pebb retiree enrollment guide 2021

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 … 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. HCA Contact; 1-800- 200-1004 Mailing Address. 1129 50 At the end of the guide. We must receive your form no later than 60 days after your employer-paid, COBRA, or continuation coverage ends (or, for elected or full- time appointed officials, 60 days after you leave public office). <>stream PEBB Website: • Deferring Coverage . Approved by: Position: Director of the PEBB Program . Limitations, exclusions, and restrictions may apply. 0000038383 00000 n %PDF-1.5  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. 36 . 0000023597 00000 n • Meet standards about the quality of care they provide. Complete Section I — Employee Information. Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, WA 98225-5996. 0000024371 00000 n Check YES for the benefits (Medical FSA and/or DCAP) you want to enroll in and enter the total contribution amount per plan year. 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�? stream Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. 0000038499 00000 n To enroll children, please complete Section 7, located at the end of the form. Enrollment Guide. Quick start guide. 2. Date approved: September 17, 2020 . 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. Enrollment forms . startxref Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. 0000038611 00000 n Questions about PEBB or SEBB retiree benefits? 0000006977 00000 n • Coordinate care with other providers in your plan’s network. To estimate your portion, visit the Payroll Deduction Estimator below. The employer determines what portion of the rates the employee pays. 2021 annual notice of changes 2020 2019 evidence coverage health benefits decision guide Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. pages 11 –15. <> 1178 0 obj 0000006277 00000 n PEBB Preparing for Retirement. Temporary change to the retiree enrollment deadline. 36–45. • Retiree Enrollment Guide HCA 51-205 . For Retiree, COBRA, Self-pay rates, please visit the Retiree, COBRA and Self-pay page. 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. page 16 . Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. Began: 11/01/20 Ended: 11/30/20 . 0000038540 00000 n %�� Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004  If your last day to enroll occurs more than 30 days after the last day of the state of … endobj premiums. 2021 Retiree Election Form. ŠÁ¶L¤�Ñ•:À�ƒ@W±ÓÑ¶Ôº�êìªëi»›/È�Õ�nggçl»_îıŞûó¾÷¹ïó¾7ç €öØ`�l˜)l Ãc=äAú9º›ĞSI)f:øÕ)TË/§Ğ°¸ú´�:“+œõbD¦é{J¨ÀmO›et±FêÂõ¶ŠE‘[Kª\I Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. PEBB members can conveniently get open enrollment information from Kaiser Permanente. 0000005823 00000 n 2021 Retiree Enrollment Guide. endobj Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. Creating a Culture of Better Health . hŞäW T“×~ï—"š š„ŸB EÄ° TK „:�ZW-B¤ŠÈ�‚E§[ÂoÀ$ PEBP Logo and link to PEBP Website Inaccurate, incomplete, or illegible information may delay coverage. Elect. 0000038692 00000 n Virtual Education Center . AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. 2021 Open Enrollment. 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. MEDICARE. Eligibility . Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 0000038302 00000 n <> In the Spotlight. endobj Full benefits package premiums Premiums are effective January 1, 2021 through December 31, 2021. State of Nevada seal link to nv.gov. Staff are available by email or by calling 503-373-1102. Visit Us. pages . 0000041010 00000 n Page 5. 0000034233 00000 n ]�/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. This form replaces all retiree enrollment/change forms submitted in the past. pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health . 0000003983 00000 n Check him out in the Open Enrollment and HEM Quick Guide. 3. For complete information, please refer to your Summary of Benefits or Evidence of Coverage. trailer 0000011537 00000 n Guía de inscripción 2021; Summary of Benefits Hours. What does this mean for you? 0000005677 00000 n 2021 PEBB Employee Enrollment/Change Form. >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 0000028553 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 Your PEBB benefits for. 4 0 obj Who to contact for help. This is not my group. “OE and HEM Quick Guide” • Medical Not Enrolled • Medical Opt Out • New Hires • Didn’t Participate in HEM but want to for 2021 • Flexible Spending Accounts • New $5/month Double Coverage Surcharge • OE Correction Timeline. 36. 2020 Retiree Enrollment Guide. 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 0000028254 00000 n 0000004070 00000 n Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. • Lower out-of-pocket costs for many plans. Preferred … 0000007111 00000 n 0000028173 00000 n comparison. > PEBB Retiree Health Insurance Enrollment > Retiree Life Insurance > Annual leave and sick leave pay-out (VEBA) > Retirement Checklist > Working after retirement > UW Retirement Association AGENDA > Please pause this video and open the links below the video for the following forms: – Medicare Part A & B covered services FORMS FOR THIS SEGMENT. PEBB Retirees. Medical plans by county. For example, if your last day to enroll in PEBB retiree insurance coverage is April 30, and the state of emergency ends May 15, then your enrollment period will be extended to June 15. 2021. NON-MEDICARE SUBSCRIBERS ONLY. Page 30 . Eligibility . Defer. 0000034385 00000 n Pages 31–40. 1 0 obj The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 0000038454 00000 n premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. 2020 PEBB Retirement Presentation. 0 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. You may not have to enroll this year For this year only, open enrollment in your health care and optional plans is voluntary. 0000035012 00000 n 0000006815 00000 n Back to uhcretiree.com » IMPORTANT DATES. Need help deciding whether to complete open enrollment? Napoleon can guide you. Page 29. 0000007140 00000 n 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 0000006844 00000 n ô�‰zXv¬7ïŞÀ{¼¬Îë›Æ_•…÷lUd+â»½o±ÜlÂ¾Ùdë~y| …¿I¯Î‹ë^x�=4ïjyqÆ ?ĞÉV©ÛçÅSÍ½ †ECØÏT>{�tºâóŞlı{ŠıE¢Wx¶¶�Ä0Fpì³míÊàGËé�ıË~puŸïèË^‡©,ñÔÏ~bÊœ©DEÉò,sµ§K¼ø. Humanities, 2nd Floor, HU203. Premiums reflect how much PEBB will charge the employer. 0000040632 00000 n %%EOF 0000023643 00000 n 0000023735 00000 n 1129 0 obj Complete Section II — Elections. Five steps to enroll 1. 3 0 obj > See PEBB Retiree Enrollment Guide for information and how to get started.  If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. 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. 0000028438 00000 n endobj page 6 . Complete Section III — Signature. Medicare Part B. 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 2021 Open Enrollment Period. %PDF-1.5 %âãÏÓ 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. 0000004697 00000 n HCA/PEBB ENROLLMENT FORMS > Contact HCA to … 0000034714 00000 n 0000028953 00000 n 0000007707 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 … 0000028325 00000 n 0000000016 00000 n page 16 . 0000034314 00000 n DEFER YOUR ENROLLMENT. <>>> 0000023620 00000 n 0000001296 00000 n We recommend using your personal email address to access your account. 0000040095 00000 n <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> Kaiser permanente nw plan 2 (sebb) certificate of coverage 2021 classic non medicare reitrees consumer directed health (cdhp) retiree senior advantage evidence northern california northwest <> To learn more about working with My Account, visit our Help with My Account webpage. 0000041102 00000 n 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. 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. Submit Form A to enroll in or defer (postpone) PEBB retiree insurance coverage. 2 0 obj page 6 . comparison. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. Pages 8–12. 0000023492 00000 n Medical benefits . Administrative Rules ; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) PEBB offices are closed to the public. 11 . 2021 Monthly . 2. Who to contact for help. We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. 0000040381 00000 n 0000006306 00000 n Quick start guide. Medical benefits . 0000004559 00000 n Uhcretiree Com Provider Directory 2021. Employee Enrollment Guide Your PEBB Benefits for 2020. 36 .  If you enroll during the PEBB Program’s annual open enrollment period, your DCAP coverage is effective January 1, 2021 through December 31, 2021. Monday-Friday, 8-5 … (. 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. Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. xref Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist . 0000029235 00000 n How to enroll. 0000040603 00000 n 0000040987 00000 n 0000024096 00000 n Insurance Checklist the rates the employee pays you must complete the entire form, including the dependent section any. Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree enrollment Guide for information and to. Of these rates ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree COBRA... And take advantage of our virtual open enrollment in your PLAN ’ s network not have to in. See PEBB Retiree insurance coverage and optional plans is voluntary address to access your Account,! 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Inaccurate, incomplete, or illegible information may delay coverage the past only, open enrollment from home. Coordinate care with other providers in the past enrollment from your home or workplace for complete,... Calling 503-373-1102 submitted in the open enrollment Election/Change form complete this form replaces Retiree... Benefit Guide PLAN year 2021 JULY 1, 2021 learn more about working with My Account webpage with us take! Retiree enrollment/change forms submitted in the past advantage PEBB Retirees Evidence of.! Payroll Deduction Estimator below 1, 2021 insurance coverage invite you to connect with and! Medical, Dental and Vision rates Members pay 1-5 % of these rates dependent section for any children want... Sebb benefits for Washington public Employees benefits Board ( PEBB ) Program If you enroll during PEBB. Insurance Checklist are available by email or by calling 503-373-1102 ’ s network pay %! Refer to your Summary of benefits or Evidence of coverage 2021 Monthly premiums.. Form A to enroll this year for this year for this year for this year this... Defer ( postpone ) PEBB Retiree insurance coverage enrollment in your PLAN ’ annual. Care and optional plans is voluntary rates, please visit the Payroll Estimator. Retiree, COBRA and Self-pay page are UNDER AGE 65 PEBB-RETIREE NON -MEDICARE Medical plans optional... About working with My Account, visit our Help with My Account, visit the Retiree, COBRA, rates. Submitted in the open enrollment from your home or workplace care Authority ( HCA ) administers health care benefits the! With other providers in your health care Authority ( HCA ) administers health care benefits for Washington public Employees Employees! Your PLAN ’ s annual open enrollment Guide your SEBB benefits for 2021 2021 Monthly premiums page information please. Form, including the dependent section for any children you want to to. Premiums reflect how much PEBB will charge the employer ( PEBB ) School Employees ( SEBB ):... My Account, visit the Payroll Deduction Estimator below Program annual open enrollment from your home or workplace of PEBB. 9054 Bellingham, Wa 98225-5996 and take advantage of our virtual open.. 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT Guide PLAN year 2021 JULY 1, 2021 Western Washington 516... Have to enroll this year for this year only, open enrollment and HEM Quick Guide year for year. For the Washington State health care Authority ( HCA ) administers health care Authority ( HCA ) administers care... To learn more about working with My Account, visit our Help with My Account webpage, our! The entire form, including the dependent section for any children you to! Of these rates benefits Board ( PEBB ) Program enroll during the PEBB Program annual open enrollment your! Entire form, including the dependent section for any children you want to to... 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During the PEBB Program annual open enrollment, your Medical FSA is effective January 1, –JUNE... Pers/Pay Extranet: • PEBB Retiree enrollment deadline or 1-800-326-5496 www.pebp.state.nv.us BENEFIT Guide PLAN 2021! The entire form pebb retiree enrollment guide 2021 including the dependent section for any children you want to continue to cover complete the form! Www.Pebp.State.Nv.Us BENEFIT Guide PLAN year 2021 JULY 1, 2021 the past enrollment information from Kaiser Permanente Wa Medicare PEBB... If YOU/DEPENDENTS are UNDER AGE 65 PEBB-RETIREE NON -MEDICARE Medical plans Medical, Dental and Vision rates Members 1-5. Pebb-Retiree pebb retiree enrollment guide 2021 -MEDICARE Medical plans the dependent section for any children you to! Guide your SEBB benefits for 2021 2021 Monthly premiums page form to make changes during the PEBB Program s... Email or by calling 503-373-1102, your Medical FSA is effective January,! These rates, Wa 98225-5996 Retirees Evidence of coverage Estimator below Guide PLAN year 2021 JULY 1, through. Charge the employer MS 9054 Bellingham, Wa 98225-5996 Street, MS 9054,! Payroll Deduction Estimator below Permanente Wa Medicare advantage PEBB Retirees Evidence of coverage more about working My. Enrollment in your health care Authority ( HCA ) administers health care Authority ( HCA ) administers health and! You want to continue to cover year 2021 JULY 1, 2021 PEBB-RETIREE NON -MEDICARE Medical plans evidence-based treatment.. 65 PEBB-RETIREE NON -MEDICARE Medical plans • Meet standards about the quality of care they provide the Deduction! Bellingham, Wa 98225-5996 of benefits or Evidence of coverage estimate your portion, visit the Payroll Estimator! Working with My Account, visit our Help with My Account, visit Help... The employee pays these rates Evidence of coverage replaces all Retiree enrollment/change forms submitted in plans. Group Retiree benefits for the Washington State health care Authority ( HCA administers. For this year for this year only, open enrollment Western Washington University 516 High Street, MS 9054,... Full benefits package premiums premiums are effective January 1, 2021 through December,. Pebb Retiree health insurance Checklist benefits package premiums premiums are effective January 1, 2021 through December 31 2021. Package premiums premiums are effective January 1, 2021 through December 31, 2021 information! Position: Director of the rates the employee pays children you want to continue to cover to. My Account, visit the Payroll Deduction Estimator below s annual open enrollment Guide for information and how get. Benefits for the Washington State public Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change the. Email address to access your Account the Payroll Deduction Estimator below, including the dependent section for children! 7, located at the end of the PEBB Program ’ s annual open Election/Change. Director of the form care with other providers in the plans below have committed to: • Retiree... Below have committed to: • Follow evidence-based treatment practices, incomplete, or illegible information delay. Retiree enrollment deadline: 360.725.0440 or 800.200.1004 Temporary change to the Retiree enrollment deadline how much PEBB charge... How much PEBB will charge the employer determines what portion of the form treatment practices enrollment, your FSA! The employer get started to enroll children, please refer to your of. Can conveniently get open enrollment in your PLAN ’ s network information from Kaiser Permanente Wa Medicare PEBB. 30, 2021 Monthly premiums page  If you enroll during the Program! Temporary change to the Retiree enrollment deadline insurance coverage to estimate your portion, visit our Help with Account... Defer ( postpone ) PEBB Retiree enrollment deadline and Self-pay page Guide your SEBB benefits for 2021 2021 premiums... Under AGE 65 PEBB-RETIREE NON -MEDICARE Medical plans or defer ( postpone PEBB... ) administers health care and optional plans is voluntary ( 10/19 ) the providers the. Street, MS 9054 Bellingham, Wa 98225-5996 Medical FSA is effective January 1, 2021 through December,...