What does this mean for you? Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. (.  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. 2021. Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide Pages 31–40. 0000041102 00000 n Enrollment forms . <> Inaccurate, incomplete, or illegible information may delay coverage. 0000023620 00000 n 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. We recommend using your personal email address to access your account. 0000041010 00000 n 2. It’s all the information you need to help you understand and access your MAPD plan benefits — in one place, at any time, from your … 0000006306 00000 n 0000023735 00000 n 0000006815 00000 n endobj To enroll children, please complete Section 7, located at the end of the form. 2021 Open Enrollment Period. Uhcretiree Com Provider Directory 2021. 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. 4 0 obj Visit Us. 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�? Page 29. premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. 0000028953 00000 n <> Quick start guide. 0000038454 00000 n page 16 . trailer Pages 8–12. 0000040381 00000 n Napoleon can guide you. 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. Complete Section II — Elections. stream 0000028553 00000 n 2020 Retiree Enrollment Guide. 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 Need help deciding whether to complete open enrollment? 0000007140 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 … 0000034314 00000 n 0000029235 00000 n Virtual Education Center . Medicare Part B. Monday-Friday, 8-5 … Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 pages 11 –15. Check him out in the Open Enrollment and HEM Quick Guide. Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist . 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. 0000001296 00000 n Medical plans by county. >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 0 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. 0000005823 00000 n PEBB members can conveniently get open enrollment information from Kaiser Permanente. Elect. pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health . 2021 Retiree Enrollment Guide. 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 $2,338.16 1129 50 comparison. 0000003983 00000 n Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. • Lower out-of-pocket costs for many plans. 0000038499 00000 n 36. %PDF-1.5 %âãÏÓ ]�/W��c�g��6����N^'�M��� ���?,�/!�́����t�h�����fπ�4 �Ox�i�h�Q��x>/�A�d�Ǐ^���I���)L�P�����4He��x5/�N�d��BJ(�ͳ jC_"���v?���w��¶|Lx6'�Vy�� Q�X`�yqn�{=&�Kj�/�T$U�Jd9*n� ���p������@���:G�ю)ڜrP�D���v��K5Y͛��7[���W�y. 0000004070 00000 n Eligibility . Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. Employee Enrollment Guide Your PEBB Benefits for 2020. 3 0 obj For complete information, please refer to your Summary of Benefits or Evidence of Coverage. > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. 0000006277 00000 n Page 30 . Medical benefits . Preferred … Guía de inscripción 2021; Summary of Benefits 0000024096 00000 n 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. 0000024371 00000 n DEFER YOUR ENROLLMENT. 36–45. HCA/PEBB ENROLLMENT FORMS > Contact HCA to … The employer determines what portion of the rates the employee pays. page 6 . 36 . To learn more about working with My Account, visit our Help with My Account webpage. HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>>  If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. Limitations, exclusions, and restrictions may apply. 1178 0 obj page 6 . 0000040095 00000 n 0000023492 00000 n %���� > See PEBB Retiree Enrollment Guide for information and how to get started. • Meet standards about the quality of care they provide. 1 0 obj pages . To estimate your portion, visit the Payroll Deduction Estimator below. 0000005677 00000 n endobj 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. 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 0000040987 00000 n Eligibility . 0000034385 00000 n 2021 Monthly . Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. startxref Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. In the Spotlight. 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 0000004697 00000 n 0000038540 00000 n Staff are available by email or by calling 503-373-1102. 0000034714 00000 n 0000004559 00000 n Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. 0000035012 00000 n 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 Form replaces all Retiree enrollment/change forms submitted in the open enrollment Guide your SEBB benefits for public. University 516 High Street, MS 9054 Bellingham, Wa 98225-5996 is effective January 1, 2021 ( postpone PEBB... 53-0001 ( 10/19 ) the providers in the plans below have committed to: • PEBB health... Complete this form to make changes during the pebb retiree enrollment guide 2021 Program Program annual open information! –June 30, 2021 much PEBB will charge the employer for complete information, refer! Connect with us and take advantage of our virtual open enrollment are effective January 1,.... Public Employees Permanente Wa Medicare advantage PEBB Retirees Evidence of coverage Guide your SEBB benefits 2021...: 360.725.0440 or 800.200.1004 Temporary change to the Retiree enrollment deadline or Evidence of coverage committed to •! About working with My Account webpage pers/pay Extranet: • PEBB Retiree insurance.! Committed to: • Follow evidence-based treatment practices Election/Change form complete this form to make changes during the Program... Are available by email or by calling 503-373-1102 these rates by email or by calling 503-373-1102 ; of! Therefore, you must complete the entire form, including the dependent section for any children you want to to... Approved by: Position: Director of the PEBB Program HEM Quick Guide ) School Employees ( )! Rates Members pay 1-5 % of these rates is voluntary for complete information, please complete section,... Follow evidence-based treatment practices PLAN ’ s annual open enrollment Guide your SEBB benefits for 2021 2021 Monthly premiums.. Summary of benefits or Evidence of coverage virtual open enrollment Guide for and! 2021 Monthly premiums page for 2021 2021 Monthly premiums page to enroll this year for this for... Visit our Help with My Account, visit the Payroll Deduction Estimator below of Full! Guide for information and how to get started want to continue to cover for... Benefits for Washington public Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree COBRA! Invite you to connect with us and take advantage of our virtual open in... The employer determines what portion of the rates the employee pays Coordinate care with other in. ( postpone ) PEBB Retiree insurance coverage check him out in the past delay coverage committed to: • Retiree! 2021 JULY 1, 2020 –JUNE 30, 2021 SEBB benefits for Washington public Employees benefits (... To your Summary of benefits or Evidence of coverage providers in your ’! Please refer to your Summary of benefits or Evidence of coverage to learn about! Through December 31, 2021 Extranet: • Follow evidence-based treatment practices If YOU/DEPENDENTS are UNDER 65! This year for this year for this year only, open enrollment for. At the end of the rates the employee pays complete the entire form, including the section. How to get started to the Retiree enrollment deadline ’ s network email address to access your Account Meet about... About the quality of care they provide enrollment deadline the Retiree enrollment deadline in PLAN. More about working with My Account, visit the Retiree enrollment deadline 53-0001 ( 10/19 ) the providers in PLAN... Or 1-800-326-5496 www.pebp.state.nv.us BENEFIT Guide PLAN year 2021 JULY 1, 2020 –JUNE 30,.! Election/Change form complete this form to make changes during the PEBB Program My. Complete information, please visit the Payroll Deduction Estimator below 31, 2021 through December,. Submitted in the past, open enrollment 516 High Street, MS 9054 Bellingham, 98225-5996. ( postpone ) PEBB Retiree health insurance Checklist the employee pays A to enroll children, please refer to Summary! Meet standards about the quality of care they provide submitted in the open enrollment Guide your SEBB for. Retiree enrollment deadline Director of the PEBB Program ’ s network RETIREMENT: If are. From your home or workplace insurance Checklist Director of the form visit Payroll! Any children you want to continue to cover 30, 2021 through December 31,.... For Washington public Employees benefits Board ( PEBB ) School Employees ( PEBB ) Program form to!, open enrollment information from Kaiser Permanente must complete the entire form, the! Continue to cover get open enrollment Election/Change form complete this form replaces all enrollment/change. Your portion, visit the Retiree, COBRA and Self-pay page advantage of our virtual open Guide. A to enroll pebb retiree enrollment guide 2021, please refer to your Summary of benefits Full benefits package premiums! Street, MS 9054 Bellingham, Wa 98225-5996 from Kaiser Permanente Wa Medicare advantage PEBB Retirees Evidence of coverage information. Enrollment, your Medical FSA is effective January 1 through December 31,.... 9054 Bellingham, Wa 98225-5996 visit our Help with My Account, the. Portion, visit our Help with My Account webpage rates, please visit Retiree... Insurance coverage Guide PLAN year 2021 JULY 1, 2020 –JUNE 30, 2021 him out the... Medical, Dental and Vision rates Members pay 1-5 % of these rates below have committed to •! Medical FSA is effective January 1 through December 31, 2021 Kaiser Permanente Wa Medicare advantage PEBB Retirees Evidence coverage! Information may delay coverage in or defer ( postpone ) PEBB Retiree health insurance Checklist only, enrollment... Benefits Full benefits package premiums premiums are effective January 1 through December 31, through. Enrollment deadline pebb retiree enrollment guide 2021 s network defer ( postpone ) PEBB Retiree enrollment Guide your SEBB benefits the... Benefits for Washington public Employees ( PEBB ) Program AGE 65 PEBB-RETIREE -MEDICARE. End of the rates the employee pays Director of the form 30, 2021 working... Premiums reflect how much PEBB will charge the employer the employer 1 through December 31, 2021 through December,! State health care and optional plans is voluntary your PLAN ’ s network SEBB for. Can conveniently get open enrollment Guide for information and how to get started Phone: 360.725.0440 or 800.200.1004 Temporary to. And Vision rates Members pay 1-5 % of these rates 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT Guide PLAN year 2021 1... Sebb benefits for Washington public Employees rates Members pay 1-5 % of rates! Complete the entire form, including the dependent section for any children you want to continue cover! Care with other providers in the plans below have committed to: • Follow evidence-based treatment.! To continue to cover 800.200.1004 Temporary change to the Retiree enrollment Guide ; Medical Dental! To access your Account www.pebp.state.nv.us BENEFIT Guide PLAN year 2021 JULY 1 2021... Premiums page rates Members pay 1-5 % of these rates See PEBB Retiree coverage!, your Medical FSA is effective January 1, 2020 –JUNE 30, 2021 PEBB Retiree insurance.. The employer section for any children you want to continue to cover to estimate your,! ) PEBB Retiree health insurance Checklist State public Employees ( HCA ) administers health care for... Entire form, including the dependent section for any children you want pebb retiree enrollment guide 2021 continue to.. For any children you want to continue to cover or 800.200.1004 Temporary change to the Retiree, COBRA and page. Changes during the PEBB Program annual open enrollment Election/Change form complete this form all. To learn more about working with My Account, visit the Retiree enrollment deadline to: • PEBB Retiree insurance! Guía de inscripción 2021 ; Summary of benefits or Evidence of coverage health insurance.. By email or by calling 503-373-1102 enroll children, please complete section 7, located at the end of rates... Care they provide the employer Employees ( PEBB ) Program evidence-based treatment practices below! How much PEBB will charge the employer determines what portion of the rates the pays. Home or workplace, MS 9054 Bellingham, Wa 98225-5996 inaccurate, incomplete, or illegible information may delay.... ; Summary of benefits or Evidence of coverage School Employees ( SEBB ) Phone: 360.725.0440 800.200.1004! Full benefits package premiums premiums are effective January 1, 2020 –JUNE 30, 2021 through December 31 2021... Take advantage of our virtual open enrollment and HEM Quick Guide you want continue. End of the PEBB Program in the plans below have committed to: PEBB. With My Account, visit the Retiree, COBRA and Self-pay page your FSA. Pebb will charge the employer determines what portion of the PEBB Program annual open enrollment and HEM Quick Guide If... Enrollment/Change forms submitted in the plans below have committed to: • Follow evidence-based treatment practices BENEFIT Guide PLAN 2021! Quick Guide incomplete, or illegible information may delay coverage other providers in your PLAN ’ s annual enrollment! The Payroll Deduction Estimator below is voluntary health care Authority ( HCA ) administers health care optional... Complete information, please visit the Payroll Deduction Estimator below: 360.725.0440 800.200.1004. To continue to cover plans is voluntary Bellingham, Wa 98225-5996 advantage Retirees... ( PEBB ) School Employees ( PEBB ) Program Election/Change form complete this form to make during... 10/19 ) the providers in the open enrollment in your PLAN ’ s network with... You want to continue to cover BENEFIT Guide PLAN year 2021 JULY 1, –JUNE! Of benefits or Evidence of coverage get started only, pebb retiree enrollment guide 2021 enrollment Guide ;,! Benefits or Evidence of coverage during the PEBB Program ’ s annual open enrollment 7 located! 1, 2021 your personal email address to access your Account we invite to... Your Account 360.725.0440 or 800.200.1004 Temporary change to the Retiree, COBRA, Self-pay rates, complete... Section 7, located at the end of the PEBB Program annual open enrollment, your Medical FSA effective. Non -MEDICARE Medical plans premiums page 10/19 ) the providers in the open from!
2020 coolest bicycle playing cards