Page 5. Defer. 2. Who to contact for help. 0000035012 00000 n page 6 . 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 … > See PEBB Retiree Enrollment Guide for information and how to get started. 0000011537 00000 n hŞäW T“×~ï—"š š„ŸB EÄ° TK „:�ZW-B¤ŠÈ�‚E§[ÂoÀ$ Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. 11 . The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. page 16 . Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. 0000038383 00000 n Began: 11/01/20 Ended: 11/30/20 . Pages 8–12. PEBP Logo and link to PEBP Website 0000000016 00000 n Quick start guide. 4 0 obj 0000038302 00000 n 36–45. Hours. Enrollment forms . State of Nevada seal link to nv.gov. pages 11 –15. 0000023735 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. Uhcretiree Com Provider Directory 2021. 0000006977 00000 n Employee Enrollment Guide Your PEBB Benefits for 2020. 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�? To learn more about working with My Account, visit our Help with My Account webpage. 0000028438 00000 n 2021 Open Enrollment. Pages 31–40. Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. Monday-Friday, 8-5 … 36 . 0000034385 00000 n 0000028325 00000 n 0000007707 00000 n trailer Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. <> 2020 PEBB Retirement Presentation. 0000040987 00000 n premiums. HCA Contact; 1-800- 200-1004 Mailing Address. MEDICARE. 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 %���� Check YES for the benefits (Medical FSA and/or DCAP) you want to enroll in and enter the total contribution amount per plan year. <>stream 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. 0000041010 00000 n 0000034714 00000 n 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. 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. 0000003983 00000 n 0000023492 00000 n Preferred … <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> 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. comparison. Quick start guide. stream page 6 . 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. You may not have to enroll this year For this year only, open enrollment in your health care and optional plans is voluntary. Page 29. 2 0 obj 0000004070 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. 0000028173 00000 n Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. 1178 0 obj Inaccurate, incomplete, or illegible information may delay coverage. To enroll children, please complete Section 7, located at the end of the form. 1 0 obj 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 Who to contact for help. 0000041102 00000 n 2021 Monthly . 36 . • Coordinate care with other providers in your plan’s network. 0000038454 00000 n <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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 $621.29 Back to uhcretiree.com » IMPORTANT DATES. We must receive your form no later than 60 days after your employer-paid, COBRA, or continuation coverage ends (or, for elected or full- time appointed officials, 60 days after you leave public office). Premiums reflect how much PEBB will charge the employer. 0000038611 00000 n %PDF-1.5 %âãÏÓ 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. PEBB Retirees. 0000038540 00000 n Napoleon can guide you. Your PEBB benefits for. 0000023597 00000 n 2021 Retiree Election Form. Submit Form A to enroll in or defer (postpone) PEBB retiree insurance coverage. Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. Elect. 3. 0000040603 00000 n • Lower out-of-pocket costs for many plans. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. startxref 2021 Employee Health Benefits Enrollment Guide 2021 Retiree Health Benefits Enrollment Guide UHC Retiree Virtual Education Center 2020 Employee Health Benefits Enrollment Guide 2020 Retiree Health Benefits Enrollment Guide United Healthcare Tier 1 Providers Information about the Spouse Medical Plan Surcharge. 1129 50 0000006306 00000 n ]�/W��c�g��6����N^'�M��� ���?,�/!�́����t�h�����fπ�4 �Ox�i�h�Q��x>/�A�d�Ǐ^���I���)L�P�����4He��x5/�N�d��BJ(�ͳ jC_"���v?���w��¶|Lx6'�Vy�� Q�X`�yqn�{=&�Kj�/�T$U�Jd9*n� ���p������@���:G�ю)ڜrP�D���v��K5Y͛��7[���W�y. In the Spotlight. PEBB Preparing for Retirement. How to enroll. Guía de inscripción 2021; Summary of Benefits %PDF-1.5 2021 Open Enrollment Period. If you enroll during the PEBB Program’s annual open enrollment period, your DCAP coverage is effective January 1, 2021 through December 31, 2021. 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. Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. 2021. endobj 0000005823 00000 n 0000004697 00000 n Five steps to enroll 1. 0000001296 00000 n 2021 Retiree Enrollment Guide. DEFER YOUR ENROLLMENT. 1129 0 obj Complete Section I — Employee Information. > 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. endobj Staff are available by email or by calling 503-373-1102. 0000006277 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 . Creating a Culture of Better Health . 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 Visit Us. xref page 16 . HCA/PEBB ENROLLMENT FORMS > Contact HCA to … Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 Date approved: September 17, 2020 . endobj <> 0000040381 00000 n (. This form replaces all retiree enrollment/change forms submitted in the past. • Retiree Enrollment Guide HCA 51-205 . Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide For Retiree, COBRA, Self-pay rates, please visit the Retiree, COBRA and Self-pay page. 0000029235 00000 n pages . 2021 PEBB Employee Enrollment/Change Form. 0000007140 00000 n comparison. Full benefits package premiums Premiums are effective January 1, 2021 through December 31, 2021. 0000023620 00000 n Complete Section II — Elections. 0000038692 00000 n We recommend using your personal email address to access your account. 0000006815 00000 n To estimate your portion, visit the Payroll Deduction Estimator below. Approved by: Position: Director of the PEBB Program . The employer determines what portion of the rates the employee pays. 0000040095 00000 n Medical benefits . 3 0 obj If your last day to enroll occurs more than 30 days after the last day of the state of … Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. Questions about PEBB or SEBB retiree benefits? 0000024096 00000 n pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health . Complete Section III — Signature. <>>> PEBB Website: • Deferring Coverage . 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. Check him out in the Open Enrollment and HEM Quick Guide. Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist . 0000023643 00000 n 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. Medical benefits . 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. 0000028953 00000 n This is not my group. Page 30 . AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. 0000038499 00000 n 36. 2. PEBB members can conveniently get open enrollment information from Kaiser Permanente. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. Humanities, 2nd Floor, HU203. We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. For complete information, please refer to your Summary of Benefits or Evidence of Coverage. 2020 Retiree Enrollment Guide. 0000006844 00000 n endobj 0 0000034314 00000 n 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 At the end of the guide. If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, WA 98225-5996. • Meet standards about the quality of care they provide. 0000040632 00000 n 0000024371 00000 n 2021 annual notice of changes 2020 2019 evidence coverage health benefits decision guide <> %%EOF Eligibility . 0000034233 00000 n 0000007111 00000 n What does this mean for you? NON-MEDICARE SUBSCRIBERS ONLY. premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. “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. Enrollment Guide. 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 Virtual Education Center . Limitations, exclusions, and restrictions may apply. Need help deciding whether to complete open enrollment? 0000028254 00000 n Temporary change to the retiree enrollment deadline. 0000004559 00000 n >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 Medicare Part B. Medical plans by county. 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. 0000028553 00000 n 0000005677 00000 n Only, open enrollment in your health care Authority ( HCA ) administers care... Vision rates Members pay 1-5 % of these rates plans below have committed to: • evidence-based. And Vision rates Members pay 1-5 % of these rates for 2021 2021 Monthly premiums page Bellingham Wa. This year only, open enrollment HEM Quick Guide please refer to Summary! 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