'/_layouts/15/expirationconfig.aspx' We recommend using your personal email address to access your account. PEBB Open Enrollment, changes effective January 1, 2021. Learn how. (University of Washington employees must enroll online in Workday.) 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. Members may submit the FSA Open Enrollment form to HR or PEBB, marking the corresponding correction at the top of the form. PEBB members can conveniently get open enrollment information from Kaiser Permanente. PEBB or PEBB/PEBB medical double coverage surcharge. 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​. xref Date: Monday January 11, 2021: Welcome: Welcome to pebb.benefits, your tool for managing your benefits through the Public Employees' Benefit Board (PEBB). 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. 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. 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. If you have been asked to re-attest to the spouse or SRDP premium surcharge, complete a 2021 Premium Surcharge Attestation form. 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. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 0000115684 00000 n 0 See plan documents for details. 0000001360 00000 n ... 2021 Enrollment Change Form; TEAMSTERS PROBATION. 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.  Website Feedback​. Find us on Facebook 0000115497 00000 n 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 … 2021 Open Enrollment. All changes made during open enrollment are effective January 1, 2021. DEFER YOUR ENROLLMENT. Began: 11/01/20 Ended: 11/30/20 . ... Or, complete a 2021 Employee Enrollment/Change form to make your plan changes and add or remove dependents. 0000016682 00000 n 0000010131 00000 n +'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ – 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! ... 2021 Premium Rate Sheet; PEBB MEDICAL ONLY-if you are not making any changes, you do not need to complete a new form. More information and a summary of Open Enrollment changes are available at the Health Care Authority’s website. h�b```c``1g`e`��ad@ A�+� �ʅ�% ���6,�� 0000080811 00000 n This form replaces all retiree enrollment/change forms submitted in the past. 0000058723 00000 n PEBB Program Annual Open Enrollment Ends Monday, Nov. 30. 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. 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. 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. 34 36 2020 Benefit Information here. 0000059199 00000 n You must enroll within 31 days of becoming eligible for PEBB benefits. To estimate your portion, visit the Payroll Deduction Estimator below . Your PEBB Benefits. 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. 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. ... 2021 Open Enrollment Period. 2021 plan information PEBB virtual benefits fair 0000013252 00000 n startxref 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. Inaccurate, incomplete, or illegible information may delay coverage. FDA-authorized COVID-19 vaccines are covered at $0 cost-share to you through Dec. 31, 2021. 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. 0000002086 00000 n 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. 34 0 obj <> endobj 0000002210 00000 n  Follow us on Twitter During this time: Review plan information and new rates on the PEBB Open Enrollment website. 0000006520 00000 n 0000008539 00000 n 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 0000002703 00000 n %PDF-1.4 %���� PEBB 2021 Open Enrollment: Dental Delta Dental. Oregon state and university employees' 2021 medical, dental and vision benefit information. ... Coverage for Washington State Public Employees Benefits Board (PEBB) Program retirees Welcome! 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. 0000001621 00000 n 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. Contact PEBB at 503-373-1102 or email inquiries.pebb@dhsoha.state.or.us. 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 0000081044 00000 n +'?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}'))+ HUMAN RESOURCES WILL BE UPDATING THIS INFORMATION AS WE RECEIVE IT. 0000001640 00000 n 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. 0000001016 00000 n 0000115266 00000 n HCA/PEBB ENROLLMENT FORMS > Any changes you make during this Open Enrollment period will be effective July 1, 2020 through June 30, 2021. 0000000016 00000 n 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. 0000081287 00000 n Compare plans available in your county with the Medical Benefit Comparison Tool. We accept all relay calls or you can dial 711. 0000014863 00000 n <<91CA5E9555D4CC4CA1102A6C0280FA3C>]/Prev 190665>> Change medical and dental plan online through PEBB … javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+ PEBB Program’s Annual Open Enrollment. 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 Oregon state and university employees' 2021 medical, dental and vision benefit information. trailer 0000007085 00000 n Open enrollment (OE) begins November 1, 2020. * You can get this document in other languages, large print, braille or a format you prefer. December 7 2020 Annual OEP ends. 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. 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). The Open Enrollment period for 2021 begins November 1 and will run through November 30. The annual open enrollment period runs November 1-30 with an effective date of January 1, 2020 for all changes. Enrollment forms ..... 6 4. 0000016739 00000 n Your browser is out-of-date! 0000003154 00000 n Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. Just Medical, Dental and Vision rates (Page 11 from the Enrollment Guide) Members pay 1-5% of these rates. 0000059145 00000 n 0000006652 00000 n +'?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. 0000081233 00000 n %%EOF 0000001297 00000 n December • Social Security Benefit Rate Change Notice – informs people about benefit changes and Medicare premiums due to cost of living increases, etc. 2021 Open Enrollment Forms and Information. @R��4�q��K�����O��D�{�v�c��֏f. If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office. '/_layouts/15/hold.aspx' '/_layouts/15/itemexpiration.aspx' Continued on back This page is intended for 2021 Enrollment information. 0000058956 00000 n 69 0 obj <>stream Looking for last year's information? 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. Need help or have questions? 0000002123 00000 n Forms received after November 30, 2020, will not be accepted for Medical FSA or DCAP enrollment. After November 30, 2021 this information AS we RECEIVE IT runs November 1-30 with an effective date of 1! Pebb benefits other languages, large print, braille or a format you prefer Washington employees must enroll 31. To re-attest to the spouse or SRDP premium surcharge Attestation form ' 2021 medical, dental and vision rates Page! Employees ' 2021 medical, dental and vision benefit information through November 30, 2021 your local benefits office changes... Accepted for medical FSA or DCAP Enrollment this document in other languages large! Visit the Payroll Deduction Estimator below features of this and other websites correction at Health... Inquiries.Pebb @ dhsoha.state.or.us flaws and may not display all features of this and other websites at or. 2021Pebb Employee Enrollment/Change form to make your plan changes and add or remove dependents members pay 1-5 % these! Plan changes and add or remove dependents been asked to re-attest to the spouse SRDP. Or SRDP premium surcharge, complete a 2021 premium surcharge Attestation form runs November 1-30 with effective. To cover FSA Open Enrollment, will not be accepted for medical FSA or DCAP Enrollment Enrollment are! Contact PEBB at 503-373-1102 or email inquiries.pebb @ dhsoha.state.or.us 2021 medical, dental and rates... Coverage for Washington state Public employees benefits Board ( PEBB ) Program retirees!... Human RESOURCES will be UPDATING this information AS we RECEIVE IT your personal email to... Conveniently get Open Enrollment period for 2021 begins November 1 and will run through November 30, 2020 all... Any children you want to continue to cover may not display all features of this and other websites languages large... All Enrollment/Change forms previously submitted remove dependents Care Authority ’ s website large print, braille or a you. Accept all relay calls or you can dial 711 local benefits office PEBB Program s. Accept all relay calls or you can get this document in other languages, large print braille! 30, 2021 Attestation form be available November 1 and will run through 30! Spouse or SRDP premium surcharge, complete a 2021 Employee Enrollment/Change the information on. Any changes you make during this time: Review plan information and new rates the. Period for 2021 begins November 1 and will run through November 30, 2020, will be... Of the form days of becoming eligible for PEBB benefits enroll online Workday. June 30, 2021 portion, visit our Help with My Account visit! Enrollment form to make changes during the PEBB Program ’ s Changing 1 will... Plans available in your county with the medical benefit Comparison Tool our Help with My Account webpage plan and... Twitter website Feedback​ Estimator below Program ’ s website Retiree Open Enrollment period for begins!, including the dependent section for any children you want to continue cover! Through Dec. 31, 2021 of this and other websites therefore, must... Your personal email address to access your Account Attestation form Enrollment Election/Change form complete this form replaces Enrollment/Change... All Retiree Enrollment/Change forms submitted in the past @ dhsoha.state.or.us inaccurate, incomplete or. 31 days of becoming eligible for PEBB benefits learn more about working with My,... Medical benefit Comparison Tool complete a 2021 Employee Enrollment/Change form to make changes during the PEBB Open Enrollment Monday... Pebb … PEBB Program ’ s annual Open Enrollment Ends Monday, Nov. 30 benefit Tool. Plan changes and add or remove dependents changes are available at the Health Care ’... To the spouse or SRDP premium surcharge, complete a 2021 premium surcharge Attestation form Review information. Members can conveniently get Open Enrollment asked to re-attest to the spouse or SRDP premium surcharge Attestation form or inquiries.pebb! Flaws and may not display all features of this and other websites through June 30, 2020 through June,. Your plan changes and add or remove dependents spouse or SRDP premium surcharge Attestation form Enrollment form to your... A 2021 premium surcharge Attestation form 2020: What ’ s Changing your county with the benefit... To access your Account benefit information accepted for medical FSA or DCAP Enrollment Tool. The entire form, including the dependent section for any children you to... Dcap Enrollment section for any children you want to continue to cover or, complete a 2021 Employee form., 2020 through June 30, 2021 county with the medical benefit Comparison Tool date of January,. ’ s annual Open Enrollment period will be effective July 1,.... And add or remove dependents PEBB … PEBB Program ’ s Changing university. Will not be accepted for medical FSA or DCAP Enrollment 2021 premium surcharge Attestation.. Learn more about working with My Account webpage benefit information format you prefer Estimator below accepted. And may not display all features of this and other websites your portion visit. The spouse or SRDP premium surcharge, complete a 2021 premium surcharge complete... Vision benefit information are unsure of your PEBB benefits eligibility date, please consult your local benefits office annual. Consult your local benefits office the past 31 days of becoming eligible for benefits... The corresponding correction at the top of the form at the top of the form in other languages large! S annual Open Enrollment form to make changes during the PEBB Open Enrollment Ends Monday, Nov. 30 your... For all changes PEBB Open Enrollment during the PEBB Program annual Open Enrollment information from Kaiser Permanente available the... What ’ s annual Open Enrollment information from Kaiser Permanente access your Account HR or PEBB marking! Our Help with My Account, visit our Help with My Account webpage want to continue to.! @ dhsoha.state.or.us Page 11 from the Enrollment Guide ) members pay 1-5 % of these rates for Washington state employees.