0000011722 00000 n To learn more about working with My Account, visit our Help with My Account webpage. The PEB Board has approved the Non-Medicare and Medicare Retiree premiums for 2021. • If you declined all benefits in 2020 and do not complete open enrollment for 2021: You will continue with no benefits in 2021. Welcome to Navia Benefits! For additional details, sign in to your online account . For employees. 2021 Open Enrollment: November 1 - 30. 0000031422 00000 n The benefits under the Plan are provided by PEBB on a self-insured basis. Miriam Sierra PEBB System Administrator. Code § 182-12-131, see flags on bad law, and search Casetext’s comprehensive legal database 4 Benefits payments increase by 10% each plan year provided the member has visited a Delta Dental PPO provider at least once during the plan year. 2021 PEBB Medical Premiums Available. Summary Plan Description. Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. Sections are under constuction - Please see full Summary above. 0000008470 00000 n Benefits 2021 Medicare Advantage Plan with Prescription Drugs UnitedHealthcare PEBB Complete Group Medicare Advantage (PPO) Group Name (Plan Sponsor): State of Washington Public Employees Benefits Board (PEBB) Program Group Number: 15994 H2001-816-000 Look inside to take advantage of the health services and drug coverages the plan provides. Benefit Highlights (continued) In-Plan Copay or Coinsurance Out-of-Plan Copay or Coinsurance Hospital Services Inpatient care 15% $500 then 40% Observation care 15% $500 then 40% Maternity care 15% $500 then 40% Routine newborn nursery care 15% $500 then 40% Rehabilitative care (30 days per calendar year; 60 days head or spinal cord injuries) 15% $500 then 40% 0000031795 00000 n Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. SUMMARY OF BENEFITS Public Employees’ Benefit Board – OR90 – 1/1/2021 1Benefits for implant surgery have a benefit maximum, if covered. 0000107391 00000 n max for 2021 is $270. 0000007274 00000 n 1bX. Kaiser Permanente of the Northwest will: • Cover one hearing instrument per ear every five years at no cost, up to the plan’s allowed amount (or, for Consumer-Directed Health Plan [CDHP] members, after the deductible is met). The intent is to allow an “apples to apples” comparison of medical health plan benefits across carriers. 0000010641 00000 n 0000017893 00000 n If you don’t do so, neither you 2021. Employee Premium Share Your employee premium share will calculate at a 3% share if you are a full-time employee, have two plans available and choose the lowest premium cost medical plan where you live or work; all other choices will calculate at … 0000014691 00000 n 0000077431 00000 n 2021 changes to your PEBB employee benefits. Summary of Benefits for the 2020 Plan Year; A side-by-side plan comparison for benefits, copays and deductibles. Summaries of Benefits and Coverage. 0000005415 00000 n 0000017047 00000 n 0000003388 00000 n The benefits described on the following pages are effective Jan. 1, 2021, and were designed to provide you and your dependents as PEBB Members with the best possible medical care at competitive rates. 0000135572 00000 n 0000035826 00000 n 0000143675 00000 n PEBB virtual benefits fair. 0000091225 00000 n PEBB medical. WA State PEBB Medical Flexible Spending Arrangement (FSA) & Dependent Care Assistance Program (DCAP) Open Enrollment Form Plan Year: 1/1/2021–12/31/2021 with Medical FSA Grace Period through 3/15/2022 0000017612 00000 n 0000114305 00000 n 0000018217 00000 n Read Section 182-12-131 - [Effective 1/1/2021]How do eligible employees maintain the employer contribution toward public employees benefits board (PEBB) benefits?, Wash. Admin. You may enroll during the 2021 plan year if you or an eligible family member has a qualified change in status event that creates a … 0000007708 00000 n %PDF-1.6 %���� Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. 2021 PEBB medical benefits comparison The chart below briefly compares the medical deductibles and per-visit out-of-pocket costs of some in-network benefits for PEBB medical plans. 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021 – 12/31/2021 Moda Health Plan, Inc.: PEBB - Synergy Full Time HEM Plan Coverage for: Family | Plan Type: PPO CCM The Summary of Benefits and Coverage (SBC) document will help you choose a health plan . 2323 99 0000011093 00000 n Benefit Highlights (continued) In-Plan Copay or Coinsurance Out-of-Plan Copay or Coinsurance Hospital Services Inpatient care 20% $500 then 50% Observation care 20% $500 then 50% Maternity care 20% $500 then 50% Routine newborn nursery care 20% $500 then 50% Rehabilitative care (30 days per calendar year; 60 days head or spinal cord injuries) 20% $500 then 50% 2421 0 obj <>stream (Exception: University of Washington employees must 0000028514 00000 n You must return this form to your payroll or benefits office no later than 31 days after the date you become eligible for these PEBB benefits. 1 of 7. 0000012157 00000 n ModaORLGASObk 1-1-2021 (PEBB Synergy Part time +100) Public Employees’ Benefit Board Coordinated Care Model Plan Synergy Part-Time +100 Effective Date: January 1, 2021 Group Number: 10002802 Oregon Group Medical Plan A PPO refers to a preferred-provider organization (network). 0000034180 00000 n 2021 PEBB Medical Premiums Available. 0000091030 00000 n The Uniform Medical Plan-Classic Medicare (UMP) premium will rise by $15.76 per month (4.9%), while most other plans will have more modest increases. 166 0 obj <>stream If you are eligible to enroll as a newly PEBB benefits-eligible employee, enrollment begins the first day of the month following the date you become a PEBB benefits-eligible employee and your PEBB does not designate premium contributions, contact your agency benefit office if you have additional questions about your premium contribution. If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office. Medical plans & benefits. 2021 PEBB vision plans summary employee premium contribution comparison 2021. 0000149853 00000 n 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021 – 12/31/2021 Moda Health Plan, Inc.: PEBB - Synergy Full Time HEM Plan Coverage for: Family | Plan Type: PPO CCM The Summary of Benefits and Coverage (SBC) document will help you choose a health plan . 5 For implant surgery only 6 Benefits for implant surgery have a benefit maximum. 0000007076 00000 n 2021 Open Enrollment: November 1 - 30. 0000011693 00000 n 2021 PEBB Dental Benefits Comparison For information on specific benefits and exclusions, refer to the dental plan’s certificate of coverage or contact the plan directly. 0000008814 00000 n Summaries of Benefits and Coverage. Summary Plan Desciption. Contributions increase in 2021 • Members can contribute up to $2,750 to a Health Care FSA in 2021. 0000005269 00000 n You can set aside pre-tax dollars to pay for your … 0000106678 00000 n 5 For implant surgery only 6 Benefits for implant surgery have a benefit maximum. August 20. th, 2020. 0000077601 00000 n 0000107032 00000 n endstream endobj 121 0 obj <. ��`�2�3�0O`O�[ �`�����V�R�5�h���J�Ik�v�,�]����8���m���Ԇ*�s�XjX3�?�.�c�f�������"���ќ֨n{� 0000006904 00000 n View 2021 PEBB Complete plan details: Plan Guide (PDF) (1.1 MB) Summary of Benefits (PDF) (98.0 KB) Evidence of Coverage (PDF) (1.3 MB) View 2021 PEBB Balance plan details: Plan Guide (PDF) (1.1 MB) Summary of Benefits (PDF) (99.6 KB) Evidence of Coverage (PDF) (1.3 MB) Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. The following is a brief outline of several key aspects of the PEBB Medical Benefit Comparison. 0000003961 00000 n 0000122238 00000 n 0000130337 00000 n 0000010183 00000 n 148 0 obj <>/Filter/FlateDecode/ID[<5ACE5A0A37CA234188A0EC55B1E9F37B>]/Index[120 47]/Info 119 0 R/Length 125/Prev 142620/Root 121 0 R/Size 167/Type/XRef/W[1 3 1]>>stream 0000143746 00000 n Providence Choice (PDF) Providence Choice +100 (PDF) Coverage for Washington State Public Employees Benefits Board (PEBB) Program retirees h�b```g``:������?� 0� EY8f0ltc`8�H����� ���```���h � &A -��`�P~�I�:lx?�)�3�ca[�{G�Y@�c���ֲ�+/>���RѮ�8�\�f'��B �D߀4��t���P^&��PU� ��#� 0000005714 00000 n 0000035418 00000 n (Exception: University of Washington employees must For complete information, please refer to your Summary of Benefits or Evidence of Coverage. 0000114419 00000 n 2021. For additional questions about your enrollment,visit th e PEBB Program’s open enrollment webpa ge or, call PEBB Customer Service at 1-800-200-1004, 8 a.m. to 4:30 p.m., Monday through Friday. Just Medical, Dental and Vision rates (Page 11 from the Enrollment Guide) Members pay 1-5% of these rates. • Single or married members (filing jointly) can fund up to $5,000 to a Dependent Care FSA. Read Section 182-12-131 - [Effective 1/1/2021]How do eligible employees maintain the employer contribution toward public employees benefits board (PEBB) benefits?, Wash. Admin. *If you intend to enroll in a consumer-directed health plan (CDHP) with a health savings account (HSA) for 2022, you must use all your 2021 Medical FSA funds and have all your claims paid by Navia Benefits Solutions by December 31, 2021. 0000106415 00000 n PEBB is mailing all members of our self-insured plans - Moda, PEBB Statewide and Providence Choice - a letter requesting SSNs of their covered dependents. DeltaORASObk 1-1-2021 (PEBB Premier Plan) SECTION 1. Questions about PEBB or SEBB retiree benefits? We look forward to meeting your health care needs. 0000000016 00000 n 0000122530 00000 n 0000149275 00000 n Summaries of Benefits and Coverage. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. You must enroll within 31 days of becoming eligible for PEBB benefits. 2020: 2021: What type of enrollee are you? 0000091101 00000 n Under the current tier structure, PEBB would pay a tax penalty. 2An office visit copayment applies at each visit, in addition to any copayments for services. %%EOF 0000015493 00000 n Medical, Dental and Vision rates. startxref trailer And you have expanded access to telehealth through the national public health emergency period, currently scheduled to end Jan. 20, 2021. If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. 0000085190 00000 n Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. Moda 360 is a dedicated team of navigators who help identify, coordinate and connect resources available to you and your family: Managed-care plans have a closed network. PEBP Logo and link to PEBP Website The PEB Board has approved the Non-Medicare and Medicare Retiree premiums for 2021. 0000010612 00000 n If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office. 411 2021 PEBB Premium Surcharge Attestation Change Form Use this form to report a change that affects your premium surcharge for tobacco use or spouse or state-registered domestic partner (as defined by Washington Administrative Code 182-12-109) coverage. Married members who file separately can fund up to $2,500. You must return this form to your payroll or benefits office no later than 31 days after the date you become eligible for these PEBB benefits. 2021. PEBB/My Account login Log into My Account to view your coverage and premium surcharge information, get your statement of insurance, and make open enrollment changes. 0000002324 00000 n The PEBB basic life benefit will increase from $5,000 to $10,000. To estimate your portion, visit the Payroll Deduction Estimator below. You will be able to make most changes to your PEBB benefits on the Health Care Authority (HCA) PEBB My Account page. Benefits 2021 Medicare Advantage Plan with Prescription Drugs UnitedHealthcare PEBB Complete Group Medicare Advantage (PPO) Group Name (Plan Sponsor): State of Washington Public Employees Benefits Board (PEBB) Program Group Number: 15994 H2001-816-000 Look inside to take advantage of the health services and drug coverages the plan provides. State of Nevada seal link to nv.gov. 0000035489 00000 n PEBB. %%EOF 0000130443 00000 n 0000008295 00000 n The Plan is self-funded by the Group and has contracted Oregon Dental Service (ODS), doing 0000010154 00000 n 0000034932 00000 n 2021 plan information. Navia Benefit Solutions in January 2021. xref This information gives a high-level summary only. 3Dental implants-supported prosthetics (crowns, … You will not receive this benefit if you enroll in a consumer-directed health plan (CDHP) with a health savings account (HSA) for 2021. For questions about eligibility and enrollment, members should contact the Public Employees’ Benefit Board at 503-373-1102 or inquiries.pebb@state.or.us. WA State Public Employees Benefits Board (PEBB) FSA & DCAP The State of Washington FSA & DCAP plans help you save money on your out-of-pocket health and dependent day care costs. PEBB Plan Employee Benefit Group. 0000034644 00000 n This limitation is an Internal Revenue Service rule. 0000019981 00000 n PEBB has designed this Plan and the benefits are provided by PEBB on a self-insured basis. PEBB Basic Life is a required enrollment when enrolling … 2021 rates. You will also forfeit this $250 benefit if you waive PEBB medical coverage for 2021, unless you waive to enroll as a 2 New! 0000085921 00000 n 0000043932 00000 n The PEBB Program must receive your Retiree Election/Change form for Open Enrollment and Retiree Medicare Advantage Enrollment form (form C) by November 30, 2020. We recommend using your personal email address to access your account. 0000066826 00000 n Plan Year: 1/1/2021–12/31/2021 with Medical FSA Grace Period through 3/15/2022 Complete this form to enroll in a Medical FSA or DCAP during a plan year. www.PEBBenroll.com USING THE PLAN For questions about the Plan, members should contact Customer Service. INTRODUCTION TO: PEBB Members FROM: Public Employees’ Benefit Board (PEBB) Thank you for choosing the PEBB Statewide PPO Plan. Copays and coinsurance may apply; some copays and coinsurance do not apply until after you have paid … 0000004979 00000 n opt out of medical for 2021. Providence Choice (PDF) Providence Choice +100 (PDF) 0000016804 00000 n 0000016655 00000 n 0000149538 00000 n 0000017583 00000 n You can set aside pre-tax dollars to pay for your … WA State PEBB Medical Flexible Spending Arrangement (FSA) & Dependent Care Assistance Program (DCAP) Enrollment Form Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. 0000036009 00000 n You may enroll during the 2021 plan year if you or an eligible family member has a qualified change in status event that creates a … 0000043472 00000 n BENEFITS (PDB) Open Enrollment (OE) 2020-2021 Agency Training. 120 0 obj <> endobj The purpose is to match up provisions of the ACA with employer-provided health care benefits. An overview of the PEBB Program’s long-term disability insurance benefit. SBC-ASO20-108601-449866 4 Benefits payments increase by 10% each plan year provided the member has visited a Delta Dental PPO provider at least once during the plan year. PEBB will be running a daily job to terminate any 2020 FSA that was reinstated by a QSC or through the daily files (employment changes sent to PEBB). 2021 Benefit Information. If you are eligible, the Health Care Authority, on behalf of your employer, will contribute the following amounts to your HSA: • $58.34 each month for an individual subscriber, up to $700.08 for 2021; or • $116.67 each month for a subscriber with one or more enrolled dependents, up to $1,400.04 for 2021. For more information about SBCs, visit HealthCare.gov. A federal rule that becomes effective in 2021 will place an excise tax on annual premium amounts above a certain level. Please see the next page for important information about the above benefits. For additional details, sign in to your online account . 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