Napoleon can guide you. Five steps to enroll 1. 36 . endobj 2021 PEBB Employee Enrollment/Change Form. 0000041010 00000 n Staff are available by email or by calling 503-373-1102. Full benefits package premiums Premiums are effective January 1, 2021 through December 31, 2021. 2021 Open Enrollment Period. %PDF-1.5 %âãÏÓ Monday-Friday, 8-5 … 3 0 obj Medicare Part B. Creating a Culture of Better Health . page 6 . 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. <> %���� <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 0000000016 00000 n PEBB information Public Employees Benefit Board 2021 Enrollment uide 34 COBRA member information — continued 2021 COBRA medical plan monthly premium rates Self Self & spouse/partner Self & children Self & family Children only7 Kaiser Traditional2 $836.34 $1,672.69 $1,421.78 $2,258.13 $672.45 Kaiser Deductible2 $767.71 $1,535.43 $1,305.12 $2,072.85 $621.29 Preferred … Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. Health Details: HCA 51-205 (11/16) HCA 51-205 (10/19) Your PEBB Benefits for 2020 PEBB Retiree Enrollment Guide Monthly Premiums Pages 6-9 Eligibility Summary Pages 10-13 How PEBB Plans with Prescription Drug pebb benefits retiree guide › Verified 3 days ago › Url: https://www.healthlifes.info Go Now 0000024371 00000 n pages 11 –15. 0000040987 00000 n 2021 Employee Health Benefits Enrollment Guide 2021 Retiree Health Benefits Enrollment Guide UHC Retiree Virtual Education Center 2020 Employee Health Benefits Enrollment Guide 2020 Retiree Health Benefits Enrollment Guide United Healthcare Tier 1 Providers Information about the Spouse Medical Plan Surcharge. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 0000029235 00000 n PEBB Website: • Deferring Coverage . Humanities, 2nd Floor, HU203. 0000038302 00000 n <> We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. Page 5. Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, WA 98225-5996. Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. 0000023620 00000 n 0000005677 00000 n MEDICARE. 2021. For example, if your last day to enroll in PEBB retiree insurance coverage is April 30, and the state of emergency ends May 15, then your enrollment period will be extended to June 15. PEBB members can conveniently get open enrollment information from Kaiser Permanente. 0000004697 00000 n Temporary change to the retiree enrollment deadline. 0000040603 00000 n Hours. premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. 2021 Retiree Election Form. HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. DEFER YOUR ENROLLMENT. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. Pages 8–12. Enrollment Guide. 2021 rates 2021 Employee medical plan monthly premium rates Employee Employee & spouse/partner Employee & children Employee & family Kaiser Traditional1 $819.95 $1,639.90 $1,393.91 $2,213.86 Kaiser Deductible1 $752.66 $1,505.33 $1,279.53 $2,032.21 Moda Synergy2 $759.23 $1,518.47 $1,290.69 $2,049.92 Providence PEBB Statewide3 $865.98 $1,731.97 $1,472.17 $2,338.16 Began: 11/01/20 Ended: 11/30/20 . 1 0 obj Check YES for the benefits (Medical FSA and/or DCAP) you want to enroll in and enter the total contribution amount per plan year. Check him out in the Open Enrollment and HEM Quick Guide. Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. Virtual Education Center . Quick start guide. %PDF-1.5 HCA Contact; 1-800- 200-1004 Mailing Address. endobj In the Spotlight. pages . page 16 . 0000034314 00000 n Elect. State of Nevada seal link to nv.gov. 2021 Retiree Enrollment Guide. Guía de inscripción 2021; Summary of Benefits 0000034385 00000 n Approved by: Position: Director of the PEBB Program . 0000007707 00000 n Need help deciding whether to complete open enrollment? 0000040632 00000 n 0000035012 00000 n <> 0000024096 00000 n Eligibility . x���ݏ�F�ߑ��Ѯt���+E���\S)m��pɃcb lb�����]��6�z�,~�����0�o�jW��y3�ﺢ���8�7]�?�6ד���}U]�Գ��/���]�t�}���|�N2���2h:ˡu�ɟ�@=��7����V�f7�0�-JfHws�ZK�鶇��g�I�? 0000038540 00000 n 0000028254 00000 n The employer determines what portion of the rates the employee pays. Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide 0000004559 00000 n “OE and HEM Quick Guide” • Medical Not Enrolled • Medical Opt Out • New Hires • Didn’t Participate in HEM but want to for 2021 • Flexible Spending Accounts • New $5/month Double Coverage Surcharge • OE Correction Timeline. Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. 0000038383 00000 n Who to contact for help. 0000023492 00000 n Premiums reflect how much PEBB will charge the employer. To learn more about working with My Account, visit our Help with My Account webpage. <>stream xref 1129 50 Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. For complete information, please refer to your Summary of Benefits or Evidence of Coverage. Complete Section III — Signature. 0000023735 00000 n • Coordinate care with other providers in your plan’s network. Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 To enroll children, please complete Section 7, located at the end of the form. 0000041102 00000 n 0000006977 00000 n 2021 annual notice of changes 2020 2019 evidence coverage health benefits decision guide >PEBB Retiree Life Insurance – $5,000, $10,000, $15,000 or $20,000 in coverage – Enrollment form included in the PEBB Retiree Enrollment Guide – Include MetLife enrollment form when sending Retiree healthcare election form(s) to HCA OPTIONS  If you enroll as a newly PEBB benefits-eligible employee, enrollment begins the first of the month following the date you become eligible for benefits. • Lower out-of-pocket costs for many plans. Medical benefits . 36. stream Kaiser permanente nw plan 2 (sebb) certificate of coverage 2021 classic non medicare reitrees consumer directed health (cdhp) retiree senior advantage evidence northern california northwest • Meet standards about the quality of care they provide. 0000040095 00000 n 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. Page 29. Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. Inaccurate, incomplete, or illegible information may delay coverage. Visit Us. This form replaces all retiree enrollment/change forms submitted in the past. Medical plans by county. Your PEBB benefits for. ŠÁ¶L¤�Ñ•:À�ƒ@W±ÓѶԺ�êìªëi»›/È�Õ�nggçl»_îıŞûó¾÷¹ïó¾7ç €öØ`�l˜)l Ãc=äAú9º›ĞSI)f:øÕ)TË/­§Ğ°¸ú´�:“+œõbD¦é{J¨ÀmO›et±FêÂõ¶ŠE‘[Kª\I  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 Mid-Year Enrollment Form (or enrollment in Workday, for UW employees) is received by your payroll … 0000028553 00000 n 0000034233 00000 n <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. Defer. To estimate your portion, visit the Payroll Deduction Estimator below. 0000001296 00000 n It’s all the information you need to help you understand and access your MAPD plan benefits — in one place, at any time, from your … Eligibility .  If your last day to enroll occurs more than 30 days after the last day of the state of … hŞäW T“×~ï—"š š„ŸB EÄ° TK „:�ZW-B¤ŠÈ�‚E§[ÂoÀ$ 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. Complete Section II — Elections. SMARTHEALTH > If you have medical coverage which qualifies to defer PEBB retiree coverage – Check “Defer my Coverage” box and select the appropriate eligible deferral option box immediately below. 2021 Monthly . pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health . 0000004070 00000 n 2021 PEBB Employee Enrollment/Change for Medical Only Groups Subscriber’s last name Social Security number 2 Spouse or state-registered domestic partner (SRDP) List an eligible spouse or state-registered domestic partner (SRDP), as defined by WAC 182-12-109, you wish to enroll in medical coverage. 0000028438 00000 n We recommend using your personal email address to access your account. 0000006277 00000 n Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. 0000023643 00000 n %%EOF This is not my group. 0000038454 00000 n 2020 Retiree Enrollment Guide. You may not have to enroll this year For this year only, open enrollment in your health care and optional plans is voluntary. 0000007140 00000 n Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist .  If you enroll during the PEBB Program’s annual open enrollment period, your DCAP coverage is effective January 1, 2021 through December 31, 2021. Submit Form A to enroll in or defer (postpone) PEBB retiree insurance coverage. 2020 PEBB Retirement Presentation. <>>> PEBB information Public Employees Benefit Board 2021 Enrollment uide 36 Retiree member information — continued 2021 Retiree medical plan monthly premium rates Retiree Retiree & spouse/ partner Retiree & children Retiree & family Children only9 Kaiser Traditional1 $831.90 $1,663.79 $1,414.23 $2,246.12 $668.88 Kaiser Deductible1 $763.63 $1,527.27 $1,298.18 $2,061.82 $618.00 0 Pages 31–40. AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. How to enroll. premiums. HCA/PEBB ENROLLMENT FORMS > Contact HCA to … trailer ô�‰zXv¬7ïŞÀ{¼¬Îë›Æ_•…÷lUd+⻽o±Ül¾Ùdë~y| …¿I¯Î‹ë^x�=4ïjyqÆ ?ĞÉV©ÛçÅSͽ †ECØÏT>{�tºâóŞlı{ŠıE¢Wx¶¶�Ä0Fpì³míÊàGËé�ıË~puŸïèË^‡©,ñÔÏ~bÊœ©DEÉò,sµ§K¼ø. 0000011537 00000 n Uhcretiree Com Provider Directory 2021. endobj 0000034714 00000 n Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. Employee Enrollment Guide Your PEBB Benefits for 2020. 0000038611 00000 n 1178 0 obj comparison. comparison. 0000028173 00000 n Date approved: September 17, 2020 . PEBP Logo and link to PEBP Website 0000028953 00000 n 0000007111 00000 n For Retiree, COBRA, Self-pay rates, please visit the Retiree, COBRA and Self-pay page. 0000038499 00000 n 1129 0 obj • Retiree Enrollment Guide HCA 51-205 . > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. 2. Who to contact for help. Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. (. startxref What does this mean for you? Limitations, exclusions, and restrictions may apply. 3.  If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. PEBB Retirees. 0000006815 00000 n PEBB Preparing for Retirement. Questions about PEBB or SEBB retiree benefits? 0000038692 00000 n At the end of the guide. Enrollment forms . Complete Section I — Employee Information. Back to uhcretiree.com » IMPORTANT DATES. 2 0 obj page 6 . We must receive your form no later than 60 days after your employer-paid, COBRA, or continuation coverage ends (or, for elected or full- time appointed officials, 60 days after you leave public office). NON-MEDICARE SUBSCRIBERS ONLY. endobj 2. 2021 Open Enrollment. 0000006844 00000 n Quick start guide. Page 30 . 0000006306 00000 n 0000040381 00000 n 11 . 36–45. Administrative Rules ; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) PEBB offices are closed to the public. 0000005823 00000 n Medical benefits . Health Details: HCA’s website at hca.wa.gov/pebb-employee Your spouse or SRDP cannot be enrolled in two PEBB Program medical and dental accounts at the same time. 4 0 obj The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. 0000023597 00000 n 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. > See PEBB Retiree Enrollment Guide for information and how to get started. 0000028325 00000 n 36 . > PEBB Retiree Health Insurance Enrollment > Retiree Life Insurance > Annual leave and sick leave pay-out (VEBA) > Retirement Checklist > Working after retirement > UW Retirement Association AGENDA > Please pause this video and open the links below the video for the following forms: – Medicare Part A & B covered services FORMS FOR THIS SEGMENT. ]�/W��c�g��6����N^'�M��� ���?,�/!�́����t�h�����fπ�4 �Ox�i�h�Q��x>/�A�d�Ǐ^���I���)L�P�����4He��x5/�N�d��BJ(�ͳ jC_"���v?���w��¶|Lx6'�Vy�� Q�X`�yqn�{=&�Kj�/�T$U�Jd9*n� ���p������@���:G�ю)ڜrP�D���v��K5Y͛��7[���W�y. 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 0000003983 00000 n Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. page 16 .