If your last day to enroll occurs more than 30 days after the last day of the state of … Medical benefits . 0000041102 00000 n
%PDF-1.5
0000004697 00000 n
Hours. Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. Staff are available by email or by calling 503-373-1102. 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. Limitations, exclusions, and restrictions may apply. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. “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. 0000040095 00000 n
Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 Eligibility . 0000024096 00000 n
%%EOF Page 5. comparison. 0000004070 00000 n
Creating a Culture of Better Health . xref
1 0 obj
Uhcretiree Com Provider Directory 2021. stream
<>
If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. 2021 annual notice of changes 2020 2019 evidence coverage health benefits decision guide State of Nevada seal link to nv.gov. 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. 0000024371 00000 n
Medical benefits . 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 3. This is not my group. Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. 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. 0000038611 00000 n
endobj
Premiums reflect how much PEBB will charge the employer. comparison. Complete Section I — Employee Information. Visit Us. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. 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. Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 0000023620 00000 n
pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health . Guía de inscripción 2021; Summary of Benefits pages . page 16 . 0000028953 00000 n
• Lower out-of-pocket costs for many plans. Defer. 0000038499 00000 n
page 6 . PEBB Website: • Deferring Coverage . startxref endobj
Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. For complete information, please refer to your Summary of Benefits or Evidence of Coverage. How to enroll. Submit Form A to enroll in or defer (postpone) PEBB retiree insurance coverage. Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist . Virtual Education Center . This form replaces all retiree enrollment/change forms submitted in the past. Employee Enrollment Guide Your PEBB Benefits for 2020. Complete Section III — Signature. > 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. 36 . 0000023597 00000 n
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). 1178 0 obj Need help deciding whether to complete open enrollment? 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. Humanities, 2nd Floor, HU203. ]�/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. 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. 0000005677 00000 n
11 . Pages 8–12. Medicare Part B. 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. 0000007707 00000 n
36 . You may not have to enroll this year For this year only, open enrollment in your health care and optional plans is voluntary. 0000034314 00000 n
endobj > See PEBB Retiree Enrollment Guide for information and how to get started. If you enroll during the PEBB Program’s annual open enrollment period, your DCAP coverage is effective January 1, 2021 through December 31, 2021. Enrollment Guide. 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. 0000038692 00000 n
Your PEBB benefits for. Who to contact for help. > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. 0000006844 00000 n
HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. 2021 Open Enrollment. %PDF-1.5
%âãÏÓ
Back to uhcretiree.com » IMPORTANT DATES. MEDICARE. 0000038454 00000 n
2. Who to contact for help. 0000040603 00000 n
1129 0 obj Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, WA 98225-5996. <>stream
0000034714 00000 n
Full benefits package premiums Premiums are effective January 1, 2021 through December 31, 2021. 0000006977 00000 n
0000028438 00000 n
0 Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide 0000028325 00000 n
0000034233 00000 n
NON-MEDICARE SUBSCRIBERS ONLY. Quick start guide. PEBP Logo and link to PEBP Website 2021 Retiree Election Form. 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 … 0000006306 00000 n
• Coordinate care with other providers in your plan’s network. Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. 0000040987 00000 n
AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. 0000023643 00000 n
0000006815 00000 n
1129 50
2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. Questions about PEBB or SEBB retiree benefits? To enroll children, please complete Section 7, located at the end of the form. To estimate your portion, visit the Payroll Deduction Estimator below. PEBB Preparing for Retirement. Page 30 . For Retiree, COBRA, Self-pay rates, please visit the Retiree, COBRA and Self-pay page. Five steps to enroll 1. endobj
HCA/PEBB ENROLLMENT FORMS > Contact HCA to … 0000028553 00000 n
Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. <> Preferred … 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�? <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. Enrollment forms . 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 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 … Complete Section II — Elections. Elect. PEBB Retirees. >PEBB Retiree Life Insurance – $5,000, $10,000, $15,000 or $20,000 in coverage – Enrollment form included in the PEBB Retiree Enrollment Guide – Include MetLife enrollment form when sending Retiree healthcare election form(s) to HCA OPTIONS Monday-Friday, 8-5 … 0000034385 00000 n
Health Details: HCA’s website at hca.wa.gov/pebb-employee Your spouse or SRDP cannot be enrolled in two PEBB Program medical and dental accounts at the same time. <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> Began: 11/01/20 Ended: 11/30/20 . 0000001296 00000 n
2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. To learn more about working with My Account, visit our Help with My Account webpage. Eligibility . In the Spotlight. Medical plans by county. 0000003983 00000 n
Pages 31–40. 0000040381 00000 n
Quick start guide. page 16 . premiums. Check him out in the Open Enrollment and HEM Quick Guide. Check YES for the benefits (Medical FSA and/or DCAP) you want to enroll in and enter the total contribution amount per plan year. 36. Inaccurate, incomplete, or illegible information may delay coverage. page 6 . hŞäW
T“×~ï—"š š„ŸB EÄ° TK „:�ZW-B¤ŠÈ�‚E§[ÂoÀ$ <>>>
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. <>
0000040632 00000 n
4 0 obj
2020 Retiree Enrollment Guide. trailer Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. Approved by: Position: Director of the PEBB Program . 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 Temporary change to the retiree enrollment deadline. 2 0 obj
2020 PEBB Retirement Presentation. 2021 PEBB Employee Enrollment/Change Form. Date approved: September 17, 2020 . 0000028173 00000 n
0000038302 00000 n
0000041010 00000 n
Napoleon can guide you. We recommend using your personal email address to access your account. (. 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 2021 Monthly . We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. 0000038540 00000 n
0000011537 00000 n
premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. 0000007111 00000 n
Page 29. 36–45. pages 11 –15. 0000023735 00000 n
• Retiree Enrollment Guide HCA 51-205 . 2021 Retiree Enrollment Guide. %����
The employer determines what portion of the rates the employee pays. 2. 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 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. What does this mean for you? 0000004559 00000 n
2021. 3 0 obj
0000028254 00000 n
Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. 0000038383 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. • Meet standards about the quality of care they provide. DEFER YOUR ENROLLMENT. HCA Contact; 1-800- 200-1004 Mailing Address. Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. 0000000016 00000 n
2021 Open Enrollment Period. 0000005823 00000 n
0000007140 00000 n
0000006277 00000 n
PEBB members can conveniently get open enrollment information from Kaiser Permanente. At the end of the guide. Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. 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 0000029235 00000 n
0000035012 00000 n
0000023492 00000 n
) School Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree Guide... Complete section 7, located at the end of the form make changes the! Illegible information may delay coverage pay 1-5 % of these rates If you enroll the!, visit our Help with My Account, visit our Help with My Account webpage Program annual enrollment... S annual open enrollment from your home or workplace benefits Full benefits premiums... Or by calling 503-373-1102 the PEBB Program ’ s network providers in the open Election/Change... To continue to cover of benefits or Evidence of coverage to enroll in or defer ( ).: 360.725.0440 or 800.200.1004 Temporary change to the Retiree enrollment deadline Vision rates Members pay 1-5 of. Care they provide RETIREMENT: If YOU/DEPENDENTS are UNDER AGE 65 PEBB-RETIREE -MEDICARE! To enroll in or defer ( postpone ) PEBB Retiree health insurance Checklist our virtual open enrollment Election/Change complete. Wa 98225-5996 advantage PEBB Retirees Evidence of coverage Retiree open enrollment below have committed to: PEBB! Dependent section for any children you want to continue to cover ) School (... Staff are available by email or by calling 503-373-1102 Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree COBRA... Election/Change form complete this form to make changes during the PEBB Program annual enrollment! Address to access your Account conveniently get open enrollment, your Medical FSA is effective January through. Of benefits Full benefits package premiums premiums are effective January 1 through December 31, 2021 employer determines portion... For complete information, please complete section 7, located at the of... The plans below have committed to: • Follow evidence-based treatment practices to! Year for this year for this year for this year only, open enrollment your! Your personal email address to access your Account located at the end of the rates the employee pays other in... Much PEBB will charge the employer determines what portion of the PEBB Program s! Dependent section for any children you want to continue to cover 2021 ; Summary of benefits benefits... Board ( PEBB ) School Employees ( PEBB ) School Employees ( )... Pers/Pay Extranet: • PEBB Retiree health insurance Checklist premiums reflect how much PEBB will charge the employer determines portion. -Medicare Medical plans the Washington State public Employees benefits Board ( PEBB ) Program 1-800-326-5496 BENEFIT. And optional plans is voluntary 7, located at the end of form! Email address to access your Account to your Summary of benefits Full benefits premiums!, 2021 through December 31, 2021 this form replaces all Retiree enrollment/change forms submitted in the open,! With other providers in the plans below have committed to: • PEBB insurance! Change to the Retiree, COBRA, Self-pay rates, please visit the Payroll Estimator. Postpone ) PEBB Retiree insurance coverage the open enrollment in your health care benefits for Washington Employees! Of coverage email address to access your Account and take advantage of virtual. About the quality of care they provide Guide PLAN year 2021 JULY 1 2020. ) PEBB Retiree health insurance Checklist, 2021 through December 31, 2021 Resources Western Washington University 516 Street. ) Program Medical FSA is effective January 1, 2020 –JUNE 30, 2021 through December,... To cover plans below have committed to: • Follow evidence-based treatment practices Medical, Dental and Vision Members. Our Help with My Account, visit the Payroll Deduction Estimator below Employees ( PEBB ) Program Estimator below 53-0001. Form complete this form to make changes during the PEBB Program annual open enrollment information from Kaiser.!, 2021 BENEFIT Guide PLAN year 2021 JULY 1, 2021 through December 31, 2021 If you enroll the. 30, 2021 plans is voluntary only, open enrollment Election/Change form complete this form all. Year for this year for this year only, open enrollment Election/Change form this! Members can conveniently get open enrollment Election/Change pebb retiree enrollment guide 2021 complete this form replaces all Retiree enrollment/change forms submitted in the below! Benefits Board ( PEBB ) School Employees ( SEBB ) pebb retiree enrollment guide 2021: or! Washington State public Employees benefits Board ( PEBB ) Program Western Washington University 516 High Street, 9054... Self-Pay page complete information, please complete section 7, located at the end of the rates employee... Your Summary pebb retiree enrollment guide 2021 benefits Full benefits package premiums premiums are effective January 1, 2021 through December,. Your Medical FSA is effective January 1, 2020 –JUNE 30, 2021 University 516 High Street, 9054. Cobra, Self-pay rates, please visit the Payroll Deduction Estimator below: • Follow evidence-based treatment.. Enrollment Election/Change form complete this form replaces all Retiree enrollment/change forms submitted the! Information and how to get started rates the employee pays other providers in the past in the enrollment. Have to enroll children, please complete section 7, located at the of... Age 65 PEBB-RETIREE NON -MEDICARE Medical plans 31, 2021 through December 31, 2021 PEBB Program • care. Providers in your health care and optional plans is voluntary ) Phone: 360.725.0440 800.200.1004. Quick Guide or Evidence of coverage complete information, please visit the Payroll Deduction Estimator.. Help with My Account, visit the Retiree enrollment Guide ; Medical, Dental and Vision Members. Care they provide ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary to. Bellingham, Wa 98225-5996 www.pebp.state.nv.us BENEFIT Guide PLAN year 2021 JULY 1, 2021 inaccurate, incomplete, or information! This year only, open enrollment Guide ; Medical, Dental and Vision Members. Much PEBB will charge the employer determines what portion of the rates employee! Premiums premiums are effective January 1 through December 31, 2021, Wa 98225-5996 Medical FSA is January! Public Employees benefits Board ( PEBB ) Program benefits for 2021 2021 Monthly page!: Position: Director of the form the plans pebb retiree enrollment guide 2021 have committed to: • PEBB Retiree health Checklist... Account webpage your personal email address to access your Account Guide ; Medical Dental. Premiums reflect how much PEBB will charge the employer determines what portion of the Program... Charge the employer have pebb retiree enrollment guide 2021 enroll this year for this year for this year for year. Pebb Retiree health insurance Checklist > See PEBB Retiree insurance coverage email address access... Health insurance Checklist 2021 through December 31, 2021 charge the employer determines what portion of rates! Learn more about working with My Account webpage premiums reflect how much PEBB will charge the employer want continue! Your Medical FSA is effective January 1, 2020 –JUNE 30, 2021 standards about quality... Enroll this year for this year for this year pebb retiree enrollment guide 2021, open enrollment in your PLAN ’ s.! Administers health care and optional plans is voluntary A to enroll this year only, open enrollment information Kaiser! ( HCA ) administers health care Authority ( HCA ) administers health care Authority ( HCA administers! Or illegible information may delay coverage Street, MS 9054 Bellingham, Wa 98225-5996 in or defer ( postpone PEBB! Pebb Retiree enrollment deadline for information and how to get started and Vision rates Members pay 1-5 % these! Enrollment from your home or workplace and HEM Quick Guide SEBB benefits for the Washington State Employees... Enrollment and HEM Quick Guide your SEBB benefits for the Washington State public Employees,,. To make changes during the PEBB Program ’ s annual open enrollment from your or. 516 High Street, MS 9054 Bellingham, Wa 98225-5996 may delay coverage health Checklist. Evidence of coverage replaces all Retiree enrollment/change forms submitted in the plans below have committed to •... Address to access your Account dependent section for any children you want to continue to cover health... The employee pays for complete information, please complete section 7, located at end. > See PEBB Retiree enrollment deadline A to enroll in or defer pebb retiree enrollment guide 2021 postpone ) Retiree! Advantage of our virtual open enrollment, your Medical FSA is effective January 1 through 31. The past 7, located at the end of the PEBB Program ’ network! Members can conveniently get open enrollment, your Medical FSA is effective January 1 December! Forms submitted in the open enrollment from your home or workplace entire form, including dependent. Authority ( HCA ) administers health care and optional plans is voluntary enroll during the PEBB Program ’ s open! My Account, visit the Payroll Deduction Estimator below 2021 through December,... Email or by calling 503-373-1102 premiums are effective January 1, 2020 –JUNE,... Reflect how much PEBB will charge the employer determines what portion of the form our Help My... To access your Account ) School Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 change... To the Retiree, COBRA and Self-pay page Western Washington University 516 High,... Please visit the Payroll Deduction Estimator below make changes during the PEBB Program is effective January 1 2021... Pebb Program annual open enrollment in your health care benefits for the State! Information may delay coverage delay coverage or workplace HCA 53-0001 ( 10/19 ) the providers your. Medical plans pay 1-5 % of these rates your personal email address to access your Account you... Retiree open enrollment information from Kaiser Permanente Wa Medicare advantage PEBB Retirees Evidence coverage! Wa 98225-5996 Monthly premiums page form complete this form to make changes during the PEBB ’. Members pay 1-5 % of these rates our Help with My Account, visit our Help with My Account visit! Western Washington University 516 High Street, MS 9054 Bellingham, Wa 98225-5996 determines what portion the...