(University of Washington employees must enroll online in Workday.) Addendum 45-2A (effective 1/1/2021) Health Care Authority Page: 2 of 16 Special Open Enrollment (SOE) Matrix ERB Division Policy, Rules, and Compliance This matrix only summarizes special open enrollment events in chapters 182-08 and 182-12 WAC and the corresponding actions that are allowed. Enrollment forms ..... 6 4. ... Or, complete a 2021 Employee Enrollment/Change form to make your plan changes and add or remove dependents. Contact PEBB at 503-373-1102 or email inquiries.pebb@dhsoha.state.or.us. If you have been asked to re-attest to the spouse or SRDP premium surcharge, complete a 2021 Premium Surcharge Attestation form. 34 36 HUMAN RESOURCES WILL BE UPDATING THIS INFORMATION AS WE RECEIVE IT. 0000006520 00000 n 0000002703 00000 n %PDF-1.4 %���� ... 2021 Enrollment Change Form; TEAMSTERS PROBATION. 2021 Open Enrollment Forms and Information. Looking for last year's information? Need help or have questions? 0000002123 00000 n +'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ Inaccurate, incomplete, or illegible information may delay coverage. Title: PEBB Program Open Enrollment Switching Report 2021 … See plan documents for details. 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 special open enrollment. To estimate your portion, visit the Payroll Deduction Estimator below . PEBB Health Insurance Open Enrollment for 2021 Benefits Takes place October 1 through October 31, 2020 2021 PEBB Enrollment Guide 2021 PEBB Summary of Benefits 2021 PEBB Benefits Comparison Tool 2021 Payroll Deduction Estimator Flu Shot 2020 Information Open Enrollment Summary & Plan Changes Dependent Eligibility and PEBB’s Dependent Eligibility Review Process Children turning Continued on back Oregon state and university employees' 2021 medical, dental and vision benefit information. '/_layouts/15/itemexpiration.aspx' 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. 0 0000081233 00000 n All changes made during open enrollment are effective January 1, 2021. 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. h�b```c``1g`e`��ad@ A�+� �ʅ�% ���6,�� More information and a summary of Open Enrollment changes are available at the Health Care Authority’s website. PEBB or PEBB/PEBB medical double coverage surcharge. This is "PEBB medical open enrollment 2021 webinar" by Moda Health on Vimeo, the home for high quality videos and the people who love them. 2021 Open Enrollment: November 1 - 30 You will be able to make most changes to your PEBB benefits on the Health Care Authority (HCA) PEBB My Account page. 0000001640 00000 n PEBB Program Annual Open Enrollment Ends Monday, Nov. 30. 0000115684 00000 n During this time: Review plan information and new rates on the PEBB Open Enrollment website. +'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ 69 0 obj <>stream PEBB 2021 Open Enrollment: Medical and Pharmacy • You will be connected with a Moda 360 health navigator when calling Moda Health • The navigator will assist you with any questions you may have, but will also serve as your guide to connect you with the care, resources Open Enrollment Transfers from Old Carrier to New Carrier: Medical - All Subscribers ... Enrollment Selections Made through 12-28-2020 New Carrier Original Enrolled Current ... Tf.fi Th.ni f.el Ähange T Dental. The Open Enrollment period for 2021 begins November 1 and will run through November 30. Open Enrollment Webinar UMP Plus-UW Medicine Accountable Care Network is a cost-effective option for Public Employees Benefits Board (PEBB) eligible employees living in King, Snohomish, Kitsap, Pierce, Skagit, Thurston and Spokane counties. Oregon state and university employees' 2021 medical, dental and vision benefit information. 0000016739 00000 n To learn more about your new benefits, your welcome packet, and what to do if you have an urgent health care issue please visit the New to Oregon Health Care web page​. It has known security flaws and may not display all features of this and other websites. 0000001016 00000 n <<91CA5E9555D4CC4CA1102A6C0280FA3C>]/Prev 190665>> Any changes you make during this Open Enrollment period will be effective July 1, 2020 through June 30, 2021. Submit a new PEBB Retiree Election form within 60 days – Have no break in other qualifying medical coverage (not even one day) – Include a loss of coverage letter – Questions: Contact Health Care Authority at 1-800-200-1004. 2020 Benefit Information here. 0000080811 00000 n @R��4�q��K�����O��D�{�v�c��֏f. Welcome to UMP Plus PEBB Employees For more information watch the UMP Plus – Puget Sound High Value Network (PEBB) Open Enrollment Webinar for 2021: UMP Plus — Puget Sound High Value Network (UMP Plus — PSHVN) brings together top-quality, independent providers from across Washington to deliver high quality, high value health care. 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. Benefits Newsletter: The October edition of the PEBB Program's For Your Benefit newsletter is your source for updates about your health benefits and open enrollment information. This is "PEBB dental open enrollment 2021 webinar" by Moda Health on Vimeo, the home for high quality videos and the people who love them.  Follow us on Twitter ... 2021 Open Enrollment Period. PEBB Program’s Annual Open Enrollment. %%EOF 0000001360 00000 n Forms received after November 30, 2020, will not be accepted for Medical FSA or DCAP enrollment. 0000007085 00000 n '/_layouts/15/expirationconfig.aspx' +'?ID={ItemId}&List={ListId}'); return false;}}, null); Other Health System Reform Related Topics, Birth, Death, Marriage and Divorce Records, Residential and Outpatient Behavioral Health, Other License and Certificate Related Topics, Open Enrollment and Health Engagement Model (HEM) Quick Guide, Accidental Death and Dismemberment (AD&D), OHA ADA Policy and Request for Modification. December • Social Security Benefit Rate Change Notice – informs people about benefit changes and Medicare premiums due to cost of living increases, etc. trailer Your PEBB Benefits. Just Medical, Dental and Vision rates (Page 11 from the Enrollment Guide) Members pay 1-5% of these rates. All other corrections to member plans can be made until February 27, 2021, by submitting the Open Enrollment form to HR or PEBB, marking the correction option at … This page is intended for 2021 Enrollment information. 0000013252 00000 n This form replaces all retiree enrollment/change forms submitted in the past. 2021 PEBB Employee Enrollment/Change 2021 PEBB Employee Enrollment Change for Medical Only Groups Long-term Disability (LTD) Enrollment/Change Form Premium Surcharge Attestation Help Sheet HCA is committed to providing equal access to our services. Change medical and dental plan online through PEBB … 0000006652 00000 n 0000011661 00000 n 0000002210 00000 n 0000003154 00000 n – You must do open enrollment during October 2020 and CHOOSE to participate in HEM – You must do your Health Assessment on your current PEBB medical plan between September 1 st and October 31 2020 I wanna play in 2021! 34 0 obj <> endobj 0000014863 00000 n  Website Feedback​. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. We accept all relay calls or you can dial 711. Open enrollment is the one time each year when you can change your medical or dental plan, add or remove dependents, enroll or re-enroll in FSA/DCAP for the next year, and re-attest to the spousal surcharge questionnaire. xref PEBB Open Enrollment, changes effective January 1, 2021. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 3 Delta Dental plans • Delta Dental Premier® Network −Largest dental network in Oregon −Over 2,400 providers in Oregon & over 155,000 providers nationwide • Delta Dental PPO SM Network −Over 1,300 providers in Oregon & over 112,000 providers PEBB plan changes for 2021 The Public Employees Benefits Board (PEBB) approved a number of changes to PEBB Program rules, policies, benefits, and premiums that will go into effect on January 1, 2021. We recommend using your personal email address to access your account. DEFER YOUR ENROLLMENT. 0000115266 00000 n 0000059145 00000 n * You can get this document in other languages, large print, braille or a format you prefer. 0000010131 00000 n Compare plans available in your county with the Medical Benefit Comparison Tool. 0000115910 00000 n Whether you’re a member or are thinking about joining, we’ll help you get the information you need to make an informed decision about your health coverage. 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. Began: 11/01/20 Ended: 11/30/20 . 0000081044 00000 n 0000016682 00000 n PEBB 2021 Open Enrollment: Dental Delta Dental. 0000001818 00000 n '/_layouts/15/Reporting.aspx' FDA-authorized COVID-19 vaccines are covered at $0 cost-share to you through Dec. 31, 2021. 0000002086 00000 n Date: Monday January 11, 2021: Welcome: Welcome to pebb.benefits, your tool for managing your benefits through the Public Employees' Benefit Board (PEBB). HCA/PEBB ENROLLMENT FORMS > Plan Year: 1/1/2021–12/31/2021 with Medical FSA Grace Period through 3/15/2022 Only use this form during the PEBB Program’s annual open enrollment period, November 1 through 30. Your browser is out-of-date! 0000081287 00000 n PEBB members can conveniently get open enrollment information from Kaiser Permanente. 0000059199 00000 n ... 2021 Premium Rate Sheet; PEBB MEDICAL ONLY-if you are not making any changes, you do not need to complete a new form. You must enroll within 31 days of becoming eligible for PEBB benefits. 0000058723 00000 n javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+ Members may submit the FSA Open Enrollment form to HR or PEBB, marking the corresponding correction at the top of the form. '/_layouts/15/hold.aspx' 0000000016 00000 n 0000008539 00000 n ... Coverage for Washington State Public Employees Benefits Board (PEBB) Program retirees Welcome! To learn more about working with My Account, visit our Help with My Account webpage. +'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ Exception: If you attest to the spouse or state-registered domestic partner coverage premium surcharge during the PEBB Program’s annual open enrollment, the change will become effective January 1, 2021. 0000001621 00000 n 2021 Open Enrollment. Open enrollment (OE) begins November 1, 2020. 0000001952 00000 n Learn how. 0000005071 00000 n 0000115497 00000 n All 2021 forms will be available November 1, 2020: What’s Changing? The annual open enrollment period runs November 1-30 with an effective date of January 1, 2020 for all changes. December 7 2020 Annual OEP ends. 2021 Open Enrollment Summary 500 Summer Street NE of Benefits Salem, OR 97301-1063 www.PEBBinfo.com 2021 PEBB Benefits www.PEBBinfo.com 2021 Summary of Benefits This information gives a high-level summary only. Open Enrollment is the only time of year you can make changes to your health benefits without experiencing a qualifying life event (e.g., marriage or birth of a child). 0000001297 00000 n If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office. startxref 2021 plan information PEBB virtual benefits fair 0000058956 00000 n Find us on Facebook