PEBB Statewide plan (part-time) (PDF) PEBB Statewide + 100 plan (part-time) (PDF) PEBB Statewide prescription drug plan (part-time) (PDF) PEBB Statewide member handbook (PDF) Summaries of Benefits and Coverage. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S>> However, the actual amount a plan subscriber pays can vary depending on if Search. PEBB Plan F pays 20% of the Medicare allowed amount for out patient behavioral health visits. PEBB offers Premera Blue Cross Medicare Supplement Plan F. There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA) Plan F (Group), administered by Premera Blue Cross www.premera.com (general information, not specific to the PEBB Program) 1-800-817-3049 1-800-842-5357 ... enrollment in Public Employees Benefits Board (PEBB) retiree insurance coverage after the … Medicare Retirees will see increase that range from $0.68 per month for Premera Medicare Plan F to a $7.45 increase for Uniform Medical Plan (UMP) Classic Medicare. PEBB Health Care and Dependent Care FSAs offer a grace period. 4 0 obj Learn more about your customer service options. x��=]�#���[��������4���]���x��ısvU�{�j43*�j�#�ƛ_ Hv��$��ͥb�F� @ ٿ�|Q���2+�^�NfO�/��i�}���O/_���ڼ(��n^� Vd"�]޶�*�Z�� ���v�[��5}��E� Summaries of benefits and coverage are not available for Medicare supplement plans. <> To learn more about working with My Account, visit our Help with My Account webpage. 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. Plan F DO I NEED MEDICARE PART D? stream Premium rates will change little in calendar year 2014. It allows members to use their 2019 funds for certain 2020 claims. 2 0 obj Scan and send this completed form and any required documents back to us as a secure email attachment. Questions about PEBB or SEBB retiree benefits? The 2019 plan year’s grace period was from January 1, through March 15, 2020. 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Premera Blue Cross For PEBB Program Medicare plan summaries, see the medical benefits comparison tool. Accountable Care Net. Medicare Supplement Plan F does not include prescription drug coverage. Supplement Plan F, submit the Group Medicare Supplement Enrollment Application (form B). Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County. **PEBB contains both State Employees and Higher Education employees. Compare medical plans. should contact Premera now, before any claim arises. >PEBB does not offer a Medicare Part D plan. Identity confirmation - Step 1 of 3. premera.com and select Secure Inbox. Otherwise, you can change your password here. Call: 800-722-1471 (TTY: 711) Monday through Friday 5 a.m. to 8 p.m. Pacific Time Email: Sign into your account at premera.com It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare. If you select Medicare Supplement Plan F, any eligible family members who are not entitled to Medicare will be enrolled in UMP Classic. Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. Box 327 Seattle, WA 98111-0327 Plan F $216.05 Plan F $427.08 Plan F $361.03 Plan F $722.06 Please Note: The subscription charge amount charged is the same for all plan subscribers with certificates like yours. ... PEBB Continuation Coverage (COBRA Medicare) PEBB Continuation Coverage (COBRA non-Medicare) PEBB Continuation Coverage … The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. These rates are for Washington state residents who are NOT a Public Employees Benefits Board (PEBB) member (PEBB members must enroll directly with the HCA). MEDICARE: PART D –Uniform Medical Classic (Coordination of Benefit Plan) –Kaiser Permanente WA & NW (Medicare Advantage Plans) –Medicare Supplement Plan F … P.O. Group Name: Washington State Health Care Authority Contract Effective Date: June 1, 2010 Plan: Group Medicare Supplement Plan F (by reason of age) Contract Form Number: GMSF65 (06-2010) NOTICE TO BUYER This plan may not cover all of your medical expenses. If you do not live in an area that offers a Medicare Advantage plan, Kaiser Permanente NW and Kaiser Permanente WA will enroll you in … *Educational Service Districts are contained within the K-12 group. >PEBB Retiree Enrollment Guide > Acronyms used in this segment – HCA Health Care Authority – PEBB Public Employees Benefits Board – FSA Flexible Spending Account – CDHP Consumer Directed Health Plan – HSA Health Savings Account – VEBA Voluntary Employee Beneficiary Association PLEASE HAVE THESE DOCUMENTS READY FOR THIS SEGMENT We recommend using your personal email address to access your account. Patients must pay … • SHIBA is familiar with how the standardized Medicare Supplement (Medigap) plans work, so we can give PEBB retirees general informationabout the Premera Medicare Supplement Plan F and how it works with Medicare. PEBB Retiree PEBB Retiree & Spouse State Resident State Resident & Spouse Plan G $165.96 Plan G $326.36 Plan G $320.79 Plan G $641.58 Please Note: The subscription charge amount charged is the same for all plan subscribers with certificates like yours. Yes No Your Other Health Coverage Please answer all the questions below as best you know how. endobj PEBB Continuation Coverage monthly premiums (2021), PEBB Continuation Coverage monthly premiums(2020), Website feedback: Tell us how we’re doing. >PEBB plans offer secondary coverage to Medicare Parts A & B and provide coverage for important services not covered by Medicare. Compare our easy-to-use plans and enroll online or attend a seminar near you. •PEBB Premera Medicare Supplement Plan F … endobj %���� If you select this plan, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable prescription drug coverage. The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. 3 0 obj Premera Blue Cross Medicare Supplement Plan F and Plan G premiums Subscriber Subscriber and spouse1 Subscriber Click here to read the PEBB Announcement. Plan F Did you receive a copy of the Premera Blue Cross “Outline of Coverage”? Welcome to the health plan that has been supporting school employees for nearly 60 years. Is there a quick way to see benefits and costs? Plan F $109.59 Plan F $214.46 Plan F $209.74 Plan F $419.48 Eligible By Reason Of Disability Subscription Charges -Per Month PEBB Retiree PEBB Retiree & Spouse State Resident State Resident & Spouse Plan F $211.27 Plan F $417.82 Plan F $356.55 Plan F $713.10 Like Anthem, Regence BlueShield (the Uniform Medical Plan’s third-party administrator) and Premera Blue Cross (which serves PEBB retirees and Washington State residents enrolled in Medicare Supplement Plan F) are also independent licensees of the Blue Cross and Blue Shield Association. SHIBA can help with comparing stand-alone Part D drug plans by running a Medicare Plan Finder analysis. Plan pays Part A deductible and coinsurance. Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 Kaiser Permanente plans. Benefits & coverage by plan. Visit Premera's online provider directory. • If enrolling a state-registered domestic partner or the partner’s child, submit the Declaration of Tax Status form. Open enrollment when you can switch health plans will be in November. <> Note: The PEBB Program does not offer the high-deductible Plan F shown in the Outline of Medicare Supplement Coverage. Tools ... here: the PEBB home page. For many it is causing stress. Supplement Plan F and how it works with Medicare. Willamette Dental Group of Washington, Inc. 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This change allows you to access all UMP benefits information in one place. There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA benefits). Group Health plans. 1 0 obj ���͝*D�sye�����J��kF�e�W�M:&�:/��"ͪM���VU����HG����;���P5m^%Sӓx�imF�u�I��nI�'Q���k{�~\���h���쯛�z�[�A�E{�p�������g�s�}�������?\g?�m���ٗ�,�v��r�y؞+��p��u�V�*���p}+x0i��1�@0͐��-{$��co�0�c��9�������7p[|�^t�-��|r���w�W%}|mW˧Eu�&��B�_��n�n��ƈ4�+��߼�߬�����j�爈;�*��ϛ���t�Yt"S��y�����f{�G)l�A ��˽��k����R2'TIwI� �:���WII�%3�eRR��+��>��8��Qu��������;ԡ���CR�U��]��D�J��� Plan pays Part B deductible and co-insurance for partial hospitalization. >If electing PEBB Medical plan, generally you do not need a Medicare Part D plan* –Prescription drug coverage included –Coverage is as good or better than Part D plans available *Except Premera Blue Cross Medicare Supp. UMP is the plan chosen by 60% of those who are eligible for PEBB coverage. @�a�ȉj�_��S�Q)=��"O�NhȲ�09�x5,d.R ֵ4 ����qB���^��%�_�����W�-yZ52�m�zX�Yp}����n׈!�-J�aE�-�4�����)�d��~��'g��\������GKv�x�h����*?74:Bkp�y��S�czm�Wnz?_�t�C���*���C+ՀJXj�!���q��C�$�lT�Λ�Cd���C�埩h�e�/�DD�3�K�)s�@0���V�U�^n6�]2��nB�f��f�����'}��gC�dkk=Ffi�o2�:�Y޳ݾW�-�}=(�u���~����z�R��JO0��0���U�A,�l�v �[��>�ѼGU$��B��1HX��^>d����ᇀ�֟ܯ4� {�_n�g_&�������LB≮ڼsDݘ��+,4fV���!�t����E��䩆�VyS��%�J��wL��r�Z�Y����UqK6��1�F�!�'�����c�zc���^+�=��#B�y�!Ip�e�ә��&.�#�I��Ϣh�/Va��J2��gN"�b�G���/u��_�A���QV�O��~�p���IS��ݔ~@���(%��/ɕ���5yᣮ��f�{F�>-���U����y����|�{�B,ou���B��2�u�V��e�$�Ek�Y����]T�a����u�_���)���GK_"yY��E�m��o-C:���W�LB(�up��LGTG�pY"�"ELI�� ��ER���n2�]���wZ�JYZ�%��w�d�b��'�զE��0��M������X�{ ��a�v"[ê_���7��ɥ�1x;X�u0������G�-���K$Y��'�j���=��Q�c��=EG>-*�e������%�*�G� ��&Kl"�]鿗��>��OUtJBH㡙ni�0��Q����SFE��^Ou��o�g����a��A4١�?�߀Y���N�!l;߀�@�ˋO�*JܾqRɰkA'�?�'�T�h|�"�]����h6��/��~0%0}'�[���5�l6�����D>��N���+/E���*��Tt�:�JI+v*m� 190 day lifetime limit in a psychiatric hospital. The charts on the premiums and the resolutions are below. Looking for Premera Blue Cross Medicare Supplement Plan F? E���zV5�7=T�� d�����\R���r�cțhGY��I�Qu�>�6! We are all experiencing some disruption in our daily lives right now. These plans include Plan A, Plan F, Plan F High Deductible, Plan G, Plan G High Deductible, and Plan N. Senior discounts program features exclusive discounts for our Medicare Supplement members, including weight management, hearing aids and screenings, eye care services, entertainment and leisure activities. 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. %PDF-1.7 As of January 1, 2020, Premera Blue Cross Medicare Supplement Plan F does not accept new members. SmartHealth Do I live in the medical plan's service area? ����. The certificate of coverage (COC) for the member's plan is the source of coverage provisions offered under the plans. 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