Medicare Supplement Plan F is available in all Washington, Oregon, and Idaho counties, and nationwide. %���� PEBB Plan F pays 20% of the Medicare allowed amount for out patient behavioral health visits. If your account is locked due to typing the password incorrectly, you may wish to wait at least 10 minutes and you can try again. Summaries of benefits and coverage are not available for Medicare supplement plans. Plan F $109.59 Plan F $214.46 Plan F $209.74 Plan F $419.48 Eligible By Reason Of Disability Subscription Charges -Per Month PEBB Retiree PEBB Retiree & Spouse State Resident State Resident & Spouse Plan F $211.27 Plan F $417.82 Plan F $356.55 Plan F $713.10 Like Anthem, Regence BlueShield (the Uniform Medical Plan’s third-party administrator) and Premera Blue Cross (which serves PEBB retirees and Washington State residents enrolled in Medicare Supplement Plan F) are also independent licensees of the Blue Cross and Blue Shield Association. >PEBB Retiree Enrollment Guide > Acronyms used in this segment – HCA Health Care Authority – PEBB Public Employees Benefits Board – FSA Flexible Spending Account – CDHP Consumer Directed Health Plan – HSA Health Savings Account – VEBA Voluntary Employee Beneficiary Association PLEASE HAVE THESE DOCUMENTS READY FOR THIS SEGMENT Medical plans available by county. 4 0 obj The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. • If adding a dependent with a disability age 26 or older, submit the PEBB … PEBB offers Medicare Advantage plans with Kaiser Permanente NW (Kaiser Senior Advantage) and Kaiser Permanente WA. endobj Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. Yes No Your Other Health Coverage Please answer all the questions below as best you know how. We recommend using your personal email address to access your account. <> Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 1or state-registered domestic partner 2If a Medicare supplement plan is selected, non-Medicare enrollees are enrolled in UMP Classic.The rates shown reflect the total due, including premiums for both plans. Box 327 Seattle, WA 98111-0327 Identity confirmation - Step 1 of 3. endobj enroll in the supplement plan PEBB offers, if eligible for PEBB retiree coverage. allows the use of any Medicare contracted physician or hospital nationwide • PEBB Premera Medicare Supplement Plan F does not cover outpatient prescription drugs. The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. State residents should call the Blue Cross Premera number at 1888--208-6264 and ask for a paper application for Group ID: 1000041 , and for P2019196 (the HCA Plan G pre-sales enrollment kit). There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA benefits). ... PEBB Continuation Coverage (COBRA Medicare) PEBB Continuation Coverage (COBRA non-Medicare) PEBB Continuation Coverage … SmartHealth Online: Premera website (general information, not PEBB specific)Phone: 1-800-817-3049TTY: 1-800-842-5357, Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. ����. 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. 2 0 obj The 2019 plan year’s grace period was from January 1, through March 15, 2020. 190 day lifetime limit in a psychiatric hospital. Mail to: Premera Blue Cross PO Box 910 59 Seattle, WA 98111 -9159 Questions? <> Looking for Premera Blue Cross Medicare Supplement Plan F? This change allows you to access all UMP benefits information in one place. However, the actual amount a plan subscriber pays can vary depending on if As of January 1, 2020, Premera Blue Cross Medicare Supplement Plan F does not accept new members. <> Medical Plan Comparisons PEBB 2020 & Premera 2021 . Premera Blue Cross If you select this plan, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable prescription drug coverage. Plan F Did you receive a copy of the Premera Blue Cross “Outline of Coverage”? @�a�ȉj�_��S�Q)=��"O�NhȲ�09�x5,d.R ֵ4 ����qB���^��%�_�����W�-yZ52�m�zX�Yp}����n!�-J�aE�-�4�����)�d��~��'g��\������GKv�x�h����*?74:Bkp�y��S�czm�Wnz?_�t�C���*���C+ՀJXj�!���q��C�$�lT�Λ�Cd���C�埩h�e�/�DD�3�K�)s�@0���V�U�^n6�]2��nB�f��f�����'}��gC�dkk=Ffi�o2�:�YݾW�-�}=(�u���~����z�R��JO0��0���U�A,�l�v �[��>�ѼGU$��B��1HX��^>d����ᇀ�֟ܯ4� {�_n�g_&�������LB≮ڼsDݘ��+,4fV���!�t����E��䩆�VyS��%�J��wL��r�Z�Y����UqK6��1�F�!�'�����c�zc���^+�=��#B�y�!Ip�e�ә��&.�#�I��Ϣh�/Va��J2��gN"�b�G���/u��_�A���QV�O��~�p���IS��ݔ~@���(%��/ɕ���5yᣮ��f�{F�>-���U����y����|�{�B,ou���B��2�u�V��e�$�Ek�Y����]T�a����u�_���)���GK_"yY��E�m��o-C:���W�LB(�up��LGTG�pY"�"ELI�� ��ER���n2�]���wZ�JYZ�%��w�d�b��'�զE��0��M������X�{ ��a�v"[ê_���7��ɥ�1x;X�u0������G�-���K$Y��'�j���=��Q�c��=EG>-*�e������%�*�G� ��&Kl"�]鿗��>��OUtJBH㡙ni�0��Q����SFE��^Ou��o�g����a��A4١�?�߀Y���N�!l;߀�@�ˋO�*JܾqRɰkA'�?�'�T�h|�"�]����h6��/��~0%0}'�[���5�l6�����D>��N���+/E���*��Tt�:�JI+v*m� Premera Blue Cross Medicare Supplement Plan F and Plan G premiums Subscriber Subscriber and spouse1 Subscriber Otherwise, you can change your password here. Open enrollment when you can switch health plans will be in November. Yes No Did you receive a copy of Medicare’s “Choosing A Medigap Policy” guide? •PEBB Premera Medicare Supplement Plan F … Benefits & coverage by plan. Accountable Care Net. Medicare Supplement Plan F, administered by Premera Blue Cross, allows the use of any Medicare contracted physician or hospital nationwide. Group Health plans. If you do not live in an area that offers a Medicare Advantage plan, Kaiser Permanente NW and Kaiser Permanente WA will enroll you in … Welcome to the health plan that has been supporting school employees for nearly 60 years. The charts on the premiums and the resolutions are below. 1 0 obj The certificate of coverage (COC) for the member's plan is the source of coverage provisions offered under the plans. Plan F DO I NEED MEDICARE PART D? Designed with K-12 employees in mind, our School Employees Benefits Board (SEBB) health plans offer robust benefits and include the same great service you have come to expect from Premera. Medicare Supplement Plan F allows the use of any Medicare contracted physician or hospital nationwide. PEBB Statewide plan (part-time) (PDF) PEBB Statewide + 100 plan (part-time) (PDF) PEBB Statewide prescription drug plan (part-time) (PDF) PEBB Statewide member handbook (PDF) Summaries of Benefits and Coverage. We are all experiencing some disruption in our daily lives right now. PEBB Health Care and Dependent Care FSAs offer a grace period. *Educational Service Districts are contained within the K-12 group. PEBB Retiree PEBB Retiree & Spouse State Resident State Resident & Spouse Plan G $165.96 Plan G $326.36 Plan G $320.79 Plan G $641.58 Please Note: The subscription charge amount charged is the same for all plan subscribers with certificates like yours. Tools ... here: the PEBB home page. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S>> It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare. >If electing PEBB Medical plan, generally you do not need a Medicare Part D plan* –Prescription drug coverage included –Coverage is as good or better than Part D plans available *Except Premera Blue Cross Medicare Supp. Search. 2 TABLE OF CONTENTS ... 2020 KAISER VALUE PLAN & 2021 PREMERA VALUE PLAN Kaiser Value Plan In-Network Benefits Premera Value Plan In-Network Benefits Calendar Year Deductible Individual Coverage $250 Family Coverage Up to $750 –Uniform Medical Classic (Coordination of Benefit Plan) –Kaiser Permanente WA & NW (Medicare Advantage Plans) –Medicare Supplement Plan F … Scan and send this completed form and any required documents back to us as a secure email attachment. premera.com and select Secure Inbox. Supplement Plan F and how it works with Medicare. Plan pays Part A deductible and coinsurance. Wednesday, July 17th, the PEBB Board met and passed 8 resolutions regarding the 2014 Premiums and Medical Plan designs. Supplement Plan F, submit the Group Medicare Supplement Enrollment Application (form B). To learn more about working with My Account, visit our Help with My Account webpage. Kaiser Permanente plans. These rates are for Washington state residents who are NOT a Public Employees Benefits Board (PEBB) member (PEBB members must enroll directly with the HCA). In Medicare Supplement Plan F, benefits such as vision, hearing exams, and routine physical exams may have limited coverage or may not be covered at all. UMP is the plan chosen by 60% of those who are eligible for PEBB coverage. stream Questions about PEBB or SEBB retiree benefits? Do I live in the medical plan's service area? It allows members to use their 2019 funds for certain 2020 claims. Plan F $216.05 Plan F $427.08 Plan F $361.03 Plan F $722.06 Please Note: The subscription charge amount charged is the same for all plan subscribers with certificates like yours. PEBB offers Premera Blue Cross Medicare Supplement Plan F. There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA) Premera Blue Cross Medicare Supplement Plan F: 7,436 5: 3 2,284: UMP Plus–UW Med. Personal email address to access all UMP benefits information in one place pays! Resolutions regarding the 2014 Premiums and Medical Plan 's Service area SBCs, are required under the plans coverage. Status form Comparisons PEBB 2020 & Premera 2021, WA 98111-0327 Supplement Plan F available... Address to access your Account passed 8 resolutions regarding the 2014 Premiums and Medical Plan Comparisons PEBB 2020 & 2021. 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