**Open Enrollment is required for all PEBB members this year.  Failure to complete open enrollment may result in higher out of pocket costs or loss of benefits.

**This is the time that you can change any of your coverages, 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, or 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, 2023.

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 2023.  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 by October 31, 2022 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:

  1. Enroll in a PEBB medical plan by October 31, 2022. (Be sure to say you plan to take part in HEM.)
  2. Take your health assessment on by October 31, 2022. Health assessments done after this date will not be accepted.
  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.

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.

 

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.
2023 Plan Changes

Medical Plans

General/All Medical Carriers:

  • PEBB is adding breast reduction surgery when deemed medically necessary.
  • Continuous Glucose Monitors (CGM) and diabetic testing supplies will only be covered under the pharmacy benefit- no longer covered under DME.
    • You can obtain these supplies through a retail pharmacy or mail-order pharmacy, Postal Prescription Services and Costco for more savings
    • You will be notified 60 days in advance if you are impacted by this change
    • If you currently have a prior authorization approved under the medical benefit, you do not need to seek an additional prior authorization. It will be loaded under the pharmacy benefit to ensure there is no disruption in coverage:
  • NEW! Effective 1/1/2023: PEBB members will have access to Livongo’s Diabetes Prevention Program (DPP). The program will identify members who are at risk for developing Type 2 diabetes.
    • Members who sign up will receive:
      • An advanced smart scale and app
      • Unlimited one-on-one expert coaching
      • Guidance on creating healthy habits that last
      • All-in-one weight, activity and food tracking

Kaiser Plans

  • Deductible Plan Changes ($250 deductible incentive plan or the $350 deductible plan)
  • HMO Plan (Full time Traditional HMO and $100 deductible)
    • Naturopath: copay equal to office visit ($5). Remove the annual dollar limit.
    • Chiropractic: $10 copay with 20 visit annual limit. Remove annual dollar limit.
    • Acupuncture: $10 copay with 12 visit annual limit. Remove the annual dollar limit..

Providence Plans

Providence Choice Plan

Alternative care can no longer have dollar limits on benefits. The benefit will now be:

  • Spinal manipulation = 20 visit yearly limit.
  • Acupuncture = 12 visit yearly limit
  • Massage therapy = $1,000 benefit max per year

Dental Plans

Willamette Dental

Waiving 2022 office visit copays to encourage members back for cleanings and maintenance work.

Delta Dental: No 2022 benefit changes.

Kaiser Permanente Dental: No 2022 benefit changes

Vision Plans

VSP

Adding vision therapy coverage:

  • Up to $85 for sensorimotor exam annually
  • Up to $750 for orthoptic and/or pleoptic training (therapy session) annually

Optional Plans

  • No 2022 benefit changes.

Opt-Out or Decline? There is a difference

  • 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 2022 you must:
    • Complete open enrollment between Oct. 1 and Oct. 31, 2021.
    • 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.

Part-time Faculty Benefits

New this fall, related to SB 551, actively working part-time faculty working at least half-time at a single public institution of higher education or in aggregate at multiple public institutions of higher education in Oregon (Public Community College or University) during at least three of the four previous academic terms may be eligible for employee only, medical only insurance coverage.  Please note current members and dependents in PEBB/OEBB plans are not eligible for this coverage. For more details regarding eligibility please visit the website here.

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