Provider Information/Policy Numbers

WOU’s PEBB Agency Number is 58020. Don’t know your PEBB Benefits number, or have other questions? Contact the Office of Human Resources at benefitsretirement@wou.edu or Michelle Sides, Benefits Coordinator, at 503-838-9390. Click here for the Summary Plan Description.

Medical Plans

Kaiser Permanente HMO

500 NE Multnomah, STE 100
Portland, OR 97232-2099
Phone: (800) 813-2000

Group Number: 18273
Member Number: Assigned by carrier

Kaiser Deductible

500 NE Multnomah, STE 100
Portland, OR 97232-2099
Phone: (800) 813-2000

Group Number: 18273
Member Number: Assigned by carrier

PEBB Statewide Plan (Administered by Providence)

PO Box 3125
Portland, OR 97208-3125
Phone: (800)423-9470

Group Number: 108601
Member Number: Assigned by carrier

Providence Choice

PO Box 3125
Portland, OR 97208-3125
Phone: (800) 878-4445

Group Number: 106528
Member Number: Assigned by carrier

Moda Health (Synergy)

PO Box 40384
Portland, OR 97240
Phone: (877)605-3229

Group Number: 10002802
Member Number: Assigned by carrier

Dental Plans

Willamette Dental

14025 SW Farmington Rd, Ste 300
Beaverton, OR 97005
Phone: (800) 460-7644

Group Number: Z250I
Member Number: *PEBB.Benefits Number

Moda Health Premier

(Previously ODS Traditional)
Moda refers to plan as Delta Dental Premier
601 SW 2nd Avenue
Portland, OR 97204
Phone: (800) 452-1058

Group Number: 6570
Member Number: *PEBB.Benefits Number

Moda Health PPO

(Previously ODS Preferred)
Moda refers to plan Delta Dental PPO
601 SW 2nd Avenue
Portland, OR 97204
Phone: (800) 452-1058

Group Number: 6571
Member Number: *PEBB.Benefits Number

Kaiser Permanente

500 NE Multnomah, Ste 100
Portland, OR 97232-2099
Phone: (800) 813-2000

Group Number: 18273
Member Number: Assigned by carrier

*(You should receive a card in the mail.)

Vision Plan (Except for Kaiser Members)

Vision Service Plan (VSP)

PO Box 997105
Sacramento, CA 95899
Phone: (800) 877-7195

Group Number: 12179989
Member Number: PEBB.Benefits Number

Life Insurance, AD&D, Disability

The Standard

PO Box 2800
Portland, OR 97208
Phone: Life Insurance/AD&D: (800)628-8600
Phone: Short-Term Disability: (800) 368-2859
Phone: Long-Term Disability: (800) 368-1135

Plan: Basic Life & Optional Life Insurance
Policy Number: 606814-D

Plan: Accidental Death & Dismemberment
Policy Number: 603073-A

Plan: Short-Term Disability
Policy Number: 442210-C

Plan: Long-Term Disability
Policy Number: 606717-A

Long Term Care

UNUM

2211 Congress Street
Portland ME 04122
800-227-4165

Plan Number: 025758-003 6
Plan Highlights
Certificate of Coverage

Flexible Spending Account- Medical and Dependent Care

ASIFlex

PO Box 6044
Columbia, MO 65205-6044
800-659-3035

Employee Assistance Program

Canopy Inc.

7180 S.W. Fir Loop Suite 100
Portland, OR 97223-8023
info@canopywell.com

(503) 639-3009
1-800-433-2320

You will need your Medical Card ID# issued by provider.
To enroll online use Company Name “State of Oregon”

Mail Order Pharmacy- Statewide & Providence Choice Plans

MEDEX Travel Assist (included with Employee Basic Life Insurance)

US, Canada, Puerto Rico, Bermuda, US Virgin Islands
800-527-0218

All Other Countries (Call collect.)
410-453-6330

Retirement Provider Information

Public Employees Retirement System (PERS)

11410 SW 68th Parkway
Tigard, OR 97223

P: 503-598-7377
F: 503-598-0561

Employer Number:
Western Oregon University
01255

PERS Health Insurance Program

PO Box 40187
Portland, OR 97240

P: 1-800-768-7377

Employer Number:
Western Oregon University
01255

Fidelity

Greg Weston, Workplace Planning & Guidance Consultant
825 SW Fifth Avenue
Portland, OR 97204

P: 1-800-343-0860
P: 503-716-2533
F: 508-460-2704

Oregon Public Universities
ORP: 71681
TDI: 71678

TIAA-CREF

Braden Danielson, Financial Consultant
4730 University Way NE, Suite 201
Seattle, WA 98105

P: 1-800-842-2888
P: 503-452-6986
F: 206-523-6866

Oregon Public Universities
ORP: 101528
TDI: 101529

Oregon Savings Growth Plan

800 Summer Street NE, Suite 200
Salem, OR 97301

P: 503-378-3730
F: 503-378-5888