This form replaces all retiree enrollment/change forms submitted in the past. 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. Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. 0000038454 00000 n 0000004070 00000 n In the Spotlight. Enrollment Guide. 0000034714 00000 n  If your last day to enroll occurs more than 30 days after the last day of the state of … %���� 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. 0000004559 00000 n Creating a Culture of Better Health . <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> 0000024371 00000 n 0000000016 00000 n 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. <>stream Limitations, exclusions, and restrictions may apply. endobj Date approved: September 17, 2020 . page 16 . 0000038302 00000 n Back to uhcretiree.com » IMPORTANT DATES. 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 <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> >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 Humanities, 2nd Floor, HU203. Five steps to enroll 1. PEBB Preparing for Retirement. Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. This is not my group. Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. HCA Contact; 1-800- 200-1004 Mailing Address. Quick start guide. 2021 PEBB Employee Enrollment/Change Form. Began: 11/01/20 Ended: 11/30/20 . premiums. 0000023620 00000 n Uhcretiree Com Provider Directory 2021. Preferred … 0000034233 00000 n Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide 0000028325 00000 n Submit Form A to enroll in or defer (postpone) PEBB retiree insurance coverage. 4 0 obj <> Page 30 . 0000006815 00000 n 36 . 1178 0 obj HCA/PEBB ENROLLMENT FORMS > Contact HCA to … 0000040603 00000 n Complete Section II — Elections. 1129 0 obj Temporary change to the retiree enrollment deadline. 0000029235 00000 n For complete information, please refer to your Summary of Benefits or Evidence of Coverage. 0000034314 00000 n PEBB/My Account login Log into My Account to view your coverage and premium surcharge information, get your statement of insurance, and make open enrollment changes. page 6 . Who to contact for help. page 16 . HCA 53-0001 (10/19) The providers in the plans below have committed to: • Follow evidence-based treatment practices. What does this mean for you? pages 11 –15. We recommend using your personal email address to access your account. The employer determines what portion of the rates the employee pays. 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. 1129 50 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. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. 0000041102 00000 n endobj comparison. 2021 Retiree Enrollment Guide. %%EOF Complete Section III — Signature. Eligibility . 2021 Open Enrollment. 0000035012 00000 n Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. Pages 31–40. Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist .  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. 0000001296 00000 n You may not have to enroll this year For this year only, open enrollment in your health care and optional plans is voluntary. 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. 0000006844 00000 n How to enroll. 0000007707 00000 n Page 5. 11 . Visit Us. 36 . 3 0 obj Guía de inscripción 2021; Summary of Benefits Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 Staff are available by email or by calling 503-373-1102. Hours. 2. Who to contact for help. 0000005823 00000 n <>>> Medical plans by county. For Retiree, COBRA, Self-pay rates, please visit the Retiree, COBRA and Self-pay page. 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 0000028254 00000 n 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 0000040381 00000 n • Lower out-of-pocket costs for many plans. Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 2021. 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�? Medicare Part B. <> xref 0000028953 00000 n Pages 8–12. startxref We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. Your PEBB benefits for. trailer Enrollment forms . 36–45. 2021 Monthly . AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. %PDF-1.5 %âãÏÓ Kaiser Permanente Nw Plan 2 Sebb Certificate Of Coverage 2021. 0000038692 00000 n Need help deciding whether to complete open enrollment? Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. 2020 PEBB Retirement Presentation. 0000007140 00000 n 2 0 obj page 6 . DEFER YOUR ENROLLMENT. Full benefits package premiums Premiums are effective January 1, 2021 through December 31, 2021. 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. NON-MEDICARE SUBSCRIBERS ONLY. 2021 annual notice of changes 2020 2019 evidence coverage health benefits decision guide • Retiree Enrollment Guide HCA 51-205 . 0000005677 00000 n 0000004697 00000 n Premiums reflect how much PEBB will charge the employer. comparison. pebb insurance wa › Verified 2 days ago › Url: https://www.healthgolds.com Go Now › Get more: Pebb insurance wa Show List Health . Medical benefits . 1 0 obj 0000007111 00000 n 0000011537 00000 n 0000038540 00000 n 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 Questions about PEBB or SEBB retiree benefits? Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, WA 98225-5996. PEBP Logo and link to PEBP Website Eligibility . 0000040095 00000 n hŞäW T“×~ï—"š š„ŸB EÄ° TK „:�ZW-B¤ŠÈ�‚E§[ÂoÀ$ > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. Medical benefits . Quick start guide. ]�/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. 0000023597 00000 n %PDF-1.5 endobj ô�‰zXv¬7ïŞÀ{¼¬Îë›Æ_•…÷lUd+⻽o±Ül¾Ùdë~y| …¿I¯Î‹ë^x�=4ïjyqÆ ?ĞÉV©ÛçÅSͽ †ECØÏT>{�tºâóŞlı{ŠıE¢Wx¶¶�Ä0Fpì³míÊàGËé�ıË~puŸïèË^‡©,ñÔÏ~bÊœ©DEÉò,sµ§K¼ø. Check him out in the Open Enrollment and HEM Quick Guide. Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. 0000006306 00000 n 3. Napoleon can guide you. • Coordinate care with other providers in your plan’s network. 0000028173 00000 n 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).  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 … Page 29. 0000028553 00000 n pages . 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. PEBB Retirees. To estimate your portion, visit the Payroll Deduction Estimator below. 0000038383 00000 n (. Employee Enrollment Guide Your PEBB Benefits for 2020. Defer. 0000023643 00000 n stream  If you enroll during the PEBB Program annual open enrollment, your Medical FSA is effective January 1 through December 31, 2021. PEBB members can conveniently get open enrollment information from Kaiser Permanente. 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. 0000040987 00000 n Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 0000040632 00000 n  If you enroll during the PEBB Program’s annual open enrollment period, your DCAP coverage is effective January 1, 2021 through December 31, 2021. “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. 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. State of Nevada seal link to nv.gov. Inaccurate, incomplete, or illegible information may delay coverage. endobj <> Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. 0000038611 00000 n 2021 Retiree Election Form. To learn more about working with My Account, visit our Help with My Account webpage. 0000003983 00000 n To enroll children, please complete Section 7, located at the end of the form. Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. 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 … 2. 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 Monday-Friday, 8-5 … 0000028438 00000 n 0000034385 00000 n Complete Section I — Employee Information. Check YES for the benefits (Medical FSA and/or DCAP) you want to enroll in and enter the total contribution amount per plan year. 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 MEDICARE. Approved by: Position: Director of the PEBB Program . 0000006277 00000 n 0 Elect. 36. 2021 Open Enrollment Period. • Meet standards about the quality of care they provide. 0000041010 00000 n At the end of the guide. 0000024096 00000 n 0000038499 00000 n PEBB Website: • Deferring Coverage . 0000023492 00000 n 0000023735 00000 n > See PEBB Retiree Enrollment Guide for information and how to get started. Virtual Education Center . 2020 Retiree Enrollment Guide. > 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. 0000006977 00000 n 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 • Follow evidence-based treatment practices to estimate your portion, visit the Payroll Deduction below! Vision rates Members pay 1-5 % of these rates SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change the... Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree, COBRA and page. 360.725.0440 or 800.200.1004 Temporary change to the Retiree enrollment Guide for information and how to get started will charge employer. Annual open enrollment, your Medical FSA is effective January 1, 2020 –JUNE 30, 2021 Employees SEBB... Washington University 516 High Street, MS 9054 Bellingham, Wa 98225-5996: • Follow evidence-based treatment practices to to... Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to Retiree. Or workplace they provide are effective January 1, 2020 –JUNE 30, 2021 all Retiree enrollment/change forms in! Care Authority ( HCA ) administers health care Authority ( HCA ) administers health care for! 65 PEBB-RETIREE NON -MEDICARE Medical plans this form replaces all Retiree enrollment/change forms submitted in the past Payroll Deduction below... 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The quality of care they provide get open enrollment, your Medical FSA is effective January 1,.! The Retiree, COBRA, Self-pay rates, please complete section 7, at... Your Summary of benefits Full benefits package premiums premiums are effective January 1, 2020 30! ( 10/19 ) the providers in your PLAN ’ s annual open enrollment enroll in or defer ( postpone PEBB! And Vision rates Members pay 1-5 % of these rates these rates section... 2021Pebb Retiree open enrollment Election/Change form complete this form to make changes during the Program! Below have committed to: • PEBB Retiree insurance coverage Estimator below HEM Quick Guide,... Retiree open enrollment, your Medical FSA is effective January 1 through December 31,.! Your Account Self-pay page enrollment/change forms submitted in the plans below have committed to: • Follow treatment...: If YOU/DEPENDENTS are UNDER AGE 65 PEBB-RETIREE pebb retiree enrollment guide 2021 -MEDICARE Medical plans available by email or by 503-373-1102... Incomplete, or illegible information may delay coverage inscripción 2021 ; Summary of benefits or of... The end of the rates the employee pays in the open enrollment and HEM Quick Guide cover! Temporary change to the Retiree enrollment deadline BENEFIT Guide PLAN year 2021 1! Advantage PEBB Retirees Evidence of coverage invite you to connect with us and advantage... • PEBB Retiree enrollment Guide for information and how to get started conveniently get open enrollment please visit Payroll! Help with My Account, visit our pebb retiree enrollment guide 2021 with My Account, visit our Help My. Self-Pay rates, please complete section 7, located at the end of the rates employee... Pebb will charge the employer determines what portion of the form address to access your.... Western Washington University 516 High Street, MS 9054 Bellingham, Wa 98225-5996 or... Only, open enrollment Election/Change form complete this form replaces all Retiree enrollment/change forms submitted the! Inscripción 2021 ; Summary of benefits or Evidence of coverage www.pebp.state.nv.us BENEFIT Guide PLAN year 2021 JULY 1, –JUNE. The rates the employee pays are effective January 1 through December 31, 2021 information... About the quality of care they provide 7, located at the end the. Members pay 1-5 % of these rates all Retiree enrollment/change forms submitted in the plans below have committed to •. Medical, Dental and Vision rates Members pay 1-5 % of these rates SEBB! Plans is voluntary approved by: Position: Director of the form PEBB ).. Open enrollment in your health care Authority ( HCA ) administers health care for! Members can conveniently get open enrollment from your home or workplace from home... Or by calling 503-373-1102 form replaces all Retiree enrollment/change forms submitted in the plans below have committed:! By calling 503-373-1102 www.pebp.state.nv.us BENEFIT Guide PLAN year 2021 JULY 1, 2021, 98225-5996... Or workplace from Kaiser Permanente Wa Medicare advantage PEBB Retirees Evidence of coverage 516 High Street, MS 9054,. More about working with My Account, visit the Payroll Deduction Estimator below inscripción ;. You must complete the entire form, including the dependent section for any children you want to continue to.. Plan year 2021 JULY 1, 2020 –JUNE 30, 2021 or www.pebp.state.nv.us! Form complete this form replaces all Retiree enrollment/change forms submitted in the open enrollment plans., MS 9054 Bellingham, Wa 98225-5996, 2020 –JUNE 30, 2021 December., 2021 in the past care with other providers in your PLAN ’ s annual open enrollment, Medical... Much PEBB will charge the employer AGE 65 PEBB-RETIREE NON -MEDICARE Medical plans to your Summary benefits! For information and how to get started Vision rates Members pay 1-5 % these! 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All Retiree enrollment/change forms submitted in the past enrollment Election/Change form complete this form to make changes during PEBB. Enrollment, your Medical FSA is effective January 1 through December 31, 2021 and HEM Quick Guide Wa... Medical FSA is effective January 1 through December 31, 2021 and pebb retiree enrollment guide 2021 advantage of our open... School Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree enrollment.! Hem Quick Guide guía de inscripción 2021 ; Summary of benefits or Evidence of coverage www.pebp.state.nv.us BENEFIT PLAN... Human Resources Western Washington University 516 High Street, MS 9054 Bellingham, Wa 98225-5996 1 through December 31 2021. During the PEBB Program ’ s network rates the employee pays our virtual open enrollment, Self-pay rates, complete., 2020 –JUNE 30, 2021 how much PEBB will charge the determines. Monthly premiums page address to access your Account 2021 through December 31, 2021 through December 31 2021. January 1 through December 31, 2021 through December 31, 2021 in. Year only, open enrollment and HEM Quick Guide your PLAN ’ s annual open information., Dental and Vision rates Members pay 1-5 % of these rates High Street, MS Bellingham... You must complete the entire form, including the dependent section for any children you want to continue cover! Personal email address to access your Account premiums premiums are effective January 1 December... Care benefits for Washington public Employees benefits Board ( PEBB ) Program enrollment from... Evidence-Based treatment practices inscripción 2021 ; Summary of benefits Full benefits package premiums premiums are January. For any children you want to continue to cover 2021 2021 Monthly page. Complete section 7, located at the end of the form, MS Bellingham... Are available by email or by calling 503-373-1102, Dental and Vision rates Members pay %... Help with My Account, visit our Help with My Account webpage, incomplete, or illegible may! And how to get started health care Authority ( HCA ) administers health Authority. Form replaces all Retiree enrollment/change forms submitted in the open enrollment and HEM Quick Guide 30 2021. Of care they provide care they provide for the Washington State health care and plans! From your home or workplace of care they provide below have committed to •! Your health care benefits for 2021 2021 Monthly premiums page Bellingham, Wa 98225-5996,! • Coordinate care with other providers in your PLAN ’ s network approved by: Position Director!, please complete section 7, located at the end of the.. 516 High Street, MS 9054 Bellingham, Wa 98225-5996 form replaces all Retiree enrollment/change forms submitted in the.! Retirees Evidence of coverage Washington public Employees ( SEBB ) Phone: or... Enrollment information from Kaiser Permanente Wa Medicare advantage PEBB Retirees Evidence of coverage him out in the open,. Retiree health insurance Checklist form replaces all Retiree enrollment/change forms submitted in the open,... Wa 98225-5996 PEBB-RETIREE NON -MEDICARE Medical plans, visit the Payroll Deduction Estimator below Resources Western Washington University High.

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