OEBB Benefits News

Deductibles and copays – sorting it all out

• If you go to the doctor or need a prescription filled for any other reason, you'll pay part of the cost before your benefits kick in.
• Some of our plans feature a copayment or "copay" for certain doctor visits or prescriptions. This is a flat amount you pay, and the plan pays the rest.
• Most of our plans also have a deductible. This means, unless the service you receive is "deductible waived" (e.g., preventive care), you pay 100% of the cost until you have paid this amount which is referred to as "meeting your deductible." 
• After you have met your deductible, you pay a percentage of the cost (called coinsurance) and the plan pays the rest. Your coinsurance may vary based on the plan you are enrolled in and the service you receive, but it's very common on OEBB plans for you to pay 20% and the plan to pay 80%. 
• You should also be aware that OEBB plans have annual "out-of-pocket" maximums to protect you if you need a high amount of medical care. All your copays and coinsurance payments are tracked by plan year. If the total you pay "out-of-pocket" reaches that maximum, the plan will pay 100% of your covered services for the rest of the plan year.
• Keep in mind that the OEBB plan year runs Oct-Sept, so each year your deductible and out-of-pocket maximum resets on October 1st. If your spouse or family member is on a health plan with a different employer, their deductibles and out-of-pocket maximums may reset in January. Be sure to factor in this timeline when planning for doctor's visits or procedures. Click the links below to review your plan details.

Alternative care may be right for you

Sometimes the care you need may be outside of “traditional" treatment. Over the years, several “alternative" treatments have come into the mainstream.

Learn more about these options and whether they might be right for you. 

All OEBB medical plans offer an alternative care benefit.

Moda Health: Chiropractic and acupuncture services are covered with 12 visits combined annually.

Kaiser Permanente: Chiropractic, acupuncture and naturopathic services are covered as follows:

• Plan 1 EOC: $20 copay, up to $2,000 a year
• Plan 2A EOC: $25 copay, up to $2,000 a year
• Plan 2B EOC: $30 copay, up to $2,000 a year
• Plan 3 EOC: $20% coinsurance after deductible, up to $2,000 a year 
  

Walgreens retail pharmacies are now part of the pharmacy network for OEBB's Moda medical plans.  

Is Invisalign right for you?

Invisalign® is a treatment that uses a series of custom-made clear aligners to reposition teeth over time – a process that’s mapped out by your orthodontist.

In general, this treatment is better suited for simpler cases of misalignment. Compared to traditional braces, Invisalign requires a higher level of commitment from the patient. 

Aligners must be worn 20-22 hours per day and removed only for eating, brushing and flossing for the most effective treatment. Each case is unique, so the duration of treatment may vary. Clear aligners are covered by orthodontia benefits under the OEBB dental plans. Learn more at the following links:

• Willamette Dental Group
  
• Moda Health/Delta Dental
  
• Kaiser Permanente Dental