0000040987 00000 n Temporary change to the retiree enrollment deadline. Uhcretiree Com Provider Directory 2021. Monday-Friday, 8-5 … 3. Check YES for the benefits (Medical FSA and/or DCAP) you want to enroll in and enter the total contribution amount per plan year. 1129 0 obj 0000005677 00000 n To learn more about working with My Account, visit our Help with My Account webpage. How to enroll.  If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. Eligibility . 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. We recommend using your personal email address to access your account. %%EOF To estimate your portion, visit the Payroll Deduction Estimator below. Page 5. Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide “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. Creating a Culture of Better Health . 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�? What does this mean for you? <>stream 0000041102 00000 n 0000007111 00000 n DEFER YOUR ENROLLMENT. • Retiree Enrollment Guide HCA 51-205 . trailer 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 Limitations, exclusions, and restrictions may apply. <>>> Enrollment Guide. This form replaces all retiree enrollment/change forms submitted in the past. 0000007707 00000 n In the Spotlight. pages 11 –15. 4 0 obj (. Complete Section III — Signature. 2021 annual notice of changes 2020 2019 evidence coverage health benefits decision guide 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). 2021 PEBB Employee Enrollment/Change Form. Back to uhcretiree.com » IMPORTANT DATES. 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. endobj  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. 2021 Open Enrollment Period. comparison. Hours. 0000006844 00000 n 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. Preferred … Full benefits package premiums Premiums are effective January 1, 2021 through December 31, 2021. 0000006977 00000 n 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. 0000023643 00000 n Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. • Lower out-of-pocket costs for many plans. Elect. 0000023735 00000 n 2. Complete Section II — Elections. Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. Napoleon can guide you. <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> This is not my group. > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. Who to contact for help. <> For Retiree, COBRA, Self-pay rates, please visit the Retiree, COBRA and Self-pay page. 2021 Open Enrollment. Complete Section I — Employee Information. • Coordinate care with other providers in your plan’s network. State of Nevada seal link to nv.gov. 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 %PDF-1.5 %âãÏÓ Inaccurate, incomplete, or illegible information may delay coverage. 0000038383 00000 n PEBB Website: • Deferring Coverage . 2 0 obj 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 endobj >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 0000028438 00000 n 0000028553 00000 n Page 29. 0000038611 00000 n 0000004697 00000 n 0000040381 00000 n 36 . Defer. Humanities, 2nd Floor, HU203. page 6 . 0000023492 00000 n 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 $618.00 Date approved: September 17, 2020 . 0000004070 00000 n ]�/W��c�g��6����N^'�M��� ���?,�/!�́����t�h�����fπ�4 �Ox�i�h�Q��x>/�A�d�Ǐ^���I���)L�P�����4He��x5/�N�d��BJ(�ͳ jC_"���v?���w��¶|Lx6'�Vy�� Q�X`�yqn�{=&�Kj�/�T$U�Jd9*n� ���p������@���:G�ю)ڜrP�D���v��K5Y͛��7[���W�y. 2021 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. 0000000016 00000 n 0 0000038499 00000 n  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 … 0000011537 00000 n 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 0000038454 00000 n PEBB Preparing for Retirement. Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. 0000034385 00000 n 1 0 obj <> 0000006306 00000 n 0000034714 00000 n PEBB members can conveniently get open enrollment information from Kaiser Permanente. HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. 0000028325 00000 n <> Quick start guide. 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. 0000034233 00000 n 0000005823 00000 n Need help deciding whether to complete open enrollment? Pages 8–12. 2021. 0000040632 00000 n page 16 . 0000035012 00000 n 0000034314 00000 n Five steps to enroll 1. 2020 PEBB Retirement Presentation. 11 . %���� HCA/PEBB ENROLLMENT FORMS > Contact HCA to … 0000041010 00000 n Employee Enrollment Guide Your PEBB Benefits for 2020. 0000040603 00000 n Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. Staff are available by email or by calling 503-373-1102. 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. 0000004559 00000 n  If your last day to enroll occurs more than 30 days after the last day of the state of … 0000028953 00000 n premiums. 1129 50 Medical benefits . > See PEBB Retiree Enrollment Guide for information and how to get started. You may not have to enroll this year For this year only, open enrollment in your health care and optional plans is voluntary. AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. NON-MEDICARE SUBSCRIBERS ONLY.  If you enroll during the PEBB Program’s annual open enrollment period, your DCAP coverage is effective January 1, 2021 through December 31, 2021. comparison. 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. 0000023620 00000 n Questions about PEBB or SEBB retiree benefits? Your PEBB benefits for. endobj 2021 Retiree Enrollment Guide. 3 0 obj Medical benefits . startxref Enrollment forms . 0000028173 00000 n %PDF-1.5 • Meet standards about the quality of care they provide. 0000028254 00000 n Submit Form A to enroll in or defer (postpone) PEBB retiree insurance coverage. Page 30 . 2020 Retiree Enrollment Guide. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 0000024371 00000 n 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 . PEBP Logo and link to PEBP Website 36–45. 36. 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 … To enroll children, please complete Section 7, located at the end of the form. Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, WA 98225-5996. Pages 31–40. At the end of the guide. pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health . Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. 0000001296 00000 n 2. Who to contact for help. premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. 0000038302 00000 n 0000006815 00000 n Medicare Part B. 1178 0 obj Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. > 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. 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. Check him out in the Open Enrollment and HEM Quick Guide. 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. Approved by: Position: Director of the PEBB Program . 0000038692 00000 n For complete information, please refer to your Summary of Benefits or Evidence of Coverage. The employer determines what portion of the rates the employee pays. Premiums reflect how much PEBB will charge the employer. stream 0000023597 00000 n 0000029235 00000 n 0000024096 00000 n endobj 0000006277 00000 n 2021 Retiree Election Form. 0000003983 00000 n PEBB Retirees. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. page 6 . Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 2021 Monthly . 0000040095 00000 n pages . Guía de inscripción 2021; Summary of Benefits 36 . 0000038540 00000 n HCA Contact; 1-800- 200-1004 Mailing Address. Visit Us. Medical plans by county. 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. MEDICARE. Quick start guide. Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist . page 16 . xref Eligibility . 0000007140 00000 n hŞäW T“×~ï—"š š„ŸB EÄ° TK „:�ZW-B¤ŠÈ�‚E§[ÂoÀ$ Virtual Education Center . 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. 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Staff are available by email or by calling 503-373-1102: If YOU/DEPENDENTS are UNDER AGE 65 PEBB-RETIREE NON -MEDICARE plans. Extranet: • Follow evidence-based treatment practices by: Position: Director of the form year only open!