School employees. PEBB Long-Term Disability Enrollment/Change form, PEBB Long-Term Disability Evidence of Insurability form, Employee Authorization for Payroll Deduction to Health Savings Account, Health Savings Account Beneficiary Designation, PEBB Program Administrative Policy Addendum 45-2A, PEBB Program Administrative Policy Addendum 45-2A. Your PEBB benefits for2021 HCA 51-0205 (10/20) PEBB Retiree Enrollment Guide Monthly Premiums Pages 7–9. Also provide evidence the marriage/partnership is still valid (e.g., a utility bill or bank statement) dated within the past six months showing both names. F��$���HK�ؖP�lvw���L݌_�ԙҘ���2��b��?�0�������r�+�/ֽ�iذ��;L�jA��? If adding the child increases your premium, your employer must receive this form no later than 60 days after the date of birth, adoption, or date the legal obligation is assumed for support in anticipation of adoption. 192 0 obj <> endobj Verify construction licenses, bond information, and worker’s compensation information. utility bill); letter or document showing coverage was lost (e.g. (Dependents can have different providers. Medicare benefit verification letter; copy of Medicare card; notice of denial of Medicare coverage; Social Security denial letter; Medicare entitlement or cessation of disability form. It allows access to care from a national network of primary care providers, specialists and pharmacies of your choice, including OHSU, without a referral. From November 1 – 30, 2018, you can make changes to your PEBB account that will be effective January 1, 2019.You can make your changes online in My Account. Use the ASIFlex website for claim forms and administrative information. Please seek tax advice from a qualified tax advisor. Get your statement of insurance. Help with PEBB My Account login. Contact PEBB; Login; Register. 257 0 obj <>stream Employee's or dependent’s current health plan becomes unavailable because the employee or dependent is no longer eligible for a health savings account (HSA). Visa or passport with date of entry; proof of former and current residence (e.g. There is something for everyone! You … Behavioral health services by plan. Good to know! You can make some changes during the year without a special open enrollment event. Changes you can make online using PEBB My Account during open enrollment. See the, Apply for, cancel (terminate), or change coverage amounts for supplemental life and accidental death and dismemberment (AD&D) insurance. How to enroll. If you use PEBB My Account, you will be directed to these forms. How do I make changes during the PEBB Program annual open enrollment? Note: "Employer contribution" means contributions made by the dependent's current or former employer toward health coverage as described in Treasury Regulation 54.9801-6. You can: Notice of privacy practices. 221 0 obj <>/Filter/FlateDecode/ID[<8B3B76BEA9CBFE41BE04C5D85DFAECAC><58BE067C9D3E1C4884397EE92039F3C4>]/Index[192 66]/Info 191 0 R/Length 136/Prev 583550/Root 193 0 R/Size 258/Type/XRef/W[1 3 1]>>stream Compare medical plans. Contact the plans. 5. Employee's dependent moves from another country to live within the United States, or from the United States to another country and that change in residence resulted in the dependent losing their health insurance. SmartHealth (PEBB) | Washington State Health Care Authority. PO Box 42684 WAC 182-08-198: When may a subscriber change health plans? Pebb Enterprises Accounts Payable, Contact Information, and Licenses On this page you can find Pebb Enterprises Accounts Payable information to get paid and other important information. Birth certificate (or hospital certificate with child’s footprints); certificate or decree of adoption; placement letter from adoption agency. The PEBB Parking account is not used to pay for monthly state lot parking.) Waive medical coverage if you are enrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare (coverage through the Health Benefit Exchange is not group coverage). We need to verify you first to ensure we have your PEBB member data. Log into My Account to view your coverage and premium surcharge information, get your statement of insurance, and make open enrollment changes. Note: University of Washington employees must make changes through Workday. Help with register. Your personnel, payroll, or benefits office must receive the appropriate, Change your life insurance beneficiary information. Get assistance with your PEBB account. endstream endobj startxref Medical plans and benefits. Parking Account (Maximum monthly contribution or reimbursement is $270.00) Monthly contribution (minimum $20) $ 1a. Type the code from the image: Submit. You can access multiple government services … You pay less for in-network services, more for out-of-network services. Find the right program for you. October newsletter now available! Kaiser Permanente WA Classic, Kaiser Permanente WA Value, and the Kaiser Permanente WA Consumer Directed Health Plan (CDHP) with a Health Savings Account (HSA) are available to residents in all counties we serve. The enrollment change will become effective January 1 of the following year. WAC 182-08-199: When may an employee enroll in or revoke an election and make a new election under the premium payment plan, Medical Flexible Spending Arrangement (FSA) or Dependent Care Assistance Program (DCAP)? Deadline to enroll The PEBB Program must receive your Retiree Election/Change form for Open Enrollment and Retiree Medicare Advantage Enrollment form (form C) by November 30, 2020. Due to COVID-19, HCA’s lobby is closed. certificate of credible coverage). Use the, Start, stop, or change your contribution to your health savings account (HSA). Birth, adoption, or assuming a legal obligation for support in anticipation of adoption. Sensitive data will be used to verify account ownership. SAW is the state’s secure single sign-on portal for external users.A SAW account will keep your sensitive information secure. 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. What changes can I make during a special open enrollment? When you submit an online plan change, please wait two business days to make any additional online plan changes. Existing dependents may not be added. You can set aside pre-tax dollars to pay for your … • Subscribe/unsubscribe to PEBB’s email service (page 3). Use the PEBB Premium Surcharge Attestation Change form or log into PEBB My Account. Note: Your personnel, payroll, or benefits office must key your enrollment in PEBB coverage before you can access My Account. Kaiser plans. Employee or a dependent becomes eligible for a state premium assistance subsidy for PEBB medical plan from Medicaid or a state CHIP. Get assistance with your PEBB account. When you enroll in a CDHP, your employer or the PEBB Program contributes money into your HSA on a prorated basis. << < > << Last 4 digits of subscriber SSN: Verify My Information. PEBB contracts with ASIFlex to administer the FSA program under PEBB administrative rules and in keeping with IRS code. %PDF-1.6 %���� 3Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner's employer-based group health plan. View your life and long-term disability insurance information. h�bbd```b``���@$��d: "��em�����`����� &��EJ��V0� �KDrE�Ȃ ɘ �+D� ��Hg�5A��^� `sv���W��n �e`HR�5�L���� � +1� Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options, Before you make a change to your health plan. If you forgot your user name/password select Get It Now or click here for tips on resetting your password . Skip Mega Menu My Accounts My Group Benefits. PEBB medical. Get Audio Code. Eligibility and enrollment. 2021 plan information. Employee or dependent loses eligibility for other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA). Sensitive data will be used to verify account ownership. PEBB does not designate premium contributions, contact your agency benefit office if you have additional questions about your premium contribution. The Navia Benefits Card. Help with register. If you have already registered, enter your User Name and Password in the Already Registered section and select Log In. Waiving medical coverage. What can I do in PEBB My Account? The last thing you want to worry about is health care. Eligibility Health coaches, online and self-guided programs, webinars, and more! You must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate) along with the Enrollment/Change form to your payroll or benefits office no later than 60 days after the event. To enroll in PEBB benefits, employees should contact your payroll or benefits office. endstream endobj 193 0 obj <. Cancellation letter from the health plan; coverage confirmation in a new health plan; Medicare entitlement letter; copy of current tax return claiming you as a dependent, Submit request for a plan change to: Note: University of Washington employees must make changes through Workday. Benefits Comparisons Pages 34–47. PEBB contracts with ASIFlex to administer Commuter Accounts to ensure they align with federal tax code. (If you prefer to fill out and mail in a printed form, select this link.) Before you make a change, it is important to: You must submit the appropriate forms to your payroll or benefits office during the PEBB Program's annual open enrollment or when a special open enrollment event occurs. Employee hire letter from their employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage. WAC 182-12-128: When may an employee waive enrollment in PEBB medical, and when may they enroll in PEBB medical after waiving enrollment? Reattest to the spouse or state-registered domestic partner coverage premium surcharge. Employee or dependent enrolls in or loses eligibility for Apple Health (Medicaid) or a state Children’s Health Insurance Program (CHIP). Help Using PEBB’s My Account We want to help you use My Account. Changes to medical and dental plans, removal of a dependent, and spouse or state registered domestic partner may be made through PEBB My Account until 11:59 pm on Monday, November 30, 2020. How and When Can I change my Commuter Account? select My Account under My PEBB in the left navigation panel. Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 Commuting means traveling between your home and your place of work on a regular basis. (Why do I need a SAW account? @Z����B ����mg9V���"T�5@� ʸ8# This guide walks you through these situations: • How to create an account (pages 1-2). If you do not enroll in PEBB retiree insurance However, if adding a newborn, newly adopted child, or child for whom the employee has assumed a legal obligation for support in anticipation of adoption, the employee should submit the required forms to the PEBB Program as soon as possible. FSA […] These changes may be allowed as a special open enrollment: Marriage certificate; certificate of state-registered domestic partnership or legal union. Read the full issue: State agency and higher-education K-12 and employer groups Retirees PEBB Continuation Coverage Since the newsletter was printed, there have been updates. 0 Check back in two business days to verify the coverage you selected and your spousal or state-registered domestic partner coverage premium surcharge attestation is correct. Your payroll, or benefits office must receive the appropriate PEBB Employee Enrollment/Change form during the PEBB Program's annual open enrolment. Valid court order showing legal custody, guardianship, or temporary guardianship, signed by a judge or officer of the court and a signed PEBB Extended Dependent Certification. Waive enrollment in PEBB medical if you have or are enrolling in other employer-based group medical insurance, a TRICARE plan, or Medicare effective January 1. UMP plans. Enrolled dependents will be listed on one account, not both. PEBB Statewide is a PPO plan. • Check your account and coverage information (page 3). You will be able to make most changes to your PEBB benefits on the Health Care Authority (HCA) PEBB My Account page. The Public Employees Benefits Board (PEBB) Program's For Your Benefit newsletter is your source for information and updates about your health benefits. If enrolling after waiving PEBB medical, only allowed if lost eligibility for Medicare. PEBB employees can choose from 4 health plans. You pay less for in-network services, more for out-of-network services. Health coaches, online and self-guided programs, webinars, and more! h�b```a``Nb`e`TNcd@ A�+s�``�q����{'�W4��n\�Q��z��|J40pt40tt�� Olympia, WA 98504-5502. Enroll in a medical plan, if you previously waived PEBB medical. Employee or dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE plan. If there is any conflict between information posted on the site and the FSA Enrollment Guide or DCAP Enrollment Guide, the Enrollment Guide prevails. However, members can use funds in their health savings account (HSA) to pay for many out-of-pocket costs (including deductibles), or allow HSA savings to grow for future medical expenses. Certificate of credible coverage; proof of enrollment or termination of coverage from TRICARE. To learn more about working with My Account, visit our Help with My Account webpage. Plan change requirements You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1 through 30) or if a special open enrollment event occurs. PEBB Retirees. PEBB virtual benefits fair. To sign up, go to PEBB My Account at hca.wa.gov/my-account. Complete the information below to get assistance with My Account. PEBB Statewide is a PPO plan. Make changes to your tobacco use premium surcharge attestation. Welcome to Navia Benefits! The Navia Benefits Card is a debit MasterCard® that allows you to access your FSA funds directly. Change your or a dependent's tobacco use premium surcharge attestation. Employee or dependent has a change in enrollment under another employer-based group health plan during its annual open enrollment that does not align with the PEBB Program’s annual open enrollment. Employee has a change in employment status that affects their eligibility for their employer contribution toward their employer-based group health plan. We recommend using your personal email address to access your account. Change your name and/or address. PEBB … Choose optional benefits you are currently enrolled in or will enroll in 2021. Employee hire letter from employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage. Use the, Change your HSA beneficiary information. Employee or dependent has a change in residence that affects health plan availability. It allows access to care from a national network of primary care providers, specialists and pharmacies of your choice, including OHSU, without a referral. Some information described in this guide is based on federal or state laws. Visit HCA’s website at hca.wa.gov/pebb-retirees or call PEBB Customer Service at 1-800-200-1004 (TRS: 711). PEBB Statewide Plan members. 2021 rates. Dependent verification. Use the appropriate, Remove dependent(s) from coverage due to loss of eligibility due to divorce, annulment, dissolution, or a qualifying event of a dependent ceasing to be eligible as a dependent child (required). Please complete your registration by entering the code you see below and clicking the Submit button. Enter subscriber last name: Enter subscriber date of birth: RadDatePicker RadDatePicker; Open the calendar popup. You … Connect with us Contact HCA. See the, Enroll in, cancel (terminate), or increase or decrease the waiting period for supplemental long-term disability coverage. Health Care Authority Questions about PEBB or SEBB retiree benefits? PEBB Statewide Plan members. Help with register. Child becomes eligible as an extended dependent through legal custody or legal guardianship. You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1 through 30) or if a special open enrollment event occurs. Retirement is an exciting time, but it can also be a challenge. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. Wellness Central; my journey, my health. 1Employee may add only the new spouse, state-registered domestic partner, or children of the spouse or partner. Just follow the “Direct Deposit” directions under “My Account” in the navigation menu. Oregon's Public Employees' Benefit Board contracts for and administers benefits for eligible state employees. Wellness Central; my journey, my health. Please confirm the email address you use to login, as well as the last 4 digits of the Subscriber SSN. All changes are effective January 1, 2019. You may also make some changes using PEBB My Account. You may be enrolled in only one PEBB medical or dental plan. All eligible dependents must enroll in the same health plan. See PEBB's Summary Plan Description for details about eligibility and enrollment in the FSA program. How to determine eligibility. Phone: 071 084 8294 If you are a new user select Register Here. 2021 Open Enrollment: November 1 - 30. Join Facebook to connect with My Pebb and others you may know. Get Audio Code. Learn the requirements to make changes to your PEBB coverage. Online changes: PEBB My Account portal. Administrative code 182-12-109 agency Benefit office if you are eligible for WA state Care! 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A CDHP, your employer or the PEBB Program contributes money into your HSA on a regular basis days! Into My Account if enrolling after waiving PEBB medical after waiving enrollment Part and. “ direct deposit of your Benefit payments from your online retirement Account learn the to. The calendar popup or document showing coverage was lost ( e.g link )... Contracts for and administers benefits for Washington Public employees ' Benefit Board contracts for and administers benefits for Washington employees... See the, Apply for, cancel ( terminate ), or assuming a legal obligation for support anticipation! Section and select log in can make some changes using PEBB My Account (. 8294 change your or a dependent ) outside of annual open enrollment letter! Affects their eligibility for Medicare information, and more employees ' Benefit Board contracts for and administers for! Showing coverage was lost ( e.g up, go to PEBB ’ s information! Additional online plan change, please wait two business days to make changes... Navigation panel as those retiring before they are Medicare-eligible find office address phone! Days to make changes to your PEBB benefits, employees should contact payroll... Online and self-guided programs, webinars, and email for each office 10 Lot, 251 Izingolweni Rd, Edward. Lot, 251 Izingolweni Rd, Port Edward, 4295, visit our help with My at. Receive the appropriate, change your contribution to your PEBB coverage before you can make some using! To view your medical and dental coverage information ( page 3 ): select My Account under My in. Like changing a health plan or payroll or benefits office ; or COBRA election notice can My! Health plans Commuter accounts to ensure they align with federal tax code if you use My Account pebb my account to! Card is a debit MasterCard® that allows you to access your Account and information. Visit HCA ’ s compensation information their employer-based group health plan or enrolling a dependent that is not group....