1 0 obj **PEBB contains both State Employees and Higher Education employees. PEBB offers Medicare Advantage plans with Kaiser Permanente NW (Kaiser Senior Advantage) and Kaiser Permanente WA. Box 327 Seattle, WA 98111-0327 The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. allows the use of any Medicare contracted physician or hospital nationwide should contact Premera now, before any claim arises. 3 0 obj Note: The PEBB Program does not offer the high-deductible Plan F shown in the Outline of Medicare Supplement Coverage. PEBB Plan F pays 20% of the Medicare allowed amount for out patient behavioral health visits. Learn more about your customer service options. –Uniform Medical Classic (Coordination of Benefit Plan) –Kaiser Permanente WA & NW (Medicare Advantage Plans) –Medicare Supplement Plan F … Medicare Supplement Plan F allows the use of any Medicare contracted physician or hospital nationwide. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S>> Supplement Plan F and how it works with Medicare. Click here to read the PEBB Announcement. Contact PEBB; Login; Forgot your password? Premera Blue Cross Medicare Supplement Plan F and Plan G premiums Subscriber Subscriber and spouse1 Subscriber Plan pays Part B deductible and co-insurance for partial hospitalization. @�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� Looking for Premera Blue Cross Medicare Supplement Plan F? Summaries of benefits and coverage are not available for Medicare supplement plans. ���͝*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��-{$��co�0�c��9�������7p[|�^t�-��|r���w�W%}|mW˧Eu�&��B�_��n�n��ƈ4�+��߼�߬�����j�爈;�*��ϛ���t�Yt"S��y�����f{�G)l�A ��˽��k����R2'TIwI� �:���WII�%3�eRR��+��>��8��Qu��������;ԡ���CR�U��]��D�J��� ����. 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Medicare Supplement Plan F, administered by Premera Blue Cross, allows the use of any Medicare contracted physician or hospital nationwide. Supplement Plan F, submit the Group Medicare Supplement Enrollment Application (form B). PEBB offers Premera Blue Cross Medicare Supplement Plan F. There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA) Is there a quick way to see benefits and costs? The certificate of coverage (COC) for the member's plan is the source of coverage provisions offered under the plans. x��=]�#���[��������4���]���x��ısvU�{�j43*�j�#�ƛ_ Hv��$��ͥb�F� @ ٿ�|Q���2+�^�NfO�/��i�}���O/_���ڼ(��n^� Vd"�]޶�*�Z�� ���v�[��5}��E� Medicare Supplement Plan F does not include prescription drug coverage. Visit Premera's online provider directory. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. • If adding a dependent with a disability age 26 or older, submit the PEBB … MEDICARE: PART D Designed with K-12 employees in mind, our School Employees Benefits Board (SEBB) health plans offer robust benefits and include the same great service you have come to expect from Premera. 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 We are all experiencing some disruption in our daily lives right now. Due to COVID-19, HCA’s lobby is closed. 190 day lifetime limit in a psychiatric hospital. 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). 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. Plan pays Part A deductible and coinsurance. Compare our easy-to-use plans and enroll online or attend a seminar near you. Kaiser Permanente plans. >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 1or state-registered domestic partner 2If a Medicare supplement plan is selected, non-Medicare enrollees are enrolled in UMP Classic.The rates shown reflect the total due, including premiums for both plans. Scan and send this completed form and any required documents back to us as a secure email attachment. <> stream Compare medical plans. endobj >PEBB plans offer secondary coverage to Medicare Parts A & B and provide coverage for important services not covered by Medicare. PEBB Health Care and Dependent Care FSAs offer a grace period. ȨBf?�~�*���j��O����׀��/_�v>#U�Wr��'�?_e�ȴy릢�(�/WE��fS�,}c{���̻�C�`�d!�_��v*� 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 As of January 1, 2020, Premera Blue Cross Medicare Supplement Plan F does not accept new members. • 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. Identity confirmation - Step 1 of 3. Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 Premera Blue Cross Premera Blue Cross Medicare Supplement Plan F: 7,436 5: 3 2,284: UMP Plus–UW Med. SHIBA can help with comparing stand-alone Part D drug plans by running a Medicare Plan Finder analysis. Plan F Did you receive a copy of the Premera Blue Cross “Outline of Coverage”? UMP is the plan chosen by 60% of those who are eligible for PEBB coverage. Tools ... here: the PEBB home page. Accountable Care Net. Wednesday, July 17th, the PEBB Board met and passed 8 resolutions regarding the 2014 Premiums and Medical Plan designs. 4 0 obj Yes No Your Other Health Coverage Please answer all the questions below as best you know how. For many it is causing stress. Plan F DO I NEED MEDICARE PART D? premera.com and select Secure Inbox. Yes No Did you receive a copy of Medicare’s “Choosing A Medigap Policy” guide? Premium rates will change little in calendar year 2014. <> 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. Medical Plan Comparisons PEBB 2020 & Premera 2021 . • If enrolling a state-registered domestic partner or the partner’s child, submit the Declaration of Tax Status form. Medical plans available by county. *Educational Service Districts are contained within the K-12 group. Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. 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. We recommend using your personal email address to access your account. For PEBB Program Medicare plan summaries, see the medical benefits comparison tool. Questions about PEBB or SEBB retiree benefits? State residents should call the Blue Cross Premera number at 1888--208-6264 and ask for a paper application for Group ID: 1000041 , and for P2019196 (the HCA Plan G pre-sales enrollment kit). Group Health plans. • PEBB Premera Medicare Supplement Plan F does not cover outpatient prescription drugs. Do I live in the medical plan's service area? P.O. 2 0 obj This change allows you to access all UMP benefits information in one place. Mail to: Premera Blue Cross PO Box 910 59 Seattle, WA 98111 -9159 Questions? %PDF-1.7 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. Medicare Supplement Plan F is available in all Washington, Oregon, and Idaho counties, and nationwide. Patients must pay … enroll in the supplement plan PEBB offers, if eligible for PEBB retiree coverage. To learn more about working with My Account, visit our Help with My Account webpage. E���zV5�7=T�� d�����\R���r�cțhGY��I�Qu�>�6! 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). It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare. 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 … 2 TABLE OF CONTENTS ... 2020 KAISER VALUE PLAN & 2021 PREMERA VALUE PLAN Kaiser Value Plan In-Network Benefits Premera Value Plan In-Network Benefits Calendar Year Deductible Individual Coverage $250 Family Coverage Up to $750 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 … It allows members to use their 2019 funds for certain 2020 claims. If you select Medicare Supplement Plan F, any eligible family members who are not entitled to Medicare will be enrolled in UMP Classic. •PEBB Premera Medicare Supplement Plan F … SmartHealth >PEBB does not offer a Medicare Part D plan. PEBB Continuation Coverage monthly premiums (2021), PEBB Continuation Coverage monthly premiums(2020), Website feedback: Tell us how we’re doing. In Medicare Supplement Plan F, benefits such as vision, hearing exams, and routine physical exams may have limited coverage or may not be covered at all. Benefits & coverage by plan. Willamette Dental Group of Washington, Inc. 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Search. The charts on the premiums and the resolutions are below. Medicare Retirees will see increase that range from $0.68 per month for Premera Medicare Plan F to a $7.45 increase for Uniform Medical Plan (UMP) Classic Medicare. endobj Otherwise, you can change your password here. These plans include Plan A, Plan F, Plan F High Deductible, Plan G, Plan G High Deductible, and Plan N. Senior discounts program features exclusive discounts for our Medicare Supplement members, including weight management, hearing aids and screenings, eye care services, entertainment and leisure activities. <> If your account is locked due to typing the password incorrectly, you may wish to wait at least 10 minutes and you can try again. >If electing PEBB Medical plan, generally you do not need a Medicare Part D plan* –Prescription drug coverage included –Coverage is as good or better than Part D plans available *Except Premera Blue Cross Medicare Supp. However, the actual amount a plan subscriber pays can vary depending on if Like Anthem, Regence BlueShield (the Uniform Medical Plan’s third-party administrator) and Premera Blue Cross (which serves PEBB retirees and Washington State residents enrolled in Medicare Supplement Plan F) are also independent licensees of the Blue Cross and Blue Shield Association. %���� endobj The 2019 plan year’s grace period was from January 1, through March 15, 2020. Group Name: Washington State Health Care Authority Contract Effective Date: June 1, 2010 Plan: Group Medicare Supplement Plan F (by reason of age) Contract Form Number: GMSF65 (06-2010) NOTICE TO BUYER This plan may not cover all of your medical expenses. If you do not live in an area that offers a Medicare Advantage plan, Kaiser Permanente NW and Kaiser Permanente WA will enroll you in … If you select this plan, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable prescription drug coverage. ��xl���Pl}��'L�*�וo$��Y�y-��2��w�q��G1$��O�XH��@B�M�N�3'����������E�ܥh���C� ��n���0~yZ뾇Gm/X��ed. Welcome to the health plan that has been supporting school employees for nearly 60 years. Open enrollment when you can switch health plans will be in November. Plan is the source of coverage ( COC ) for the member 's Plan is designed to Supplement your coverage... 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