1. Public Employees' Benefit Board (PEBB)
2. Cost of health insurance coverage
3. Your eligibility
4. Who is eligible to enroll in coverage?
5. Enrollment options
6. Enrollment timelines
7. When coverage goes into effect?
8. Core benefits - medical/vision, dental and employee basic life
9. Optional benefits
10. Watch a short video on your benefit options
11. How to enroll
12. Verify your benefit deductions on your earnings statement
13. Required notices
1. Public Employees’ Benefit Board (PEBB)
The Public Employees’ Benefit Board (PEBB) is a labor-management board that designs, contracts and administers benefits for Oregon state employees. These benefits meet IRS code requirements as a Cafeteria Plan, so they provide tax advantages.
2. Cost of Health Insurance Coverage
Effective for 2012 Plan Year Coverage:
CORE Benefits (Medical, Vision, Dental, Employee Basic Life $5k):
- OSU employer contribution is 95% of the premium cost for the plan and enrollment tier you select
- Employee contribution is 5% of the premium cost for the plan and enrollment tier you select
- If your base* monthly salary rate is less than or equal to $2,816, OSU will pay an additional monthly premium subsidy of $40 toward your premium costs. *Base salary rate is determined by the Salary Schedule Salary Range/Step and is the full-time equivalent. Furlough, differentials, etc. do not factor into the base.
Health Programs:
If you enroll in a Medical plan, you must also select your participation status in PEBB’s three Health Programs. You may be assessed additional monthly surcharges based on your participation status. For additional information on the Health Programs
- Tobacco Use – you will be assessed a monthly surcharge based on your and/or your enrolled spouse/domestic partner’s tobacco use.
- If you or your spouse/domestic partner use tobacco, the surcharge is $25 per month
- If both you and your spouse/domestic partner use tobacco, the surcharge is $50 per month
- Spouse/Domestic Partner Other Non-PEBB Employer Coverage – If your enrolled spouse/domestic partner has other employer group coverage available and does NOT enroll in that coverage, you will be assessed $50 per month.
- If your spouse/domestic partner does not have access to employer coverage, there is no surcharge
- If your spouse/domestic partner enrolls in their employer plan, there is no surcharge
- If your spouse/domestic partner has access to other PEBB employer coverage and enrolls, opts out or declines, there is no surcharge
- Other Employer Group Coverage does NOT include: Social Security, TRICARE, student insurance, individual coverage
- Health Engagement Model (HEMi) - A monthly surcharge will be assessed if you and/or your enrolled spouse/domestic partner do NOT participate in the HEM program.
- Annual surcharge amount is prorated for mid-year hires
- Annual surcharge is based on your enrollment tier
- $240 for “employee only” or “employee+children”
- $420 for “employee+spouse/partner” or “employee+spouse/partner+children”
- Minimum Requirements for the employee and the enrolled spouse/domestic partner
- Complete the Health Assessment Survey within 45 days of plan effective date. You are only required to answer the “Waist Circumference” question. To use the WeightWatchers benefit, all questions need to be answered.
- Complete two online e-learning lessons within 195 days of plan effective date.
Estimate your total Monthly premium costs:
3. Your eligibility
- Unclassified employee in a .50 fte position or greater (.50 - 1.0 fte) for at least 90 days
- Continued eligibility
- An unclassified employee must work or be in a paid leave status for at least one half of the available work hours in the month to earn health insurance coverage for the following month (i.e., month of June has 22 work days, you must work or be in a paid leave status for at least 88 hours to earn health insurance coverage for the month of July).
- If you do not meet the hours eligibility requirement in a month, you will lose employer paid insurance coverage the following month
4. Who is eligible to enroll in coverage
- Employee
- Spouse
- Domestic Partner (same sex/opposite sex)
- Tax consequence per IRS regulations
- Value of benefit is determined by PEBB and is subject to Social Security, Medicare, Federal and State taxes
- Qualifying dependent children and domestic partner’s dependent children up to age 27 (tax consequences for domestic partner’s children per IRS regulations). The term “child” will apply to any son, daughter, stepson, stepdaughter, foster child, adopted child, or child for whom a member is legally obligated. Eligibility will not depend on marital, student, employment, residency or tax status.
5. Enrollment Options
Enroll in benefits
- Core Benefits (Medical/Vision, Dental) and any optional coverages
Opt Out of Coverage
- Employees may opt out of either medical coverage only or medical and dental coverage
- Provides a cash incentive for not enrolling in a medical plan or medical/dental plan
- Cash back is subject to Federal, State, and Social Security taxes
- Medical only opt out amount is $233 per month less the cost of dental plan and employee basic life insurance. You will receive approximately $150-$170 per month cash back depending on the dental plan chosen and the number of family members enrolled.
- Medical/Dental opt out amount is $193.50 per month less the cost of employee basic life insurance of $1 per month. Thus, you will receive $192.50 per month in cash back.
- To be eligible to opt out you must be covered by another employer sponsored health insurance program or employer sponsored health and dental programs. Other group coverage does not include Medicare, Medicaid, Veterans Administration Health Benefits, Student Health Insurance, or an individual plan.
- Can enroll in any of the PEBB optional insurance coverage
- If opting out of Medical only, you must enroll in a dental plan
- Must enroll in employee basic life insurance
- Must complete enrollment process to opt-out and receive cash back
- Must provide proof of other employer coverage with your enrollment forms
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- MUST use Paper Forms
- Forward paper forms to Employee Benefits at
- Campus Mail: 204 Kerr Administration Building
- US Mail: 122 Kerr Administration Building, Corvallis OR 97330-2132
- Fax 541-737-0553
RESOURCES:
PEBB Dental Rates
PEBB Opt Out information
Decline Benefits
- Can decline coverage by
- Not completing the enrollment process within 30 days of hire; OR
- Completing the enrollment process and choosing “decline” coverage
- If you decline coverage, you are declining enrollment in the CORE benefits (medical, vision, dental and employee basic life insurance). You will also not be eligible to enroll in any of the other PEBB optional insurances (e.g., optional life, long-term care, etc.)
6. Enrollment Timelines
- Within 30-days of hire date
- If you don’t complete the enrollment process within 30 days, you will not have benefits and you will have to wait until Open Enrollment to enroll for the next calendar year. You may be eligible to enroll prior to open enrollment if you experience a Qualified Status Change during the year.
- During the year if you experience a Qualified Status Change
- Must complete Mid-year Update Form within 30 days of the qualifying event and return to Employee Benefits.
- Qualifying Mid-year events include, but not limited to: Marriage, Divorce, Birth, Death, Loss of other Coverage, Gain Other Coverage, etc.
- Open Enrollment each year
- This is the time you can make changes to your benefit elections, increase coverage, drop coverage, etc.
- Month of October with changes taking effect in January. Exception is when a plan requires review of medical history before approving or denying coverage (Optional life insurance and long-term care insurance).
- Each year you must re-enroll in your Flexible Spending Accounts if applicable
7. When coverage goes into effect
Generally, coverage goes into effect the first of the month following your online enrollment or receipt of enrollment forms by OSU. Exceptions are when a plan requires review of medical history before approving or denying coverage (Optional Life and Long-term Care insurance). Coverage in these plans goes into effect the first of the month after approval by the plan.
8. Core Benefits – Medical/Vision, Dental and Employee Basic Life
Medical/Vision Plan Options
Comparison of medical plans
PEBB Statewide “Full-time” Plan administered by Providence
- PPO Plan – Statewide and National PPO networks
- Medical deductible is $250/individual or a maximum family deductible of $750
- Deductible does not apply to the first 4 primary care office visits (per individual). Coinsurance amount applies (i.e., 15%, etc.) even if the deductible does not.
- Prescription deductible is $50 per individual
- Vision Benefits Provided by VSP
Providence Choice – available in certain cities/counties only
- Medical Home Plan
- Must select a provider within an approved Medical Home
- Must live or work in Benton, Clackamas, Clark, Curry, Deschutes, Linn, Marion, Multnomah, Polk, Yamhill or Washington counties
- Locate the Medical Home in your City
- Medical deductible is $250/individual or a maximum family deductible of $750
- Deductible does not apply to the first 4 primary care office visits. Coinsurance amount applies (i.e., 15%, etc.) even if the deductible does not.
- Prescription deductible is $50 per individual
- Vision Benefits Provided by VSP
Kaiser Permanente HMO – available in the Willamette Valley
Kaiser Permanente Deductible HMO – available in the Willamette Valley
- Must live or work in the Kaiser Service Area
- Facilities are located in Salem and the Portland area only
- Medical deductible is $250/individual or a maximum family deductible of $750
- Office visits and some services are not subject to the deductible
- Vision Benefits Provided by Kaiser Permanente
For Additional Information on PEBB Benefits visit:
Dental Plan Options
Comparison of Dental plans
ODS Traditional “Full-time” Plan
- Can use any licensed dentist
- Maximum annual benefit per covered individual is $1,750
- ODS will apply a one-year waiting period for some services for dependents if you do not cover them in a PEBB dental plan when they are first eligible
- ODS refers to the plan as “Delta Dental Premier”
- ODS website
ODS Preferred
- Use Statewide Preferred Provider Network for higher benefit level
- Maximum annual benefit per covered individual is $1,750
- Progressively higher benefit level for basic and maintenance services if you visit your preferred dentist at least once per year
- Plan pays: 1st year = 80%; 2nd year = 90%; 3rd year = 100%.
- Failure to visit your preferred dentist will cause a 10% reduction in payment the following year, although payment will not fall below 70%.
- ODS will apply a one-year waiting period for some services for dependents if you do not cover them in a PEBB dental plan when they are first eligible
- ODS refers to the plan as “Delta Dental PPO”
- ODS website
Willamette Dental Plan
Kaiser Permanente “Full-time” Plan
- Must Live or work in the Kaiser Service Area (Willamette Valley)
- HMO– must use Kaiser facilities located in the Salem/Portland area
- Maximum annual benefit per covered individual is $1,750
- Do not need to be enrolled in the Kaiser medical plan
- Kaiser Permanente website
Employee Basic Life Insurance
- You are automatically enrolled in the policy when you enroll in benefits or opt-out of medical or medical/dental coverage
- If you decline benefits, you do not have this policy
9. Optional Benefits
Summary of available optional benefits below, click on the benefit link for additional information (i.e., rates, etc.)
- Employee Life Insurance – You are eligible to enroll in a $40,000 guarantee issue policy (no medical history statement required), if you enroll within 30 days of eligibility. You may purchase up to $600,000 in term life coverage. A medical history statement is required for any amount above $40,000.
- Spouse/Domestic Partner Life Insurance – You are eligible to enroll in a $20,000 guarantee issue policy (no medical history statement required), if you enroll within 30 days of eligibility. You may purchase up to $400,000 in term life coverage. A medical history statement is required for any amounts above $20,000.
- Dependent Life Insurance – You may purchase a basic $5,000 policy on each of your dependents.
- Short Term Disability – Provides income replacement if you are injured/disabled for a short period of time and not able to work. (Seasonal Employees are not eligible to enroll in short term disability plans)
- Long Term Disability – Provides income replacement if you are injured/disabled for a period of time and not able to work. (Seasonal Employees are not eligible to enroll in long term disability plans)
- Accidental Death & Dismemberment – Coverage available for employee only or employee and dependents. Policy covers accidental loss of life, limb, hand, foot, hearing, speech, sight, or thumb and index finger on the same hand.
- Long Term Care – Plans available for employee and eligible family members. You can enroll at any time during the year. Medical history statement and approval of provider is required. There is a guarantee issue policy for the employee if enrolled within 30 days of hire, coverage level of up to $4,000/month benefit with a duration of 3 to 6 years (no medical history statement is required for the guaranteed issue amounts).
- Flexible Spending Accounts – Allows you to use pre-tax dollars to reimburse yourself for qualified health care and dependent care expenses. Expenses for a domestic partner and/or domestic partner’s children is not an allowable expense. You forfeit any funds that you don’t use and claim for valid expenses by the deadline.
RESOURCES:
10. Watch a short video on your benefit options
Go to video -- Video coming soon
- Scroll to bottom of page (page looks blank)
- Press the Play Button
11. How to Enroll
12. Verify your benefit deductions on your earnings statement
13. Required Notices
