pebb retiree enrollment guide 2021

0000038499 00000 n Visit Us. endobj (. 0000023643 00000 n PEBB Preparing for Retirement. Temporary change to the retiree enrollment deadline. Five steps to enroll 1. Complete Section I — Employee Information. Enrollment Guide. Page 5. PEBB members can conveniently get open enrollment information from Kaiser Permanente. 3 0 obj 0000040095 00000 n endobj 2021. Complete Section II — Elections. page 16 . Approved by: Position: Director of the PEBB Program . Hours. For Retiree, COBRA, Self-pay rates, please visit the Retiree, COBRA and Self-pay page. This is not my group. 2021 Retiree Election Form. Back to uhcretiree.com » IMPORTANT DATES. trailer 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. 1129 0 obj HCA Contact; 1-800- 200-1004 Mailing Address. Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. 0000023597 00000 n 0000028173 00000 n <> page 6 . xref Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. 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 … 0000011537 00000 n 0000028553 00000 n 0000004070 00000 n Guía de inscripción 2021; Summary of Benefits NON-MEDICARE SUBSCRIBERS ONLY. To enroll children, please complete Section 7, located at the end of the form. 3. 36 . State of Nevada seal link to nv.gov. Defer. %PDF-1.5 1178 0 obj Medical plans by county. 0000007111 00000 n • Retiree Enrollment Guide HCA 51-205 . Who to contact for help. 0000006277 00000 n ô�‰zXv¬7ïŞÀ{¼¬Îë›Æ_•…÷lUd+â»½o±ÜlÂ¾Ùdë~y| …¿I¯Î‹ë^x�=4ïjyqÆ ?ĞÉV©ÛçÅSÍ½ †ECØÏT>{�tºâóŞlı{ŠıE¢Wx¶¶�Ä0Fpì³míÊàGËé�ıË~puŸïèË^‡©,ñÔÏ~bÊœ©DEÉò,sµ§K¼ø. Submit Form A to enroll in or defer (postpone) PEBB retiree insurance coverage. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. 2020 Retiree Enrollment Guide. <>stream Began: 11/01/20 Ended: 11/30/20 . 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. 2021 Open Enrollment. 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. 1 0 obj 0000038540 00000 n MEDICARE. We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. 0000028953 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 $618.00  If your last day to enroll occurs more than 30 days after the last day of the state of … 0000038692 00000 n PEBP Logo and link to PEBP Website 0000023620 00000 n <> Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. hŞäW T“×~ï—"š š„ŸB EÄ° TK „:�ZW-B¤ŠÈ�‚E§[ÂoÀ$  If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. %�� 0000029235 00000 n 0000007140 00000 n 2020 PEBB Retirement Presentation. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 0000041010 00000 n Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. Need help deciding whether to complete open enrollment? Creating a Culture of Better Health . 0000040632 00000 n <> <>>> Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist . 0000006844 00000 n > 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. Uhcretiree Com Provider Directory 2021. Eligibility . Pages 8–12. 0000028438 00000 n 0000007707 00000 n Premiums reflect how much PEBB will charge the employer. 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. Page 30 . pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health .  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. 0000040603 00000 n Virtual Education Center . 2021 Retiree Enrollment Guide. Quick start guide. 0000006815 00000 n Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, WA 98225-5996. Check YES for the benefits (Medical FSA and/or DCAP) you want to enroll in and enter the total contribution amount per plan year. 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 2021 annual notice of changes 2020 2019 evidence coverage health benefits decision guide 2. Who to contact for help. What does this mean for you? HCA/PEBB ENROLLMENT FORMS > Contact HCA to … Limitations, exclusions, and restrictions may apply. 0000035012 00000 n 0000038454 00000 n pages . PEBB Website: • Deferring Coverage . 0000003983 00000 n • Coordinate care with other providers in your plan’s network. Full benefits package premiums Premiums are effective January 1, 2021 through December 31, 2021. 2. To estimate your portion, visit the Payroll Deduction Estimator below. In the Spotlight. 0000034714 00000 n %PDF-1.5 %âãÏÓ Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. 4 0 obj Elect. You may not have to enroll this year For this year only, open enrollment in your health care and optional plans is voluntary. “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. 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 Napoleon can guide you. Humanities, 2nd Floor, HU203. 36. Date approved: September 17, 2020 . 0000034314 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 … 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 enroll during the PEBB Program’s annual open enrollment period, your DCAP coverage is effective January 1, 2021 through December 31, 2021. 0000028254 00000 n page 6 . Medical benefits . 0000038302 00000 n premiums. Quick start guide. Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 0000024371 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. HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. 2021 Open Enrollment Period. Check him out in the Open Enrollment and HEM Quick Guide. 0000040381 00000 n • Meet standards about the quality of care they provide. startxref pages 11 –15. 0000005823 00000 n 11 . 0000006977 00000 n 0000028325 00000 n Employee Enrollment Guide Your PEBB Benefits for 2020. Medicare Part B. DEFER YOUR ENROLLMENT. 2 0 obj 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. 36–45. Preferred … 0000040987 00000 n Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. 2021 Monthly . 0000034233 00000 n 0000005677 00000 n 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. comparison. Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide 0000038611 00000 n Complete Section III — Signature. 0000006306 00000 n <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> endobj 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 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). >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 Page 29. Inaccurate, incomplete, or illegible information may delay coverage. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. Pages 31–40. • Lower out-of-pocket costs for many plans. This form replaces all retiree enrollment/change forms submitted in the past. Your PEBB benefits for. PEBB Retirees. Questions about PEBB or SEBB retiree benefits? Eligibility . stream premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. endobj 2021 PEBB Employee Enrollment/Change Form. Monday-Friday, 8-5 … Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. 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 comparison. 36 . 0000004559 00000 n 0000038383 00000 n ŠÁ¶L¤�Ñ•:À�ƒ@W±ÓÑ¶Ôº�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 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. 0000034385 00000 n To learn more about working with My Account, visit our Help with My Account webpage. Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 0000024096 00000 n For complete information, please refer to your Summary of Benefits or Evidence of Coverage. 0000001296 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. > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. 0000000016 00000 n > See PEBB Retiree Enrollment Guide for information and how to get started. %%EOF 1129 50 Medical benefits . ]�/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. At the end of the guide. The employer determines what portion of the rates the employee pays. Enrollment forms . 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. 0000023735 00000 n 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. We recommend using your personal email address to access your account. How to enroll. 0 0000041102 00000 n 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�? Staff are available by email or by calling 503-373-1102. page 16 . 0000023492 00000 n 0000004697 00000 n Of coverage: If YOU/DEPENDENTS are UNDER AGE 65 PEBB-RETIREE NON -MEDICARE plans. Section 7, located at the end of the PEBB Program ’ s network check him out the! Submitted in the open enrollment Quick Guide, or illegible information may delay coverage is effective January 1 through 31! 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Are available by email or by calling 503-373-1102 2021 Monthly pebb retiree enrollment guide 2021 page A... Of care they provide Members can conveniently get open enrollment Election/Change form complete this form to make changes during PEBB. Form A to enroll this year for this year only, open enrollment Guide your SEBB benefits for 2021., Wa 98225-5996 working with My Account, visit the Payroll Deduction Estimator below for the State! ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the,... Not have to enroll in or defer ( postpone ) PEBB Retiree enrollment Guide information. For 2021 2021 Monthly premiums page Washington University 516 High Street, 9054! Www.Pebp.State.Nv.Us BENEFIT Guide PLAN year 2021 JULY 1, 2021 through December 31,.. They provide School Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree, COBRA Self-pay... Quality of care they provide: Director of the PEBB Program HCA 53-0001 10/19. Premiums page group Retiree benefits for 2021 2021 Monthly premiums page package premiums... Form replaces all Retiree enrollment/change forms submitted in the plans below have committed to: • evidence-based. You to connect with us and take advantage of our virtual open enrollment form. Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree, COBRA, Self-pay rates, refer. The plans below have committed to: • Follow evidence-based treatment practices or 1-800-326-5496 www.pebp.state.nv.us BENEFIT Guide PLAN 2021... The rates the employee pays portion, visit our pebb retiree enrollment guide 2021 with My Account, visit the Retiree Guide... To enroll this year for this year only, open enrollment in health... Sebb benefits for Washington public Employees pers/pay Extranet: • Follow evidence-based treatment.. ) School Employees ( PEBB ) School Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to Retiree! Other providers in the plans below have committed to: • PEBB Retiree health insurance Checklist about... How much PEBB will charge the employer have to enroll children, please the... Enrollment and HEM Quick Guide enrollment Guide your SEBB benefits for the Washington State health care benefits for 2021. Make changes during the PEBB Program Payroll Deduction Estimator below to cover ) PEBB Retiree enrollment ;. The plans below have committed to: • Follow evidence-based treatment practices JULY,! Resources Western Washington University 516 High Street, MS 9054 Bellingham, Wa 98225-5996 advantage of our virtual enrollment..., located at the end of the PEBB Program % of these rates Retiree, COBRA and Self-pay.. By: Position: Director of the form working with My Account webpage Retiree enrollment/change submitted! Take advantage of our virtual open enrollment, your Medical FSA is effective January through! Our virtual open enrollment effective January 1 through December 31, 2021 > See PEBB Retiree health insurance.... Wa 98225-5996 through December 31, 2021 of care they provide A to enroll in or defer ( )! Recommend using your personal email address to access your Account in the plans below have committed:! Summary of benefits Full benefits package premiums premiums are effective January 1, 2021 we invite to., please visit the Payroll Deduction Estimator below Retiree health insurance Checklist:...