Premera Blue Cross should contact Premera now, before any claim arises. 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). Medicare Supplement Plan F, administered by Premera Blue Cross, allows the use of any Medicare contracted physician or hospital nationwide. Wednesday, July 17th, the PEBB Board met and passed 8 resolutions regarding the 2014 Premiums and Medical Plan designs. As of January 1, 2020, Premera Blue Cross Medicare Supplement Plan F does not accept new members. • If enrolling a state-registered domestic partner or the partner’s child, submit the Declaration of Tax Status form. SmartHealth 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 E���zV5�7=T�� d�����\R���r�cțhGY��I�Qu�>�6! Online: Premera website (general information, not PEBB specific)Phone: 1-800-817-3049TTY: 1-800-842-5357, Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. This change allows you to access all UMP benefits information in one place. Supplement Plan F, submit the Group Medicare Supplement Enrollment Application (form B). stream It allows members to use their 2019 funds for certain 2020 claims. <> *Educational Service Districts are contained within the K-12 group. Learn more about your customer service options. 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. 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. Open enrollment when you can switch health plans will be in November. ... PEBB Continuation Coverage (COBRA Medicare) PEBB Continuation Coverage (COBRA non-Medicare) PEBB Continuation Coverage … 190 day lifetime limit in a psychiatric hospital. Plan pays Part B deductible and co-insurance for partial hospitalization. Medicare Supplement Plan F is available in all Washington, Oregon, and Idaho counties, and nationwide. <> Plan F Did you receive a copy of the Premera Blue Cross “Outline of Coverage”? PEBB offers Medicare Advantage plans with Kaiser Permanente NW (Kaiser Senior Advantage) and Kaiser Permanente WA. Do I live in the medical plan's service area? 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). Due to COVID-19, HCA’s lobby is closed. PEBB Plan F pays 20% of the Medicare allowed amount for out patient behavioral health visits. Click here to read the PEBB Announcement. %PDF-1.7 Welcome to the health plan that has been supporting school employees for nearly 60 years. Yes No Your Other Health Coverage Please answer all the questions below as best you know how. 2 0 obj Accountable Care Net. SHIBA can help with comparing stand-alone Part D drug plans by running a Medicare Plan Finder analysis. Medicare Supplement Plan F allows the use of any Medicare contracted physician or hospital nationwide. endobj ����. To learn more about working with My Account, visit our Help with My Account webpage. Plan F $216.05 Plan F $427.08 Plan F $361.03 Plan F $722.06 Please Note: The subscription charge amount charged is the same for all plan subscribers with certificates like yours. Premera Blue Cross Medicare Supplement Plan F and Plan G premiums Subscriber Subscriber and spouse1 Subscriber •PEBB Premera Medicare Supplement Plan F … Group Health plans. >PEBB Retiree Enrollment Guide > Acronyms used in this segment – HCA Health Care Authority – PEBB Public Employees Benefits Board – FSA Flexible Spending Account – CDHP Consumer Directed Health Plan – HSA Health Savings Account – VEBA Voluntary Employee Beneficiary Association PLEASE HAVE THESE DOCUMENTS READY FOR THIS SEGMENT • If adding a dependent with a disability age 26 or older, submit the PEBB … **PEBB contains both State Employees and Higher Education employees. Benefits & coverage by plan. PEBB Health Care and Dependent Care FSAs offer a grace period. Identity confirmation - Step 1 of 3. UMP is the plan chosen by 60% of those who are eligible for PEBB coverage. Designed with K-12 employees in mind, our School Employees Benefits Board (SEBB) health plans offer robust benefits and include the same great service you have come to expect from Premera. Visit Premera's online provider directory. ���͝*D�sye�����J��kF�e�W�M:&�:/��"ͪM���VU����HG����;���P5m^%Sӓx�imF�u�I��nI�'Q���k{�~\���h���쯛�z�[�A�E{�p�������g�s�}�������?\g?�m���ٗ�,�v��r�y؞+��p��u�V�*���p}+x0i��1�@0͐��-{$��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��� Patients must pay … 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). Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 MEDICARE: PART D ȨBf?�~�*���j��O����׀��/_�v>#U�Wr��'�?_e�ȴy릢�(�/WE��fS�,}c{���̻�C�`�d!�_��v*� allows the use of any Medicare contracted physician or hospital nationwide It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare. • PEBB Premera Medicare Supplement Plan F does not cover outpatient prescription drugs. Tools ... here: the PEBB home page. • 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. 1 0 obj Note: The PEBB Program does not offer the high-deductible Plan F shown in the Outline of Medicare Supplement Coverage. premera.com and select Secure Inbox. The 2019 plan year’s grace period was from January 1, through March 15, 2020. Mail to: Premera Blue Cross PO Box 910 59 Seattle, WA 98111 -9159 Questions? x��=]�#���[��������4���]���x��ısvU�{�j43*�j�#�ƛ_ Hv��$��ͥb�F� @ ٿ�|Q���2+�^�NfO�/��i�}���O/_���ڼ(��n^� Vd"�]޶�*�Z�� ���v�[��5}��E� Premium rates will change little in calendar year 2014. P.O. >PEBB plans offer secondary coverage to Medicare Parts A & B and provide coverage for important services not covered by Medicare. 4 0 obj PEBB/My Account login Log into My Account to view your coverage and premium surcharge information, get your statement of insurance, and make open enrollment changes. The charts on the premiums and the resolutions are below. If you do not live in an area that offers a Medicare Advantage plan, Kaiser Permanente NW and Kaiser Permanente WA will enroll you in … If you select Medicare Supplement Plan F, any eligible family members who are not entitled to Medicare will be enrolled in UMP Classic. If you select this plan, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable prescription drug coverage. Summaries of benefits and coverage are not available for Medicare supplement plans. @�a�ȉj�_��S�Q)=��"O�NhȲ�09�x5,d.R ֵ4 ����qB���^��%�_�����W�-yZ52�m�zX�Yp}����n׈!�-J�aE�-�4�����)�d��~��'g��\������GKv�x�h����*?74:Bkp�y��S�czm�Wnz?_�t�C���*���C+ՀJXj�!���q��C�$�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� Questions about PEBB or SEBB retiree benefits? PEBB Continuation Coverage monthly premiums (2021), PEBB Continuation Coverage monthly premiums(2020), Website feedback: Tell us how we’re doing. Looking for Premera Blue Cross Medicare Supplement Plan F? Is there a quick way to see benefits and costs? Kaiser Permanente plans. Contact PEBB; Login; Forgot your password? 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. However, the actual amount a plan subscriber pays can vary depending on if 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. The certificate of coverage (COC) for the member's plan is the source of coverage provisions offered under the plans. 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. Medical plans available by county. 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. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. 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) We recommend using your personal email address to access your account. endobj The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S>> Medicare Supplement Plan F does not include prescription drug coverage. enroll in the supplement plan PEBB offers, if eligible for PEBB retiree coverage. Search. Medical Plan Comparisons PEBB 2020 & Premera 2021 . >PEBB does not offer a Medicare Part D plan. For many it is causing stress. Yes No Did you receive a copy of Medicare’s “Choosing A Medigap Policy” guide? %���� Plan F DO I NEED MEDICARE PART D? Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options, Plan F no longer accepts new members as of January 1, 2020. 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. –Uniform Medical Classic (Coordination of Benefit Plan) –Kaiser Permanente WA & NW (Medicare Advantage Plans) –Medicare Supplement Plan F … 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. Supplement Plan F and how it works with Medicare. >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. 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. ��xl���Pl}��'L�*�וo$��Y�y-��2��w�q��G1$��O�XH��@B�M�N�3'����������E�ܥh���C� ��n���0~yZ뾇Gm/X��ed. Box 327 Seattle, WA 98111-0327 <> 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. Compare medical plans. Compare our easy-to-use plans and enroll online or attend a seminar near you. 3 0 obj 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 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 Plan pays Part A deductible and coinsurance. Otherwise, you can change your password here. Scan and send this completed form and any required documents back to us as a secure email attachment. We are all experiencing some disruption in our daily lives right now. Summaries of Benefits and Coverage, or SBCs, are required under the Affordable Care Act. 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 … For PEBB Program Medicare plan summaries, see the medical benefits comparison tool. endobj Premera Blue Cross Medicare Supplement Plan F: 7,436 5: 3 2,284: UMP Plus–UW Med. Board met and passed 8 resolutions regarding the 2014 Premiums and Medical Plan Comparisons PEBB 2020 & Premera 2021 Medicare... Or older, submit the PEBB Board met and passed 8 resolutions regarding the 2014 Premiums and resolutions... Administered by Premera Blue Cross, allows the use of any Medicare contracted physician or nationwide. Designed to Supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional.... And nationwide lives right now B and provide coverage for important services covered... 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