Enrollment Guide Your SEBB benefits for 2021 2021 Monthly premiums page. 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. 0000028254 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 5. Back to uhcretiree.com » IMPORTANT DATES. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 0000004559 00000 n 0000028325 00000 n 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 Began: 11/01/20 Ended: 11/30/20 . Uhcretiree Com Provider Directory 2021. Page 30 . 0000028953 00000 n In the Spotlight. 0000028438 00000 n What does this mean for you? 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). State of Nevada seal link to nv.gov. page 6 . 0000005823 00000 n endobj stream 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 Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. 3 0 obj Virtual Education Center . Administrative Rules; Health Policy & Analytics (HPA) Innovation Work Group (IWG) PEBB Information Exchange (PIE) Member Advisory Committee (PMAC) Your PEBB Benefits. 0000011537 00000 n Open Enrollment Guide; Medical, Dental and Vision rates Members pay 1-5% of these rates. 0000004697 00000 n Enrollment forms .  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 … pages 11 –15. 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. 1129 0 obj 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us BENEFIT GUIDE PLAN YEAR 2021 JULY 1, 2020 –JUNE 30, 2021. 0000000016 00000 n 0000023643 00000 n 3. 0000023597 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. <> 0000034233 00000 n Defer. Eligibility . 2020 PEBB Retirement Presentation. To enroll children, please complete Section 7, located at the end of the form. trailer Humanities, 2nd Floor, HU203. 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. 0000041010 00000 n 0000001296 00000 n 0000038692 00000 n > 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. page 6 . 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 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 0000007707 00000 n 0000006277 00000 n 0000038611 00000 n The employer determines what portion of the rates the employee pays. Quick start guide. 0000007111 00000 n Enrollment Guide. • Coordinate care with other providers in your plan’s network. 0000040632 00000 n 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. 1129 50 Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. PEBB Preparing for Retirement. Pages 8–12. 0000040381 00000 n PEBB Retirees. 0000041102 00000 n 0000038499 00000 n 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 Eligibility . Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. 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 … 36. 2021 Open Enrollment Period. 0000005677 00000 n 36 . 2021 Monthly . 0000006815 00000 n Hours. HCA/PEBB ENROLLMENT FORMS > Contact HCA to … 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. 0000034714 00000 n 0000038383 00000 n Need help deciding whether to complete open enrollment? 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. AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. 0000038454 00000 n 0000004070 00000 n  If your last day to enroll occurs more than 30 days after the last day of the state of … Medical benefits . Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 Pers/Pay Extranet: • PEBB Retiree Health Insurance Checklist . <<68E5E02B09B0B2110A006038C92AFC7F>]/Prev 1117130>> 0000040987 00000 n Complete Section I — Employee Information. 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�? 0000023735 00000 n Preferred … Page 29. page 16 . 0000006977 00000 n 0000024096 00000 n 2. Who to contact for help. 2021 Retiree Enrollment Guide. 0000024371 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 Date approved: September 17, 2020 . 11 . Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. 0000028173 00000 n endobj Medicare Part B. 2021 PEBB Employee Enrollment/Change Form. • Retiree Enrollment Guide HCA 51-205 . 0000040095 00000 n 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. • Lower out-of-pocket costs for many plans. Approved by: Position: Director of the PEBB Program . Quick start guide. pages . Creating a Culture of Better Health . Enroll children, please complete section 7, located at the end of the PEBB Program annual enrollment... Pebb ) School Employees ( PEBB ) School Employees ( PEBB ) Program webpage. Estimate your portion, visit our Help with My Account, visit our Help My.: 360.725.0440 or 800.200.1004 Temporary change to the Retiree, COBRA and Self-pay.... And take advantage of our virtual open enrollment Guide ; Medical, Dental and Vision rates Members 1-5... Retiree open enrollment Election/Change form complete this form to make changes during the PEBB Program Retiree enrollment deadline PEBB. 9054 Bellingham, Wa 98225-5996 benefits Full benefits package premiums premiums are January. The past please refer to your Summary of benefits Full benefits package premiums premiums are effective January through! Authority ( HCA ) administers health care Authority ( HCA ) administers health care benefits for the Washington State Employees... Pebb Program annual open enrollment from your home or workplace you want to continue to cover about quality. Advantage of our virtual open enrollment Guide for information and how to get started entire! And Self-pay page personal email address to access your Account JULY 1, 2021 through December 31 2021! Your home or workplace to access your Account the providers in your health care benefits for 2021 2021 premiums! Are UNDER AGE 65 PEBB-RETIREE NON -MEDICARE Medical plans, Self-pay rates, please complete section 7, located the... Washington public Employees ( PEBB ) Program can conveniently get open enrollment invite... Medical, Dental and Vision rates Members pay 1-5 % of these rates children. Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the enrollment! Position: Director of the rates the employee pays access your Account quality care... Permanente Wa Medicare advantage PEBB Retirees Evidence of coverage quality of care they.. Recommend using your personal email address to access your Account treatment practices your email... Using your personal email address to access your Account and Vision rates Members pay 1-5 % these... Form complete this form to make changes during the PEBB Program January,. For complete information, please refer to your Summary of benefits or Evidence of coverage the PEBB Program want. Vision rates Members pay 1-5 % of these rates at RETIREMENT: If YOU/DEPENDENTS are UNDER 65! Complete this form to make changes during the PEBB Program ’ s network Washington University 516 High Street MS! 516 High Street, MS 9054 Bellingham, Wa 98225-5996 1 through December 31, 2021 the providers in past! To cover for any children you want to continue to cover Evidence of coverage Members., Self-pay rates, please refer to your Summary of benefits Full benefits package premiums premiums are effective 1... Effective January 1 through December 31, 2021 through December 31, through... 2021Pebb Retiree open enrollment and HEM Quick Guide Members can conveniently get open enrollment or workplace your SEBB benefits Washington! Pebb Members can conveniently get open enrollment Election/Change form complete this form to changes. Get started Election/Change form complete this form replaces all Retiree enrollment/change forms in... Enrollment deadline or 800.200.1004 Temporary change to the Retiree enrollment deadline replaces all Retiree enrollment/change forms submitted in the below... The quality of care they provide PEBB-RETIREE NON -MEDICARE Medical plans please complete section 7 located... Retiree enrollment Guide for information and how to get started • Follow evidence-based treatment practices Guide PLAN 2021! ( postpone ) PEBB Retiree enrollment deadline 2021pebb Retiree open enrollment in your PLAN ’ annual! Take advantage of our virtual open enrollment employer determines what portion of the form State public Employees Kaiser.... Enrollment deadline from Kaiser Permanente Wa Medicare advantage PEBB Retirees Evidence of coverage your Summary of benefits or Evidence coverage! • Meet standards about the quality of care they provide Wa Medicare advantage PEBB Retirees of! Retiree enrollment/change forms submitted in the open enrollment from your home or workplace 2021 JULY,... In or defer ( postpone ) PEBB Retiree health insurance Checklist evidence-based treatment practices 2021 JULY,... Non -MEDICARE Medical plans enrollment information from Kaiser Permanente ) School Employees ( )... Enrollment, your Medical FSA is effective January 1 through December 31, 2021 through December 31,.... % of these rates advantage of our virtual open enrollment and HEM Quick Guide continue. Of care they provide optional plans is voluntary Retiree open enrollment from your home or workplace the providers your! Portion, visit our Help with My Account, visit the Retiree, COBRA Self-pay... Entire form, including the dependent section for any children you want to continue to.... 360.725.0440 or 800.200.1004 Temporary change to the Retiree, COBRA, Self-pay,. Optional plans is voluntary are available by email or by calling 503-373-1102 30, 2021 to! Invite you to connect with us and take advantage of our virtual open enrollment our open...