office. At other times, call Membership Services and choose the advice option from the menu. An advice nurse will evaluate your concern and let you know if there are home treatments you can try or if you need to come in.

 

ODS and eDocAmerica

ODS offers eDoc (www.odscompanies.com/oebb and click on myODS to register) which has the tools and information you need to take care of your health. For example, the next time you have a worrisome but non-critical medical issue, e-mail an eDoc doctor or talk to a nurse at any time, day or night. The eDoc team is ready to serve you and your family whenever you need them from any computer with Internet access. Ask board-certified physicians, psychologists, pharmacists, dentists, dietitians and personal trainers any questions, any time that is convenient for you. In most cases a personalized answer will arrive in your private eDoc inbox within two to four hours. With eDocAmerica there are no co-pays, no additional fees and no hidden costs -- the eDocAmerica providers may actually help you avoid unnecessary physician office visits and the costs that accompany such visits.

 

eDocAmerica is a free, confidential and secure service included in your ODS benefit and gives you and your family unlimited access to vital health resources around the clock.

 

ODS’ Registered Nurse Line

Members also can call the 24-hour Registered Nurse Advice Line (866-321-7580) any time to get help with medical issues ranging from home-care remedies to recommended emergency treatment. With the 24-hour Registered Nurse Advice Line you no longer have to wait to get guidance on non-emergent needs. This includes health situations that do not require the need for immediate medical attention; like when you have questions about a sick child in the middle of the night or if you do not have access to the Internet. Any time, day or night, you and your family have toll-free access to highly qualified registered nurses who will coach you through your situation and give you the expert guidance you need in making those important health-related choices.

 

Providence RN: Medical Advice Line

Providence RN Medical Advice Line (800-700-0481 or 503-574-6520) is a free telephone medical advice line available exclusively to Providence Health Plan members. You can call day or night, seven days a week to speak with a registered nurse. Providence RN Medical Advice Line is designed to give members an immediate and convenient response to their medical concerns including how to treat a specific health problem or determine whether you need to see a doctor.

 

The Providence RN Medical Advice Line telephone number is located on the back of your member identification card. You will need to provide the nurse representative with your Providence Health Plan member identification (ID) number, located on the front of your member card. All calls are confidential. Providence RN Medical Advice Line does not provide referrals. If you need to select a physician, call the Providence customer service number on the back of your ID card. Note: This service is not available to residents of California.

 

Providence offers electronic provider visits (E-visits) with your provider through e-mail. This benefit allows you to take advantage of the conveniences of e-mail when receiving healthcare services from a participating proivder who has agreed to provide this benefit for Providence Health Plan. Not all PHP participating providers offer the E-visit benefit. Please check with your participating provider’s office or consult the PHP Online Provider Directory at www.providence.org/healthplans to see if your provider offers the E-visit Benefit.

Each year following open enrollment OEBB sends a survey to its members in an effort to seek feedback, improve programs, communication materials and the annual open enrollment process. Most people will complete the survey in three or four minutes.

 

We have begun sending the survey through Survey Monkey via your e-mail address listed in MyOEBB so please look for it in your inbox in the next few days. Members who did not enter their e-mail address in the MyOEBB system during open enrollment may still do so. Simply log into MyOEBB, www.myoebb.org, and update your profile.

 

You also may contact OEBB via telephone at 888-469-6322 or e-mail OEBB.info@state.or.us and ask to have your e-mail address added to your profile and we will send you the survey.

OEBB uses its members’ e-mail addresses for official OEBB-related business only. We make every effort to minimize the number of e-mails we send our members balanced with providing necessary information and requesting feedback from our members.

 

OEBB always seeks ways to improve and make the open enrollment process easier for members in the coming years. Receiving your feedback and being able to address your questions or concerns is one of the Board’s highest priorities.

 

You’ll be able to rate your overall experiences with OEBB and let us know how we need to improve to ensure your satisfaction with OEBB’s programs and services.