Changes in Open Enrollment Training Plan and Eligibility Policies

Open Enrollment Training Plan Changes, Eligibility & Enrollment, Rules, Regulations, Policy

Open Enrollment Open Enrollment is mandatory and is October 1 through October 31, 2017 Health Assessment is September 1 through October 31, 2017 PEBB Office Hours: 8:00 AM to 5:00 PM Monday Friday during September 2017 8:00 AM to 5:00 PM Monday, Tuesday, Thursday and Friday Oct. 2017 8:00 AM to 8:00 PM every Wednesday in Oct. 2017 8:00 AM to 8:00 PM October 31, 2017

Open Enrollment PEBB Teams Member Services Staff- Assistance for Agency Staff, Members, Plans Eligibility & Enrollment, Rules, Regulations, Policy Inquiries.PEBB@dhsoha.state.or.us Telephone: 503-373-1102 Fax: 503-373-1654

Providence Health Assessment New Vendor Providence Health Assessment is under a new vendor Cerner and has a new look. This year members are able to take the assessment as many times as they want. Members must go through all the screens to get to the completed certificate. If the member does not go through the entire assessment it will not count as completed. Some answers can be left blank if the member does not have the information. PEBB will only accept a copy of the Personal Health Assessment Certificate of Completion for Providence verification

PEBB Forms and PEBB Website PEBB Open Enrollment Forms have been combined and have a new look. The PEBB website will be updated to include only PEBB forms and have links to the plans for plan forms. Once open enrollment is complete PEBB will update remaining PEBB forms.

PEBB Administrative Rules Update A number of rules were reviewed in which language and references were updated. Changes in policy were made to the following rules. 101-015-0011 Dependent Child (updated eligibility on child by affidavit) 101-020-0037 Correcting Enrollment and Processing Errors Employee errors are now all prospective same as core corrections Open Enrollment corrections till January 31stof the new plan year for OSPS and OUS employees. Only exception is OUS FSA corrections which are open till Feb. 28th. All Open Enrollment corrections will be prospective if received in January.

Whats new for 2018 Medical plans AllCare no longer available for 2018 Kaiser Permanente no plan changes Moda Copays for primary and specialty office visits will be $10 in 2018 Will have a closed drug formulary Out of Network coinsurance increased from 30% to 40% Providence Choice Copays for primary and specialty office visits will be $10 in 2018 Out of Network coinsurance increased from 30% to 40% Providence PEBB Statewide Out of Network co-insurance increased from 30% to 40% Members will pay more for out-of-network hospitals than they did last year. Emergency situations will be treaded the same as they are now. Full time Medical coverage-Family subsidy- $18.11

Employee Only Employee & Partner Employee & child(ren) Employee & Family MEDICAL COVERAGE PEBB Statewide $757.08 x 5%= $37.85 $1,514.17 x 5%=$75.71 $1,287.05 x 5%= $64.35 $2,044.13 X 5%-$18.11= $84.10 $910.51 x 5% = $45.53 $1,502.33 x 5% = $75.12 $1,274.71 x 5% = $63.74 $1,821.01 x 5%-$10.31 = $80.74 2017 Rate Providence Choice $646.86 x 3%=$19.41 $1,293.73 x 3% = $38.81 $1,099.66 x 3% = $32.99 $1,746.53 x 3%-$18.11= $34.29 $763.18 x 3% = $22.90 $1,259.24 x 3% = $37.78 $1,068.45 x 3% = $32.05 $1,526.35 x 3%-$10.31 = $35.78 2017 Rate Moda $671.90 x 3%=$20.16 $1,343.82 x 3%=$40.31 $1,142.24 x 3%= $34.27 $1,814.14 x 3%-$18.11=$36.31 $790.74 x 3% = $23.72 $1,304.71 x 3% = $39.14 $1,107.02 x 3% = $33.21 $1,581.47 x 3%-$10.31 = $37.13 2017 Rate $745.91 x 5%= $37.30 $1,491.83 x 5%= $74.59 $1,268.06 x 5%= $63.40 $2,013.98 x 5%= $100.70 Kaiser $893.14 x 5%= $44.16 $1,473.66 x 5%= $73.68 $1,250.38 x 5%= $62.52 $1,786.25 x 5%= $89.31 2017 Rate $681.35 x 3%= $20.44 $1,362.73 x 3%= $40.88 $1,158.31 x 3%= $34.75 $1,839.68 x 3%=$55.19 Kaiser Deductible $816.24 x 3%= $24.49 $1,346.78 x 3%= $40.40 $1,142.73 x 3%= $34.28 $1632.46 x 3%= $48.97 2017 Rate

Whats new for 2018 Dental and FSA Delta Dental (Moda) Preventive care costs no longer go towards annual maximum. Kaiser Permanente New facility in Lane county Willamette Dental mouth guards are covered ASIFlex Health Care FSA increase to a maximum yearly total of $2,600

DENTAL COVERAGE Moda Premier ODS ( Moda) Premiere-2017 Moda PPO ODS (Moda) PPO-2017 Willamette Willamette Dental Group-2017 Kaiser Permanente Kaiser Permanente 2017 $54.44 x 5% = $2.72 $66.85 x 5% = $3.34 $50.31 x 5% = $2.52 $61.77 x 5% = $3.09 $50.79 x 5% = $2.54 $61.70 x 5% = $3.09 $61.68 x 5%= $3.08 $75.92 x 5%= $3.80 $108.88 x 5% = $5.44 $110.29 x 5% = $ $5.51 $100.60 x 5% = $5.03 $101.91 x 5% = $5.10 $101.56 x 5% = $5.08 $101.80 x 5% = %5.09 $123.35 x 5%= $6.17 $125.27 x 5%= $6.26 $92.55 x 5% = $4.63 $93.59 x 5% = $4.68 $85.51 x 5% = $4.28 $86.46 x 5% = $4.32 $86.33 x 5% = $4.32 $86.37 x 5% = $4.32 $104.86 x 5%= $5.24 $106.29 x 5%= $5.31 $146.99 x 5% = $7.35 $133.70 x 5% = $6.69 $135.81 x 5% = $6.79 $123.53 x 5% = $6.18 $137.12 x 5% = $6.86 $123.39 x 5% = $6.17 $166.53 x 5%= $8.33 $151.85 x 5% = $7.59

Whats new for 2018 Vision VISION COVERAGE VSP Basic 2017 Basic VSP Plus 2017 Plus Plan $8.66 x 5% =$.43 $10.72 x 5% = $.54 $13.00 - $8.66 =$4.34 $16.09 - $10.72 = $5.91 $17.32 x 5% =$.87 $17.69 x 5% = $.88 $25.98 - $17.32 = $8.66 $26.53 -$17.69= $8.84 $14.72 x 5% = $.74 $15.01 x 5% = $.75 $22.09 - $14.72 = $7.37 $22.52 -$15.01 = $7.51 $23.38 x5% = $1.17 $21.44 x 5% = $1.07 $35.08 - $23.38 = $11.70 $32.16-$21.44 = $10.72

Open Enrollment Reminders Open Enrollment is mandatory for all PEBB subscribers (includes all employees even those on an approved leave, temporary employees, retirees, COBRA and self-pays). Employees intending to retire before January should complete OE New employees through October 31, including Opt Out or Decline moving to 2018 medical without medical ID need to contact PEBB for the Access Code Seasonal Employees actively working with an active PEBB enrollment no termination dates in PEBB system can complete OE Retiree, COBRA, Self-Pays with dental enrollment only do not have to complete open enrollment Retiree, COBRA, Self-Pay do not participate in HEM Affidavits or legal documents are due to agencies by November 7, 2017. Subscribers with qualified midyear change should submit a Midyear Change form along with the open enrollment form to agency/university office Tax dependent status for DP or DP s child must be submitted to agency before January 1, 2018 Open Enrollment corrections through January 31, 2018 for OSPS and OUS exception is FSA corrections for OUS which is February 28, 2018.

HEM Reminders 2018 HEM enrollment requires employees to participate. Steps to Participate: Complete health assessment on current medical plan. Sept. 1 Oct. 31, 2017 Enroll in HEM during October 2017 while completing open enrollment Complete two health actions before October 2018 Opt Out enrollees do not participate in HEM HEM status does not change during the plan year and is not correctible. Tobacco, Other Coverage Waived Monthly Surcharges and optional insurance premiums are correctible. After October 31 newly eligible employees cannot enroll for the HEM however they are in the standard deductible plan. HEM appeal close date February 28, 2018

PEBB UPDATES SSN Letters Mailings scheduled for November and December (IRS) requirements are three times a year If member already submitted SSNs and have not added a new dependent in the last year disregard the letter. If user name and password do not work members can call PEBB and a new letter will be sent out Voluntary members do not have to provide SSNs. Senate Bill 1067 Proposed legislation that was voted on and passed by the 2017 Oregon State Legislature and signed into law by the Governor. The Boards must comply with the directives in SB 1067 as law and implement them by the 2020 Plan Year for PEBB and the 2019-20 Plan Year for OEBB. For additional information you can contact Cindy Bowman at: pebb.connect@dhsoha.state.or.us Dependent Eligibility Review (Verification)

PEBB Dependent Eligibility Review Presented by: Sheila Clausen, Sandy White-Gallardo

The intent of this Dependent Eligibility Review is to make sure only those who are eligible are receiving PEBB benefits. Why is PEBB conducting a Dependent Eligibility Review? As a Section 125 Cafeteria Plan, PEBB has the responsibility to manage health care costs and to ensure that health plans offered through PEBB cover only those who meet the eligibility criteria. This helps keep health care costs down.

All active enrolled subscribers who have a dependent(s) enrolled in the PEBB benefit management system will be required to complete and return the required verification documents when selected for the review. Who must complete the Dependent Eligibility Review and when does it start? PEBB will begin mailing letters requesting documentation in mid to late- November. Members who added dependents during Open Enrollment. They will be asked to provide documents for all active dependents who are covered under their medical, dental or vision plans. The Dependent Eligibility Review will be an annual process starting this year with an expanded scope in corresponding years. Newly hired employees Members adding dependents using the Mid-Year Change Form All other members not previously reviewed

Our members information and privacy is very important to us. All information that the member provides for the dependent eligibility review will be kept confidential. Copies of documents submitted to PEBB will be destroyed following verification of the members dependent(s). No documents will be retained! That is why it is especially important that members provide PEBB only copies of the documents. What about the privacy of the members information?

Member will receive the Dependent Eligibility Packet Letter Dependent Eligibility Worksheet Documentation Requirements Eligibility Definitions How will the member know if they need to send in their dependent(s) information? Review Worksheet and Documentation Requirements Mail or Fax copiesof the required documents

What happens if the member doesn t complete the review process by the deadline or PEBB determines some dependents to be ineligible? Members will have 60 days to make photo copies of the required documents and submit them to PEBB. Mail or Fax A reminder letter is sent approximately 30 days after the Dependent Eligibility Packet is sent. A confirmation letter that confirms the eligibility status of the members dependent(s) will be mailed approximately two weeks after all of the documents are processed. Dependents identified as ineligible or who have not complete the review process will have their benefits coverage ended. Effective the last day of the month in which the determination was made and no later than the last day of the month in which the review is completed. Dependents who's coverage has ended will receive COBRA information.

If the dependent(s) lost their eligibility (coverage ended) due to not responding to the dependent review the member can: 1. Complete an Appeal form 2. Submit it to PEBB, along with their requested eligibility documentation for each dependent 3. Within 30 days of the coverage end date How can the member add their dependent(s) back on? Note: Submitting the above information is still not a guarantee that the dependent(s) will be added back on. If the dependent(s) are added back on there is also no retro enrollment.

If you have questions about the Dependent Eligibility Review Process, Eligibility Requirements, or Forms of Acceptable/Required Documentation: PEBB Member Services @ 503-373-1102 Email @ inquiries.pebb@dhsoha.state.or.us Website Info: http://www.oregon.gov/oha/PEBB/Pages/Dependent- Eligibility-Review.aspx Questions about the Dependent Eligibility Review Process?

DEFAULT PROCESS Members with current employment and actively enrolled in a Medical plan (including Opt out) must complete the Open Enrollment process by 10/31/17. Agencies have until 11/3/17 to input any OE forms received no later than 10/31/17. Members who do not actively enroll* during Open Enrollment will: 1. Move from the current standard deductible medical plan to the higher deductible medical plan as a HEM Non-Participant. All enrolled dependents will follow. This action is: Not Correctable If enrolled in an Optional life plan, move from the current optional life plan tier to the Tobacco user Optional life plan tier (both Employee and Spouse/Partner are affected). This action is: Correctable Tobacco use status will be changed to: Both my Spouse/Partner and I currently use tobacco. This action is: Correctable Other Employer Group coverage will be changed if the member has an existing Spouse or Partner enrolled in the Medical plan to: My Spouse/Partner has other employer group coverage available and waives that coverage This action is: Correctable 2. 3. 4.

DEFAULT PROCESS CONTD Employees who are enrolled in Opt Out during 2017 and intend to continue in 2018: 1. Must attest to having essential coverage for self and tax dependents. If they have active optional life insurance and intend to keep it, they must actively enroll or they will default to the tobacco user tier (the higher premium cost for the coverage). If they do not have optional life coverage, PEBB will not default them. 2. 3. Employees who are enrolled in Decline for 2017 and intend to continue for 2018 do not need to complete the Open Enrollment process. These members will not be part of the default process.