Open Enrollment
**This year’s Open Enrollment is “passive” (or nonmandatory). It takes place October 1-31, 2024.
Please note: Materials are added as they are made available.
If you’re satisfied with your current benefit plan selections, you don’t need to do anything. Your current enrollments will roll over to the next plan year. Your benefits will stay the same.
Note: You must enroll or re-enroll each year to have a Flexible Spending Account (FSA).
What does that mean for you?
It means you must login to your PEBB portal and confirm your plans. (Failure to complete open enrollment could result in higher out of pocket costs or the loss of benefits).
This is the time that you can:
- Change any of your coverages
- Current enrolled opt out employees need to re attest their opt-out status
- Add eligible dependents, remove dependents
- Enroll, or re-enroll in a flexible spending account (FSA)
- Change your Health Engagement Model (HEM) status
- Update your personal information
- Update your beneficiaries
Open Enrollment is your once-a-year opportunity to make changes to your benefit packages without having experienced a qualifying life event or family status change (marriage, birth, divorce, loss/gain of other insurance, etc.).
The changes you make during Open Enrollment will be effective in the new plan year beginning January 1, 2025.
There are two (2) Actions required to complete both the Open Enrollment and the HEM:
Action 1: PEBB Open Enrollment completion
Confirm your benefit elections, make changes, re-enroll in flexible spending accounts, AND indicate your HEM participation status for 2024. If Opting Out, you MUST take action and affirm you and your dependents have minimal essential coverage.
Action 2: (If planning to participate in the Health Engagement Model HEM) – Complete the HEM Health Assessment
Complete the HEM Health Assessment by October 31, 2024 at your current medical carrier’s website. The HEM program will provide a financial incentive in your pay of $17.50 a month if you elect to participate and an increased deductible on your health plan if you choose not to participate.
The three easy steps to participate in both are:
Step 1
Enroll in a PEBB medical plan by October 31, 2024. (Be sure to say you plan to take part in HEM.)
Step 2
Take your health assessment on by October 31, 2024. Health assessments done after this date will not be accepted.
Step 3
Complete two healthy actions during the new plan year. You don’t need to report them. You just need to let us know you did them at open enrollment next year. Remember, spouses and partners don’t participate. When you participate, they get the advantage of your low family deductible.
Please refer to the Health Engagement Model landing page for links to the medical carrier’s websites, questions about healthy actions and health assessment related questions.
** Plan early to complete your Health Assessment. You may need to have your password reset which can take time. For example, Kaiser Permanente may require 10 business days to reset your password.
How do you complete open enrollment?
Employees can enroll online or use paper forms.
- Go to: www.Pebbenroll.com to complete this process online.
- To use Paper Forms to Complete Enrollment:
- Download at: http://www.oregon.gov/oha/pebb/Pages/forms.aspx. Search for Open Enrollment forms.
- Paper forms can be faxed, scanned and e-mailed or sent through mail.
Please return the forms to Human Resources by October 31, 2023.
Surcharges and Optional Life Rates
- Tobacco Surcharge – $25/month if employee uses tobacco + $25/month if enrolled spouse/domestic partner uses tobacco.
- Spouse/Domestic Partner Surcharge – $50/month if spouse/domestic partner waives coverage in another employer’s group plan (non-PEBB plan) in favor of coverage through PEBB.
- Tobacco User Life Insurance Rates – The rates for optional employee life and optional spouse/domestic partner life insurance is higher for members that have used tobacco within the past 12 months.
- OEBB/PEBB double coverage Surcharge – You will have to pay a monthly $5 surcharge if you are an active full-time employee and:
- Someone in your family is covered as a member under their own PEBB or Oregon Educators Benefit Board (OEBB) plan, and
- That person is covered as a dependent (spouse, partner or child) on your PEBB medical plan.
2025 Medical Plan Changes
General/All Medical Carriers
Doula services: Doula services will now be available. Services include eight pre- and post-natal care visits, plus delivery.
MODA Plans:
- Teladoc: Teladoc is a virtual primary care provider that will be part of Moda’s Coordinated Care Model (CCM) network. This expands access to primary care for all PEBB members, especially those in rural Oregon and out of state.
- Mighty: Mighty offers a holistic approach to weight management. It focuses on nutrition behavior changes. It also helps reduce pain and improve mobility and function. (Mighty will be offered at no cost as an alternative to WeightWatchers®.)
- Nutritional therapy: Appointments will be covered at the standard cost-sharing without requiring a diagnosis.
- Fertility Services will now include:
- Creating embryos using the intended parent’s sperm for same-sex male couples.
- Coverage for those who have undergone voluntary sterilization.
- Cryopreservation (egg or sperm freezing) for members undergoing gender affirming care when medically necessary.
- Coverage through Kindbody, including comprehensive care services and concierge patient advocacy.
- Costco pharmacy: Members will be able to fill $0 cost-share value tier prescriptions at Costco. This program will provide a six-month supply. A membership is not required.
- Covered drugs: The plan will no longer cover certain over-the-counter drugs.
Kaiser Plans
- Fertility Services will now include:
- Cryopreservation (egg or sperm freezing) for members undergoing gender affirming care when medically necessary.
- Storage of cryopreserved tissue when medically necessary.
- Omada: Omada is a weight management program. (This program will be offered at no cost as an alternative to WeightWatchers®.)
- Traditional HMO pharmacy benefits: The costs for drugs will increase. ‒ Generic drugs: The copay will increase from $1 to $5.
- Preferred brand drugs: The copay will increase from $15 to $25.
- Non-preferred brand drugs: The cost-share will increase from a $15 copay to 50% of the cost, up to $100.
Providence Plans
Generic medications: Members will be required to use generic medications instead of brand-name medications when available.
- Alopecia areata medications. Members with severe alopecia areata can request an exception to the exclusion of hair growth medications.
- Rx Savings Solutions. This program will be available to identify potential cost-saving opportunities for members.
Covered drugs: The list of “value tier” drugs will be updated. This list includes low-cost generic drugs used to treat the most common chronic conditions. Also, the plan will no longer cover certain over-the-counter drugs.
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- Fertility Services will now include:
- Coverage for members who have undergone voluntary sterilization.
- Cryopreservation (egg or sperm freezing) for members undergoing gender affirming care when medically necessary.
- A new model for fertility benefits. Members will receive up to two advanced reproductive technology (ART) cycles each year if the first cycle doesn’t work. Each cycle includes all necessary tests and the latest technology the member’s provider decides is needed.
- Progyny: Fertility and family-building benefits, including comprehensive care services and concierge patient advocacy, will be available through Progyny.
- Mighty: Mighty offers a holistic approach to weight management. It focuses on nutrition behavior changes. It also helps reduce pain and improve mobility and function. (Mighty will be offered at no cost as an alternative to WeightWatchers®.)
- Fertility Services will now include:
Dental & Vision Plan Changes
Willamette Dental: No 2025 benefit changes
Delta Dental: Services for those with intellectual or developmental disabilities. Covered services will be expanded to include visits before the first treatment, two additional cleanings per year, silver diamine fluoride for cavities, and care enhancements for those with sensory or behavioral challenges.
Kaiser Permanente Dental:
- Nightguards: The cost for occlusal nightguards will increase from 10% to 35%. Nightguards will be covered once every five years.
- Mouthguards: The cost for athletic mouthguards will increase from 10% to 35%.
Willamette Dental: No 2025 benefit changes
Delta Dental: Services for those with intellectual or developmental disabilities. Covered services will be expanded to include visits before the first treatment, two additional cleanings per year, silver diamine fluoride for cavities, and care enhancements for those with sensory or behavioral challenges.
Kaiser Permanente Dental:
- Nightguards: The cost for occlusal nightguards will increase from 10% to 35%. Nightguards will be covered once every five years.
- Mouthguards: The cost for athletic mouthguards will increase from 10% to 35%.
Vision Plans: Contact lens: The allowance will increase to $225 every calendar year.
Optional Plans:
- PEBB will continue to offer other income protection benefits in 2025. There will be no change to rates for disability insurance, life insurance, and AD&D insurance.
- The cost for long-term care insurance may increase during the year. Costs are based on the coverage options the member chooses and the place of residence used.
Opt-Out or Decline?
Opt-out is a choice that results in PEBB membership. Employees that have other qualifying medical coverage can elect to opt-out of the PEBB medical enrollment and receive a cash payment in their monthly payroll checks. Employee’s MUST attest that all tax dependents have minimal essential health insurance coverage in order to qualify. To continue to opt out of medical benefits in 2025 you must:
- Complete open enrollment between Oct. 1 and Oct. 31, 2024.
- Attest that you still have other group (employer) coverage to receive the opt out incentive. If you don’t complete open enrollment you will remain without medical coverage and lose your monthly incentive.
- Opt out is allowed for medical only and employees must attest to having other employer group coverage to be eligible. This means all current enrolled opt out employees need to complete open enrollment to attest regarding other coverage. If employees who have opted out previously do not attest, they will be removed from opt-out cash back and will be defaulted into a medical plan.
- Decline is that an employee didn’t take an action to enroll in any PEBB option (including the opt-out cash payment option). You are not a PEBB member and receive no PEBB benefits.
