2016 Benefits. Enrollment Guide. For Newly PEBB-Eligible Employees. Public Employees Benefit Board Open Enrollment. Healthier, Together.

Transcription

1 2016 Benefts Enrollment Gude For Newly PEBB-Elgble Employees Publc Employees Beneft Board Open Enrollment Healther, Together.

2 Contents Health plans medcal, dental and vson...1 Tools to help you choose estmators, vdeos, plan comparsons, search-for-provders drectores Optonal benefts optonal lfe, dsablty, AD&D, long-term care Tax-savng accounts dependent care, health care, commuter How to enroll regster, password, process Requred notces federal and state Contact nformaton A Word from your Board We re excted by the growng engagement around our shared goal better health, better care and lower costs. Together. We re makng measurable progress. Better health. Almost 80% of our members and ther spouses/partners enroll and partcpate n the Heath Engagement Model (HEM) program. They agree annually to complete ther medcal plan s health assessment wthn a set perod and to complete two health actons by the next Open Enrollment. As HEM partcpants, they receve a health ncentve n ther pay. New elgble members can look forward to partcpaton n the next plan year. Better care. Year by year, more and more of us are choosng a medcal home. The provders n your medcal home assgn prorty to keepng you healthy through preventon, use of evdence-based care, and support to help you meet your health goals. Lower costs. The legslature has charged us wth keepng cost ncreases at or below 3.4% per year. Our new and long-standng plans are respondng to the challenge of provdng hgher qualty at a cost we can all afford. We apprecate the part you play n ths effort by sharng responsblty for your health. Trust that we wll contnue to work toward our msson of qualty, affordable benefts. Healther, Together. Your PEBB Board These flags pont to web pages that provde more nformaton about each topc. If you use the onlne verson of ths gude, just clck the web address n blue; t wll open the nformaton page. If you use the paper verson, type the web address nto your browser address bar to access the onlne nformaton page. Informaton n ths document s summary nformaton only. It does not fully descrbe plans n detal. In the case of a conflct between ths summary and your plan handbook, the plan handbook wll preval.

3 Choosng your 2016 Benefts Choose your medcal plan for 2016 We want PEBB-elgble employees to look over PEBB medcal plans at least once a year so they can make sure ther current plan s rght for them and ther famly. Another plan may offer better health, better care and lower costs. Coverng domestc partners Coverage of domestc partners and partners chldren has tax mplcatons that lower your take-home pay. Be sure you understand these mplcatons before addng these ndvduals to coverage. Opt out Opt out s a choce of medcal plan avalable to PEBB-elgble members who have other medcal coverage. Declne To declne s to choose not to partcpate n any aspect of the beneft program, ncludng the employer share of premum for core benefts. Employee premum share Employee premum share may vary dependng on the employng agency or unversty. Employees of most state agences have a premum share descrbed below. PEBB does not determne premum share. Contact your agency or unversty beneft offce for answers to questons about premum share. Employee premum share for core benefts s set as a percentage of total monthly premum cost; the employer pays the balance. The same percentage premum share you pay for medcal coverage wll apply to any enrollment n dental, vson, and employee basc lfe coverage the core benefts. Full-tme employees: Only full-tme plans are avalable to full-tme employees. You pay 5% of the total premum f you enroll n ether of the two hgher cost PEBB plans PEBB Statewde or Kaser HMO. If you enroll n any of the other PEBB full-tme plans whch have lower cost your premum share s 1%. Part-tme employees: Both full-tme and part-tme plans are avalable to part-tme employees. You pay ether 1% or 5% of the total premum based on the medcal plan you choose, and you pay any premum balance remanng after the employer pays ther premum share based on your hours of work each month. When you enroll n the full tme or part-tme plan for ether the PEBB Statewde Plan or the Kaser HMO you pay 5% premum contrbuton share, When you enroll n any of the other PEBB full tme or part-tme plans you pay the 1% premum contrbuton share. Part tme employees that choose a part-tme medcal plan also receve a flat premum subsdy amount based on the medcal plan ter chosen. Hgher-cost plans wth 5% premum share are both the full-tme and part-tme Kaser HMO and PEBB Statewde PPO medcal plans. Lower-cost plans wth 1% premum share are the followng full -tme and part-tme medcal plans: AllCare PEBB, Kaser Deductble, Moda Summt, Moda Synergy and Provdence Choce. At least one hgher-cost and one lower-cost plan s avalable n each county. Health plans medcal, dental and vson 1

4 Choosng your 2016 Benefts (contnued) The chart below shows the monthly premum rate by ter for each of the medcal plans. Part-tme employees who choose a part-tme plan have a subsdy. The subsdy s not shown n the premum rate. It s ncluded n the cost estmators shown on the Tools page Medcal Plan Premum for Full-tme plans (avalable to both full-tme and part-tme employees) Employee Employee and Spouse/Partner Employee and Chld(ren) Employee and Famly AllCare PEBB 1 $ $1, $1, $1, Kaser 2 1, , , , Kaser Deductble 2 1, , , , Moda Summt, Synergy 1 $ , , , PEBB Statewde 1 1, , , , Provdence Choce , , , No n-plan vson coverage 2 Kaser routne vson care 2016 Medcal Plan Premum Rates for Part-tme plans (avalable only to part-tme employees) Employee Employee and Spouse/Partner Employee and Chld(ren) Employee and Famly AllCare PEBB 1 $ $ $ $ Kaser , , , Kaser Deductble , , , Moda Summt, Synergy , , PEBB Statewde , , , Provdence Choce , , No n-plan vson coverage 2 Vson exam only 2 Publc Employees Beneft Board 2016 Enrollment Gude

5 Health Plans by County The chart below shows the hgher-cost and lower-cost plans avalable n each county. A part-tme verson of each of these plans s avalable to part-tme employees. County Lower-cost Plans, 1% Premum Share Hgher-cost Plans, 5% Premum Share Baker Moda Summt, Provdence Choce Kaser HMO, PEBB Statewde Benton Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Clackamas Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Clatsop Moda Synergy, Provdence Choce PEBB Statewde Columba Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Coos Provdence Choce PEBB Statewde Crook Provdence Choce PEBB Statewde Curry AllCare PEBB, Provdence Choce PEBB Statewde Deschutes Provdence Choce PEBB Statewde Douglas* Provdence Choce PEBB Statewde Gllam Moda Summt PEBB Statewde Grant Moda Summt PEBB Statewde Harney Moda Summt PEBB Statewde Hood Rver Provdence Choce Kaser HMO, PEBB Statewde Jackson AllCare PEBB, Provdence Choce PEBB Statewde Jefferson Provdence Choce PEBB Statewde Josephne AllCare PEBB, Provdence Choce PEBB Statewde Klamath Provdence Choce PEBB Statewde Lake Moda Summt PEBB Statewde Lane Moda Synergy, Provdence Choce PEBB Statewde Lncoln Moda Synergy, Provdence Choce PEBB Statewde Lnn Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Malheur Moda Summt, Provdence Choce PEBB Statewde Maron Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Morrow Moda Summt PEBB Statewde Multnomah Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Polk Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Sherman Moda Summt PEBB Statewde Tllamook Moda Synergy PEBB Statewde Umatlla Moda Summt, Provdence Choce PEBB Statewde Unon Moda Summt, Provdence Choce PEBB Statewde Wallowa Moda Summt, Provdence Choce PEBB Statewde Wasco Moda Synergy, Provdence Choce PEBB Statewde Washngton Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde Wheeler Moda Summt PEBB Statewde Yamhll Kaser Deductble, Moda Synergy, Provdence Choce Kaser HMO, PEBB Statewde *AllCare PEBB n Azalea and Glendale The rest of ths secton presents coverage n each plan. See footnotes on pages 10 and 11. Health plans medcal, dental and vson 3

6 Medcal Plans Kaser Permanente NW Deductble my.kp.org/pebb Standard deductble 2 Addtonal non-hem partcpant deductble 3 Regonal Servce Area: Benton, Clackamas, Columba, Hood Rver, Lnn, Maron, Multnomah, Polk, Washngton and Yamhll; Clark, Cowltz, Lews, Skamana & Wahkakum WA Full-tme $250/ndvdual, $750/famly Some servces not subject to deductble Addtonal deductble: $100/ndvdual, $300/famly (apples to all servces unless otherwse noted) Part-tme $250/ndvdual, $750/famly Some servces not subject to deductble Out-of-pocket max $1500/ndvdual $4500/famly $1500/ndvdual, $4500/famly Provders Referrals Kaser Permanente network of provders Referrals to non-kaser Permanente provders only from Kaser provder Prmary care vst $5, deductble waved $30, deductble waved Chronc care vst 5 $5, deductble waved $30, deductble waved Specalty vst $5 w/referral, deductble waved $30 w/referral, deductble waved Mental health care Substance abuse treatment Prenatal, frst postnatal vst Delvery Costs same as medcal servces $0, deductble waved $0, deductble waved $0, deductble waved $0, deductble waved Inpatent delvery subject to npatent hosptal charges Preventve $0, deductble waved $0, deductble waved Lab & X-ray $15, deductble waved $20, deductble waved Inpatent hosptal per $50/day up to $250 max $500 admsson Emergency department 6 $75 $100 Durable medcal 15%, deductble waved 50%, deductble waved equpment Insuln & dabetc $0 or 0%, deductble waved supples Addtonal Cost Ter $100 copay 8 $100 copay, deductble waved $100 copay, deductble waved Addtonal Cost Ter $500 copay Standard copay only, apples to out of pocket maxmum Standard copay only, apples to out of pocket maxmum Alternatve care provder vsts 13 $10, deductble waved $30, wth physcan s authorzaton referral, deductble waved Spnal manpulaton, acupuncture servces 13 $10, deductble waved $30 wth physcan s authorzaton referral, deductble waved Prescrpton drugs No deductble Copays accumulate to out-of-pocket maxmum $5 generc $25 brand 50% up to $100 max non-formulary brand Mal order (31-90 day), $5 generc, $25 formulary brand, 50% up to $100 max non-formulary brand No deductble Copays accumulate to out-of-pocket maxmum $10 generc $25 brand Mal order 2 copays for up to 90-day supply Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. See footnotes, pages Publc Employees Beneft Board 2016 Enrollment Gude

7 Medcal Plans (contnued) Kaser Permanente NW HMO my.kp.org/pebb Regonal Servce Area: Benton, Clackamas, Columba, Hood Rver, Lnn, Maron, Multnomah, Polk, Washngton and Yamhll; Clark, Cowltz, Lews, Skamana & Wahkakum WA Full-tme Part-tme Standard deductble $0 $0 Addtonal HEM non-partcpant deductble 3 Addtonal deductble: $100/ndvdual, $300/famly (apples to all servces unless otherwse noted) Out-of-pocket max $600/ndvdual, $1200/famly $1500/ndvdual, $3000/famly Provders Referrals Kaser Permanente Network of provders Referrals to non-kaser Permanente provders only from Kaser provder Prmary care vst $5 $30 Specalty vst $5, wth referral $30, wth referral Mental health care Same cost as physcal health servces Substance abuse treatment $0 $0 Prenatal, frst postnatal vst $0 $0 Delvery Inpatent delvery subject to npatent hosptal charges Preventve $0 $0 Lab & X-ray $0 $10 Inpatent hosptal per admsson $50/day, up to $250 max $500 Emergency department 6 $75 $100 Durable medcal equpment $0 50% Insuln & dabetc supples $0 Addtonal Cost Ter $100 copay 8 $100 copay $100 copay Addtonal Cost Ter $500 copay Does not apply n ths plan Does not apply n ths plan Alternatve care provder vsts 13 $10 $30, wth physcan s authorzaton approval Spnal manpulaton, acupuncture servces 13 $10 $30, wth physcan s authorzaton approval Prescrpton drugs No deductble Copays accumulate to out-of-pocket maxmum $1 generc $15 brand Mal order (31-90 day), $1 generc, $15 brand No deductble Copays accumulate to out-of-pocket maxmum $10 generc $25 brand Mal order 2 copays for up to 90-day supply Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. See footnotes, pages Health plans medcal, dental and vson 5

8 Medcal Plans (contnued) Moda Summt, Synergy Modahealth.com/pebb Synergy Servce Area: Benton, Clackamas, Clatsop, Columba, Lane, Lncoln, Lnn, Maron, Multnomah, Polk, Tllamook, Wasco, Washngton, Yamhll, and Clark n Washngton Summt Servce Area: Baker, Gllam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatlla, Unon, Wallowa, Wheeler Full-tme Part-tme Provders In Medcal home 1 Out of network 1 In Medcal home 1 Out of network 1 Standard deductble 2 Addtonal non-hem partcpant deductble 3 Out-of-pocket max (some deductbles, copays, servces don t apply) Prmary care vst $250/ndvdual, $750/famly $500/ndvdual, $1500/famly $500/ndvdual, $1500/famly $100/ndvdual, $300/famly (apples to all servces unless otherwse noted) $1500/ndvdual, $4500/famly $5, frst 4 vsts deductble waved $2500/ndvdual $7500/famly $2500/ndvdual $7500/famly 30% $30, frst 4 vsts deductble waved Chronc care vst 5 $0, deductble waved 30% $0, deductble waved 50% Specalty vst $5, wth referral 30% $30, wth referral 50% $1000/ndvdual, $3000/famly $4500/ndvdual, $13500/famly 50% Mental health care Substance abuse treatment Maternty, & chldbrth servces provder Delvery Cost same as medcal servces $0, deductble waved Cost same as medcal servces $0, deductble waved Cost same as medcal servces $0, deductble waved $30 $0, deductble waved 50% Inpatent delvery subject to npatent hosptal charges Preventve $0, deductble waved 30% $0, deductble waved 50% Lab & x-ray $0, deductble waved 30% $0, Quest provder, 50% deductble waved, or 20% Inpatent hosptal per $50/day to $250 max 30% $500 50% admsson Emergency department 6 $100 $100 $100 $100 Durable medcal equp. 15% 30% 20% 50% Insuln, dabetc supples $0, deductble waved Addtonal Cost Ter $100 $100 + $30 $100 $ % $100 copay 7 Addtonal Cost Ter $500 $ % $500 $ % $500 copay 9 Alternatve care provder vsts $5 30% $30 50% Spnal manpulaton, acupuncture servces 13 $5 up to $1,000/yr max combned. Not appled to out-of-pocket max. Prescrpton drugs $50/ndvdual, $150/ famly deductble 10 $1000 out-of-pocket maxmum 11 $0 Value, not subject to deductble 12 $10 generc $30 brand Copay x 2.5 for 90-day $100 specalty 30% up to $1,000/yr max combned. Not appled to out-of-pocket max. In-network deductble, out-of-pocket max apply $0 Value, not subject to deductble 12 $20 generc $50 preferred brand $100 specalty Copay x 2.5 for 90-day Member pays dfference between nnetwork rate and blled amount 6 Publc Employees Beneft Board 2016 Enrollment Gude $30 up to $1000/yr max combned. Not appled to out-of-pocket max. $50/ndvdual, $150/ famly deductble 10 $1000 out-of- pocket maxmum 11 $0 Value, not subject to deductble 12 $20 generc $50 preferred brand Copay x 2.5 for 90-day $100 specalty 50% up to $1000/yr max combned. Not appled to out-of-pocket max. In-network deductble, out-of-pocket max apply $0 Value, not subject to deductble 12 $20 generc $50 preferred brand $100 specalty. Copay x 2.5 for 90-day Member pays dfference between nnetwork rate and blled amount Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. See footnotes, pages

9 Medcal Plans (contnued) PEBB Statewde Provdence.org/pebb Regonal Servce Area: Statewde and Natonwde Full-tme Part-tme Provders In Network Out of Network In Network Out of Network Standard deductble 2 $250/ndvdual, $750/ famly Four prmary care vsts not subject Addtonal non-hem partcpant deductble 3 Out-of-pocket max (some deductbles, copays, servces don t apply) $500/ndvdual, $1500/ famly $500/ndvdual, $1500/ famly Four prmary care vsts not subject $100/ndvdual, $300/famly (apples to all servces unless otherwse noted) $1500/ndvdual $4500/ famly Prmary care vst 15% or 10% 4, deductble waved $2500/ndvdual $7500/ famly $2500/ndvdual $7500/ famly 30% 20% or 15% 4, deductble waved Chronc care vst 5 0%, deductble waved 30% 0%, deductble waved 50% Specalty vst 15% 30% 20% 50% $1000/ndvdual, $3000/famly $4500/ndvdual $13500/famly 50% Mental health care Cost same as medcal servces Substance abuse 0%, deductble waved 30% 0%, deductble waved 50% treatment Pre-natal 0%, deductble waved 30% 0%, deductble waved 50% Delvery and postnatal 15% 30% 20% 50% Preventve 0%, deductble waved 30% 0%, deductble waved 50% Lab & x-ray 15% 30% 20% 50% Inpatent hosptal per 15% 30% 20% 50% admsson Emergency department 6 $ % $ % $ % $ % Durable medcal equp. 15% 30% 20% 50% Insuln, dabetc supples 0% or $0, deductble waved Addtonal Cost Ter $ % $ % $ % $ % $100 copay 7 Addtonal Cost Ter $ % $ % $ % $ % $500 copay 9 Alternatve care provder vsts 15% 30% 20% 50% Spnal manpulaton, acupuncture servces 13 Prescrpton drugs 15%, up to 60 servces/yr max combned. Not apply to out of pocket max. $50/ndvdual, $150/famly deductble 10 $1000 out-of-pocket maxmum 11 $0 Value, not subject to deductble 12 $10 generc $30 brand Copay x 2.5 for 90-day $100 specalty 30 %, up to 60 servces/yr max combned. Not apply to out of pocket max. Urgent, emergent and out-of-country In-network deductble, out-of-pocket maxmum apply Rembursed as f flled n network; member pays dfference between network rate & blled amount 20%, up to 60 servces/yr max combned. Not apply to out of pocket max. $50/ndvdual, $150/ famly deductble 10 $1000 out-of- pocket maxmum 11 $0 Value, not subject to deductble 12 $20 generc $50 preferred brand Copay x 2.5 for 90-day $100 specalty 50%, up to 60 servces/yr max combned. Not apply to out of pocket max. Urgent, emergent and out-of-country In-network deductble, out-of-pocket maxmum apply Rembursed as f flled n network; member pays dfference between network rate & blled amount Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. See footnotes, pages Health plans medcal, dental and vson 7

10 Medcal Plans (contnued) Provdence Choce Provdence.org/pebb Regonal Servce Area: Baker, Benton, Clackamas, Clatsop, Columba, Coos, Crook, Curry, Deschutes, Douglas, Hood Rver, Jackson, Jefferson, Josephne, Klamath, Lane, Lncoln, Lnn, Malheur, Maron, Multnomah, Polk, Umatlla, Unon, Wallowa, Wasco, Yamhll; Clark and Walla Walla, WA; Payette, ID Full-tme Part-tme Provders In Medcal home 1 Out of medcal home 1 In Medcal home 1 Out of medcal home 1 Standard deductble 2 $250/ndvdual $750/ famly, 4 vsts not subject Addtonal non-hem partcpant deductble 3 Out-of-pocket max (some deductbles, copays, servces don t apply) Prmary care vst $500/ndvdual $1500/ famly $500/ndvdual $1500/ famly, 4 vsts not subject $100/ndvdual, $300/famly (apples to all servces unless otherwse noted) $1500/ndvdual, $4500/famly $5, frst 4 vsts deductble waved $2500/ndvdual, $7500/famly $2500/ndvdual, $7500/famly 30% $30, frst 4 vsts deductble waved Chronc care vst 5 $0, deductble waved 30% $0, deductble waved 50% Specalty vst $5, wth referral 30% $30, wth referral 50% $1000/ndvdual $3000/ famly $4500/ndvdual, $13500/famly 50% Mental health care Substance abuse treatment Maternty, & chldbrth servces provder Delvery Cost same as medcal servces $0, deductble waved Cost same as medcal servces $0, deductble waved Cost same as medcal servces $0, deductble waved 30% $0, deductble waved 50% Inpatent delvery subject to npatent hosptal charges Preventve $0, deductble waved 30% $0, deductble waved 50% Lab & x-ray $0, deductble waved 30% 20%, deductble apples 50% Inpatent hosptal per $50/day to $250 max 30% $500 50% admsson Emergency department 6 $100 $100 $100 $100 Durable medcal equp. 15% 30% 20% 50% Insuln, dabetc supples $0, deductble waved Addtonal Cost Ter $100 $ % $100 $ % $100 copay 7 Addtonal Cost Ter $500 $ % $500 $ % $500 copay 9 Alternatve care provder vsts $5 30% $30 50% Spnal manpulaton, acupuncture servces 13 $5/vst, up to $1000/yr max combned. Not appled to out-ofpocket max. Prescrpton drugs $50/ndvdual, $150/ famly deductble 10 $1000 out-of-pocket maxmum 11 $0 Value, not subject to deductble 12 $10 generc $30 brand Copay x 2.5 for 90-day $100 specalty 30%, up to $1000/yr max combned. Not appled to out-of-pocket max. In-network deductble, out-of-pocket maxmum apply $0 Value, not subject to deductble 12 $10 generc $30 brand Copay x 2.5 for 90-day $100 specalty 8 Publc Employees Beneft Board 2016 Enrollment Gude $30/vst, up to $1000/yr max combned. Not appled to out-ofpocket max $50/ndvdual, $150/ famly deductble 10 $1000 out-of- pocket maxmum 11 $0 Value, not subject to deductble 12 $20 generc $50 preferred brand Copay x 2.5 for 90-day $100 specalty 50% up to $1000/yr max combned. Not appled to out-of-pocket max. In-network deductble, out-of-pocket maxmum apply $0 Value, not subject to deductble 12 $20 generc $50 preferred brand Copay x 2.5 for 90-day $100 specalty Member pays dfference between nnetwork rate and blled amount Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. See footnotes, pages

11 Medcal Plans (contnued) AllCare PEBB Allcarepebb.com Regonal Servce Area: Curry, Jackson, Josephne, Glendale and Azalea n Douglas Full-tme Part-tme Provders Preferred Partcpatng Out-of-network Preferred Partcpatng Out-of-network Standard deductble $250/ndvdual, $750/famly $500/ndvdual, $1500/famly $500/ndvdual, $1500/famly $500/ndvdual, $1500/famly $1000/ ndvdual, $3000/famly $1000/ ndvdual, $3000/famly Apply toward each other Apply toward each other Addtonal HEM non-partcpant deductble 3 Out-of-pocket max (some deductbles, copays, servces don t apply) $100/ndvdual, $300/famly (apples to all servces unless otherwse noted) $1500/ ndvdual, $4500/famly $2500/ ndvdual, $7500/famly $2500/ ndvdual, $7500/famly $2500/ ndvdual, $7500/famly $4500/ ndvdual, $13500/famly $4500/ ndvdual, $13500/famly Apply toward each other Apply toward each other Prmary care vst Chronc care vst 5 $5, deductble waved $0, deductble waved $20, deductble waved $10, deductble waved 30% $5, deductble waved 30% $0, deductble waved $30, deductble waved $10, deductble waved Specalty vst $20, w referral $30 30% $30, w referral $60 50% Mental health care $5 $20 30% $5 $20 50% Substance abuse treatment Maternty, chld brth provder Delvery $0, deductble waved Cost same as medcal servces 50% 50% $0, deductble waved Cost same as medcal servces $0, deductble waved 30% $0, deductble waved 50% $0, deductble waved $100/day up to $500 max 30% $0, deductble waved 40% 50% Preventve $0, deductble waved 30% $0, deductble waved 50% Lab & X-ray $0 30% 30% 20% 40% 50% Inpatent hosptal per admsson Emergency deptartment $100 $50/day up to $250 max $100/day up to $500 max 30% $500 40% 50% Durable medcal equp. 15% 30% 50% Insuln, dabetc supples $0 or 0%, deductble waved Addtonal Cost Ter $100 $ % $ % $100 $ % $ % $100 copay 7 Addtonal Cost Ter $500 $ % $ % $500 $ % $ % $500 copay 9 Alternatve care provder vsts $10 $20 30% $30 40% 50% Spnal manpulaton, acupuncture servces 13 Prescrpton drugs $10 up to $1000/yr max combned. Not appled to out-ofpocket max. $20 up to $1000/yr max combned. Not appled to out-ofpocket max. (contnued on followng page) 30% up to $1000/yr max combned. Not appled to out-ofpocket max. $30 up to $1000/yr max combned. Not appled to out-ofpocket max. 40% up to $1000/yr max combned. Not appled to out-ofpocket max. Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. See footnotes, pages % up to $1000/yr max combned. Not appled to out-ofpocket max. Health plans medcal, dental and vson 9

12 Medcal Plans (contnued) AllCare PEBB (contnued) Full-tme Regonal Servce Area: Curry, Jackson, Josephne, Glendale and Azalea n Douglas Part-tme Provders Preferred Partcpatng Out-ofnetwork Prescrpton drugs $50/ndvdual, $150/ famly deductble 10 $1000 out-of-pocket maxmum 11 $0 preventve/ehb, not subject to deductble $10 generc $30 brand $60 non-preferred Copay x 2 for 90-day $100 specalty Out-of-Network. Member pays full cost and may be rembursed for AllCare PEBB share of cost. Preferred Partcpatng Out-ofnetwork $50/ndvdual, $150/ famly deductble 10 $1000 out-of-pocket maxmum 11 $0 preventve/ehb, not subject to deductble $15 generc $40 brand $75 non-preferred Copay x 2 for 90-day $100 specalty Out-of-Network. Member pays full cost and may be rembursed for AllCare PEBB share of cost. Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. Medcal Plans Footnotes 1 To receve In-Medcal Home benefts, members must choose a medcal home n the plan, notfy the plan of ther choce, and receve care through provders from that medcal home or from provders referred by ther medcal home. Otherwse, benefts typcally have hgher costs or may not be covered. See the lst of medcal homes on the plan s webste. 2 All medcal plans have a standard plan deductble (except Kaser HMO). Ths s the amount a member must pay for covered servces before the plan begns to pay ts share for medcally necessary covered servces. Deductbles apply per ndvdual, or the famly deductble wll apply when there are three or more ndvduals wthn a famly, based on the employee s choce of coverage ter. Payments toward the deductble accumulate separately for servces n-network and out-of-network, and In- Medcal Home and Out-of-Medcal Home (see 1 above). Certan n-network servces are not subject to the deductble. Examples: frst four vsts per ndvdual to a prmary care provder; nsuln and dabetc supples; vsts for care of asthma, dabetes, cardovascular dsease or congestve heart falure; and preventve servces. On the Kaser deductble plans, the deductble s waved on addtonal servces; please see the beneft summary for addtonal detals. 3 The goal of the Health Engagement Model (HEM) program s to engage as many people as possble n mprovng ther health, whch can help to contan health care costs over tme. A $100- per ndvdual HEM Non-Partcpant deductble wll be added to ther plan s standard deductble for members who 1) choose not to enroll n the HEM program 2) sgn up but don t complete ther health assessment wthn the scheduled tme frame or 3) don t actvely enroll n 2015 benefts. Ths HEM deductble s n addton to the plan s standard deductble (both n-network and out-of-network). Ths deductble works the same as the standard plan deductble as descrbed n 2 above. Kaser HMO non-hem partcpant plan wll have a $100 deductble. 4 PEBB Statewde plan members whose n-network provder has been recognzed by the Oregon Health Authorty as a Patent- Centered Prmary Care Home wll have the lower consurance. 5 These are vsts for care of asthma, dabetes, cardovascular dsease and congestve heart falure. Not subject to deductble n-network. 6 Copay amounts for use of a hosptal emergency department are waved f the member s admtted drectly to the hosptal for npatent treatment. Ths does not nclude admttance for observaton. Copay does not apply to out-of-pocket maxmum except n Kaser plans. In-plan deductble apples. 7 These procedures are MRI, CT, PET and SPECT scans; sleep studes; spnal njectons; upper endoscopy; bunonectomy; surgery for hammertoe and Morton s neuroma; and knee vscosupplementaton. Copay does not apply to out-of-pocket maxmum. Not appled to cancer-related procedures. These procedures may be overused compared wth ther rsks and benefts. 8 Apples only to MRI, CT, PET and SPECT scans, and sleep studes n Kaser plans. Addtonal copay apples to out of pocket maxmum. 9 These are surgcal procedures for hp or knee replacement or resurfacng; knee or shoulder arthroscopy; baratrc surgery; spne procedures; and snus surgery. Copay does not apply to out-of- pocket maxmum. Not appled to cancer-related procedures. These procedures may have alternatves that provde equal or better outcomes wth lower rsks and costs. 10 Publc Employees Beneft Board 2016 Enrollment Gude

13 Vson Plan You are not requred to enroll n vson coverage, but you must be enrolled n a medcal plan choce to enroll n a vson plan. You may enroll yourself, your spouse/domestc partner, and your dependents ndvdually or n any combnaton. Both the full-tme Kaser HMO and Kaser Deductble plan provde Kaser Vson, so members n those plans cannot enroll n VSP. If you enroll n any other plan, ncludng any of the parttme plans, you can enroll for VSP vson. For full-tme or part-tme employees, your premum contrbuton s the same percentage rate as medcal coverage percentage. If you enroll n Opt Out and choose to enroll n a vson or dental plan your contrbuton share s 5% of the premum Employee Vson Plan Monthly Premum Rates Employee Employee & Spouse/Partner Employee & Chld(ren) Employee & Famly VSP $14.30 $18.78 $16.13 $19.23 VSP Routne Vson Care Coverage Benefts Descrpton Copay Frequency Well Vson Exam Focuses on your eyes and overall wellness $10 Every calendar year Perscrpton Glasses $25 See frames and lenses Frames Lenses $150 allowance for a wde selecton of frames $170 allowance for featured frame brands 20% savngs on the amount over your allowance $80 allowance at Costco Sngle vson, lned bfocal, and lned trfocal lenses Polycarbonate lenses for dependent chldren Included n prescrpton glasses Included n prescrpton glasses Every calendar year Every calendar year Lens Enhancements Standard progressve lenses $50 Every calendar year Contacts (nstead of glasses) Premum progressve lenses $80 - $90 Custom progressve lenses $120 - $160 Average savngs of 35-40% on other lens enhancements $200 allowance for contacts and contact lens exam (fttng and evaluaton) 15% savngs on a contact lens exam (fttng and evaluaton) $0 Every calendar year Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. Medcal Plans Footnotes (contnued) 10 The prescrpton drug deductble s $50 per person or $150 for famles wth three or more members. It apples separately from the medcal deductble. 11 The prescrpton drug out-of-pocket maxmum s $1,000 per person, wth a famly (three-person) maxmum of $3,000. It accrues separately from the medcal out-of-pocket maxmum. 12 All plans have formulares that lst covered drugs. Value drugs typcally are generc drugs that are used n treatng most common chronc condtons. (EHB stands for Essental Health Benefts.) 13 Lmted to $1,000/year (combned n Kaser plans). Lmted to 60 vsts/year n PEBB Statewde plan max. Copays and consurance do not apply to out-of-pocket maxmum. Health plans medcal, dental and vson 11

14 Dental Plans You are not requred to enroll n a dental plan, but to enroll n a dental plan you must be enrolled n a medcal plan choce. You may enroll yourself, your spouse/domestc partner, and your dependents ndvdually or n any combnaton. Full-tme plans are avalable to both full-tme and part-tme employees. Part-tme plans are avalable only to part-tme employees. If you enroll n Opt Out and choose to enroll n a dental plan, your premum share s 5%. ODS (Moda) plans Modahealth.com/pebb When you enroll n the PPO plan, your consurance amount drops by 10% per year down to 0% at year three f you see your dentst at least once per year. Indvduals who enroll for coverage n an ODS (Moda) plan durng an open enrollment perod after they were ntally elgble may have a 12-month watng perod for basc and major servces and a 24-month watng perod for orthodonta. See the ODS (Moda) plans member handbooks for detals. Wllamette Dental Group plan Servces are provded only by Wllamette Dental Group provders and only n Wllamette Dental Group facltes. A $5 offce vst copayment s due at each vst, ncludng vsts for orthodonta. The copayment vares for vsts related to mplants. The plan has a $1,500 comprehensve copayment for orthodonta. Kaser Plans My.kp.org/pebb Kaser offers both medcal and dental plans. You do not need to enroll n a Kaser medcal plan to be able to enroll n a Kaser dental plan, and vce versa. You can enroll n a Kaser dental plan f you lve or work n the Kaser servce area. Servces are provded by Kaser provders n Kaser facltes The followng table summarzes coverage n full-tme dental plans Full-tme Dental Plans Comparson (avalable to full-tme and part-tme employees) Plan Kaser Dental ODS (Moda) PPO ODS (Moda) Premer Wllamette Dental Group Provder Kaser In-Network Out-of-Network Partcpatng Wllamette Deductble: ndvdual/famly None $50/$150 $50/$150 $50/$150 None Annual max coverage $1,750 $1,750 $1,750 $1,750 None Dagnostc & preventve servces 0%* 0% 10% Basc & mantenance servces 20% 20% year 1 10% year 2 0% year 3 0%, after $5 vst copay $5 copay 30% 20% $5 copay Crowns 25% 50% 50% 50% $190 copay Implants 50% 50% 50% 50% Vares Dentures 50% 50% 50% 50% $190 copay Orthodonta 50% to $ % to $ % to $ % $1500 copay Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. 12 Publc Employees Beneft Board 2016 Enrollment Gude

15 Dental Plans (contnued) The followng table summarzes coverage n part-tme dental plans Part-tme Dental Plans Comparson (avalable only to part-tme employees) Plan ODS (Moda) Part Tme Kaser Part Tme Provder Partcpatng Kaser Deductble per person $50 None Annual max coverage $1250 $1250 Dagnostc & preventve servces 0% 0%, not appled to annual max coverage Basc & mantenance servces 50% 50% Crowns 50% 50% Implants Not covered Not covered Dentures 50% 50% Orthodonta Not covered Not covered Dental Plan Rates The followng table shows monthly premum costs for full-tme and part-tme dental plans. For full-tme or part-tme employees, your premum contrbuton s at the same percentage rate as medcal coverage percentage. If you enroll n Opt out and choose to enroll n a dental plan your contrbuton share s 5% of the premum Employee Dental Plan Monthly Premum Rates Employee Employee & Spouse/ Employee & Chldren Employee & Famly Partner Kaser Permanente $91.54 $ $ $ ODS (Moda) PPO ODS (Moda) Premer Wllamette Dental Group Kaser Permanente Part-tme ODS (Moda) Part-tme Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. Health plans medcal, dental and vson 13

16 How to Choose a PEBB Medcal Plan PEBB offers four medcal home plans AllCare PEBB, Moda Summt and Synergy, and Provdence Choce plus the Kaser HMO and Deductble plans. The Board also offers the PEBB Statewde plan, whch s a preferred provder organzaton (PPO) plan. Look for the plan that gves you the best value cost compared wth benefts, along wth access to your choce of provders n the plan s network. Compare the premum share and out-of-pocket costs. Premum share. Generally, employee premum share s ether 5% or 1% of the monthly premum. It s 1% f you choose a lower-premum plan and 5% f you choose a hgher-premum plan. So, your premum share for coverng your famly ranges from around $150 per year up to around $900 per year. Out-of-pocket costs. You have lower costs n medcal home and Kaser plans, whch have copayments (copays) nstead of consurance. Example: $5 copay for an offce vst n a medcal home or Kaser, compared wth $18 n the PEBB Statewde plan 15% consurance for an offce vst wth a $120 charge. Look at benefts you get n medcal home and Kaser plans, compared wth a PPO. A sense of control. You gan confdence that you re gettng the best care for you as an ndvdual. Your prmary care provder takes the tme to know you and your values. You re a partner n your care, and you re always part of the decson-makng process. Savngs. You pay for fewer exams and tests because your specalty provders work very closely wth your prmary care provder even to the pont of IT systems that talk wth each other. Qualty servce. Your provder s focus and operatons revolve around you. Your prescrptons are at the pharmacy when you need them; your test and exam results are at the offce when you are; you have access to care when t s called for. The value of tme. You save tme and avod aggravaton because your provders know you, why you re there to see them, and what they need to do to gve you the hghest qualty care. Consder how mportant choce of provders s to you. Relatonshps. Have you already establshed relatonshps wth your choce of specalsts n the PPO? Keep n mnd that medcal home and Kaser plans determne referrals to specalsts. Networks. Are your provders n the plan s network? Seeng out-of-network provders means hgher deductbles and hgher costs for care. Kaser does not cover care from provders outsde the Kaser network. Access. Are the prmary care provders takng new patents? How soon can you see a new provder to establsh the clnc as your medcal home? Ths s especally mportant f you thnk you need specalty care. 14 Publc Employees Beneft Board 2016 Enrollment Gude

17 Want the best deal? Beneft estmators put you n control! Measure the bang for your beneft buck n a number of ways: Estmatng Payroll deductons Comparng benefts Comparng Annual costs Tools to help you choose estmators, vdeos, plan comparsons, search-for-provders drectores 15

18 All the tools you need to choose your 2016 health plan Here are questons to ask yourself when choosng a health plan: What terms and defntons do I need to know? What types of plans are there? What plans are avalable n my regon? What s the monthly premum share? Are my prmary care doc and hosptal n the network? Wll I need a referral to see my current specalst? How do I compare costs for each plan? How do I compare benefts n each plan? How do I fgure what wll be deducted from my pay? Use these onlne tools for answers to these questons. Learn the bascs Glossary of terms: Recorded webnars (by regon): Vdeo lbrary: See what s offered Avalable plans by county: Search-for-provders drectores (If you select a new provder, ask f they are takng new patents and when you can schedule your frst appontment.) AllCare PEBB: Kaser HMO and Deductble: consumer/locate-our-servces/doctors-and-locatons Moda Summt and Synergy: webpages/home.xhtml PEBB Statewde and Provdence Choce: Plan referral requrements: AllCare PEBB: Ths s a hybrd plan. When you use a prmary care provder n the plan s network preferred provder network, you get the n-network rate wth a referral to an n-network specalst. Kaser HMO and Deductble: Both these plans coordnate patent care wthn the Kaser system of Kaser provders. Any referrals to outsde specalsts must come through the patent s prmary care provder. my.kp.org/pebb Moda Summt and Synergy: These two plans are medcal home plans that have the same desgn but serve dfferent areas of the state. You choose your medcal home and prmary care provder. Referral from your prmary care provder s requred for access to specalsts at the n-network rate Publc Employees Beneft Board 2016 Enrollment Gude

19 All the tools you need to choose your 2016 health plan (cont.) Fgure the costs Provdence Choce: Ths s a medcal home plan. You choose your medcal home and prmary care provder wthn the plan s network. Referral from your Prmary Care Provder s requred for access to specalsts at the n-network rate. Provdence.org/pebb PEBB Statewde: Ths s a PPO (Preferred Provder Organzaton) plan. You choose provders for both prmary and specalty care. You have lower costs and lower deductbles when you choose n-network provders. When you see a prmary care provder recognzed as a Patent Centered Prmary Care Home, you get 5% off the 15% consurance. You have the largest choce of provders n ths plan, statewde and natonwde. Provdence.org/pebb Monthly premum rates Medcal Plans: See page 2 Vson Plan: See page 11 Dental Plans: See page 12 Estmators that do the math for you Compare the Plans Annual Costs: Compare the Plans Benefts: Estmate Your Monthly Payroll Deductons: Tools to help you choose estmators, vdeos, plan comparsons, search-for-provders drectores 17

20 Notes

21 Optonal Insurance Optonal Employee or Spouse/Domestc Partner Lfe Insurance You can enroll n or ncrease optonal lfe nsurance for yourself and your spouse/partner durng Open Enrollment. You pay the full premum for ths coverage. Applcatons may requre approval of a medcal hstory statement and medcal exams pad by the carrer. Ths s term lfe. The polcy pays f you (the subscrber who purchases the coverage) are stll a PEBB-elgble state employee, and the premum payments are current. Hgher, tobacco rates apply to ndvduals who have used tobacco n the pror 12 months. The premum rates ncrease when the age of covered ndvduals moves them nto a new age ter. All age-related ter rate changes are held untl the next plan year and go nto effect Jan. 1 of that year. Optonal Lfe Insurance Monthly Premum Rates (Non-Tobacco) per $10,000 n coverage* Age Ter Thru & up Rate Per $10,000 $0.40 $0.48 $0.62 $0.69 $0.75 $1.18 $1.74 $3.30 $5.13 $9.95 $16.30 $16.40 *Purchased n $20,000 ncrements, only Optonal Lfe Insurance Monthly Premum Rates (Tobacco) per $10,000 n coverage* Age Ter Thru & up Rate Per $10,000 $0.64 $0.74 $0.96 $1.06 $1.16 $1.78 $2.62 $4.80 $7.40 $13.90 $22.00 $21.50 *Purchased n $20,000 ncrements, only Optonal Dependent Lfe Insurance You pay the full premum for ths term lfe nsurance that covers all your PEBB-elgble dependents and your spouse/partner for the sngle premum payment of $1.29 per month to cover the entre group. The beneft amount s $5,000 per person. You, the benefcary, receve the beneft payment to cover the entre group f the covered person des whle covered under the polcy, and you are stll a PEBB-elgble state employee, and premum payments for the coverage are current. Accdental Death & Dsmemberment Insurance (AD&D) The AD&D plan provdes 24-hour coverage for accdental loss of lfe, lmb, hand, foot, hearng, speech, sght or thumb and ndex fnger (of the same hand). You pay the full premum for ths nsurance. The premum rate for you as the employee s $1.00 per $50,000 n coverage. The rate for employee and PEBB-elgble dependents s $1.70 per $50,000 n coverage. You may select a coverage amount from $50,000 to $500,000, n ncrements of $50,000. Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. Optonal benefts optonal lfe, dsablty, AD&D, long-term care 19

22 Dsablty Insurance Short-Term Dsablty Insurance Ths nsurance covers a porton of your salary f you become dsabled (as defned n the polcy) for a short perod. You pay the full amount for ths coverage. Premum rate = x gross monthly salary. Example: x $3,234 (gross monthly salary) = $22.31 monthly premum deducted from salary. Ths nsurance covers 60 percent of your nsured earnngs. The nsured earnngs amount s based on your weekly earnngs n effect on your last full day of work. When your nsured earnngs ncrease (for example, wth a pay ncrease), your premum rate ncreases. Insured earnngs does not nclude overtme pay, bonuses or dollars receved when you opt out of medcal coverage. The maxmum of nsured earnngs for short-term dsablty nsurance s lmted to $2,769. The maxmum weekly beneft s $1,662 before reducton of deductble ncome. The mnmum weekly beneft s $25 followng reducton of deductble ncome. The beneft f you are dsabled less than one week s one-seventh of the weekly beneft for each day you are dsabled. Deductble ncome means other ncome you are elgble to receve because of your dsablty. Long-Term Dsablty Insurance Ths nsurance covers a porton of your salary f you become dsabled (as defned n the polcy) for a long perod. You pay the full amount for ths coverage. You determne the beneft percentage of your monthly nsured earnngs when you choose from the four optons. For long-term dsablty, the nsured earnngs amount s based on your monthly earnngs n effect on your last full day of work. When your nsured earnngs ncrease (for example, wth a pay ncrease), your premum rate ncreases. Insured earnngs do not nclude overtme pay, bonuses, or dollars receved when you opt out of medcal coverage. Long-term Dsablty Premum Rates Premum = Rate x month salary Opton Premum Rate Watng Perod Coverage Coverage Maxmum/Mnmum 1 $ days 2 $ days 60% of frst $12,000 mnus deductble ncome $7,200 before reducton by deductble ncome/$50 3 $ days 4 $ days 66 2/3% of frst $12,000 mnus deductble ncome $8,000 before reducton by deductble ncome/$50 Here s an example of determnng premum rate. You choose opton 1 -- wth a 90-day watng perod and a monthly beneft amount of 60 percent of your pre-dsablty earnngs. Your gross monthly salary (before any deductons) $1,900 Tmes premum X Premum amount you pay each month $9.69 Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. 20 Publc Employees Beneft Board 2016 Enrollment Gude

23 Dsablty Insurance (contnued) The long-term dsablty beneft s a percentage of the frst $12,000 of your pre dsablty earnngs. The maxmum monthly beneft (before reducton of deductble ncome) s $7,200 f you choose opton 1 or 2, or $8,000 f you choose opton 3 or 4. The mnmum s $50. The maxmum weekly beneft s $1,662 before reducton of deductble ncome. Deductble ncome means other ncome you are elgble to receve because of your dsablty. Long Term Care Insurance You may enroll n ths nsurance at any tme not just durng Open Enrollment. Long term care nsurance provdes benefts when you are unable to perform at least two actvtes of daly lvng (ADLs). ADLs are dressng, bathng, transferrng, toletng, eatng and contnence. You are elgble for a monthly beneft after you meet all these condtons: You become Dsabled; You are recevng servces n a Long Term Care Faclty or Asssted Lvng Faclty/Adult Foster Home; or Professonal Home Care Servces f your plan ncludes a Professonal Home Care Servces beneft; or Total Home Care f your plan ncludes a Total Home Care beneft; You have satsfed your Elmnaton Perod; and A Physcan has certfed that you are unable to perform, wthout Substantal Assstance from another ndvdual, two or more ADLs for a perod of at least 90 days, or that you requre Substantal Supervson by another ndvdual to protect you and others from threats to health or safety due to Severe Cogntve Imparment. You wll be requred to submt a Physcan certfcaton every 12 months. The amount of your monthly beneft wll be based on the coverage optons you chose and the place of resdence used for long term care. If your coverage ncludes Professonal Home Care Servces, the beneft payment wll be based on the number of days you receve these servces. You should read the entre polcy and revew all rates; they are avalable on the plan s webste: Ths s a summary only. See the plan s documents for detals. In the case of a dscrepancy between ths summary and a plan document, the plan document wll apply. Optonal benefts optonal lfe, dsablty, AD&D, long-term care 21

24 Tax-savng Accounts Flexble spendng accounts (FSAs) Because FSAs help you save on ncome tax, they adhere to IRS code. These are annual accounts and are USE OR LOSE IT ACCOUNTS. If you want an FSA for the comng plan year, you must enroll durng Open Enrollment. You can t revoke your partcpaton n an FSA after t goes nto effect. FSAs allow you to use pre-tax dollars to remburse yourself for IRS-qualfed expenses. Use a Health Care FSA for IRS-qualfed medcal and dental expenses not covered n your plan. Use a Dependent Care FSA for IRS-qualfed day care expenses that allow you to work. You choose an annual amount to contrbute to your account, and payroll deducts your salary contrbuton (whch must be at least $20) before calculatng your taxes. Payng for elgble expenses wth these pre-tax dollars saves on your taxes. A Health Care FSA allows you to pay for deductbles, copays and consurance wth pre-tax dollars. Some examples are dental and orthodontc expenses above the plan maxmum, lask eye surgery, and certan over-the-counter medcatons for whch you have a prescrpton. A Dependent Care FSA allows you to use pre-tax dollars to pay for qualfed dependent care expenses that allow you to work. Thngs to know about these accounts: FSAs operate accordng to IRS code. The annual employee contrbuton lmt for an ndvdual health care FSA s $2,550 (an ncrease of $50 from 2015). The annual employee contrbuton lmt for an ndvdual dependent care FSA s $5,000. The mnmum monthly contrbuton amount s $20. When you enroll, you enroll for the entre plan year; plan accordngly. These are USE IT OR LOSE IT accounts. You forfet any funds that you don t use and clam for vald expenses by the end of PEBB s grace perod. Your payroll wll deduct even portons (whch must be at least $20) of your annual total electon amount from each paycheck over the course of the year. For academc-year employees, ths may be nne or 10 months. Ask your benefts offce f ths apples to you. PEBB contracts wth ASIFlex to admnster the FSA program under PEBB admnstratve rules and n keepng wth IRS code. For more nformaton vst ASIFlex onlne at Commuter Accounts Commuter accounts nclude both a Transportaton account and a Parkng account. Ths beneft allows PEBB beneft-enrolled employees to contrbute to one or both accounts on a pretax bass to pay for work-related commutng expenses. These are employee only accounts governed and regulated by an Internal Revenue Code (Commuter Benefts 26 CFR ). 22 Publc Employees Beneft Board 2016 Enrollment Gude