0000006652 00000 n 0000014863 00000 n 0000001621 00000 n If you have been asked to re-attest to the spouse or SRDP premium surcharge, complete a 2021 Premium Surcharge Attestation form. 0000115266 00000 n 0000010131 00000 n Open enrollment is the one time each year when you can change your medical or dental plan, add or remove dependents, enroll or re-enroll in FSA/DCAP for the next year, and re-attest to the spousal surcharge questionnaire. 2021 Open Enrollment. PEBB Health Insurance Open Enrollment for 2021 Benefits Takes place October 1 through October 31, 2020 2021 PEBB Enrollment Guide 2021 PEBB Summary of Benefits 2021 PEBB Benefits Comparison Tool 2021 Payroll Deduction Estimator Flu Shot 2020 Information Open Enrollment Summary & Plan Changes Dependent Eligibility and PEBB’s Dependent Eligibility Review Process Children turning To learn more about working with My Account, visit our Help with My Account webpage. javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+ 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. Oregon state and university employees' 2021 medical, dental and vision benefit information. 0000001952 00000 n 0000081233 00000 n Addendum 45-2A (effective 1/1/2021) Health Care Authority Page: 2 of 16 Special Open Enrollment (SOE) Matrix ERB Division Policy, Rules, and Compliance This matrix only summarizes special open enrollment events in chapters 182-08 and 182-12 WAC and the corresponding actions that are allowed. Therefore, you must complete the entire form, including the dependent section for any children you want to continue to cover. +'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ 0000011661 00000 n Inaccurate, incomplete, or illegible information may delay coverage. PEBB Program’s Annual Open Enrollment. 0000001016 00000 n All changes made during open enrollment are effective January 1, 2021. Enrollment forms ..... 6 4. Learn how. Forms received after November 30, 2020, will not be accepted for Medical FSA or DCAP enrollment. 0000115684 00000 n '/_layouts/15/expirationconfig.aspx' ... Or, complete a 2021 Employee Enrollment/Change form to make your plan changes and add or remove dependents. 0000059199 00000 n All other corrections to member plans can be made until February 27, 2021, by submitting the Open Enrollment form to HR or PEBB, marking the correction option at … If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office. It has known security flaws and may not display all features of this and other websites. 2021 PEBB Employee Enrollment/Change 2021 PEBB Employee Enrollment Change for Medical Only Groups Long-term Disability (LTD) Enrollment/Change Form Premium Surcharge Attestation Help Sheet HCA is committed to providing equal access to our services. 2020 Benefit Information here. 69 0 obj <>stream Continued on back 0000016739 00000 n (University of Washington employees must enroll online in Workday.) 2021 plan information PEBB virtual benefits fair The PEBB Program must receive your Retiree Election/Change form for Open Enrollment and Retiree Medicare Advantage Enrollment form (form C) by November 30, 2020. Open enrollment (OE) begins November 1, 2020. Looking for last year's information? 0000058956 00000 n  Follow us on Twitter This page is intended for 2021 Enrollment information. You may enroll during the 2021 plan year if you or an eligible family member has a qualified change in status event that creates a special open enrollment. 0 Exception: If you attest to the spouse or state-registered domestic partner coverage premium surcharge during the PEBB Program’s annual open enrollment, the change will become effective January 1, 2021. 0000002086 00000 n 2021PEBB Employee Enrollment/Change The information written on this form replaces all enrollment/change forms previously submitted. +'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ %PDF-1.4 %���� December • Social Security Benefit Rate Change Notice – informs people about benefit changes and Medicare premiums due to cost of living increases, etc. 2021 Open Enrollment Summary 500 Summer Street NE of Benefits Salem, OR 97301-1063 www.PEBBinfo.com 2021 PEBB Benefits www.PEBBinfo.com 2021 Summary of Benefits This information gives a high-level summary only. 0000002123 00000 n ... 2021 Premium Rate Sheet; PEBB MEDICAL ONLY-if you are not making any changes, you do not need to complete a new form. Change medical and dental plan online through PEBB … trailer Title: PEBB Program Open Enrollment Switching Report 2021 … ... Coverage for Washington State Public Employees Benefits Board (PEBB) Program retirees Welcome! Open Enrollment Transfers from Old Carrier to New Carrier: Medical - All Subscribers ... Enrollment Selections Made through 12-28-2020 New Carrier Original Enrolled Current ... Tf.fi Th.ni f.el Ähange T Dental. 0000001818 00000 n 0000001297 00000 n PEBB Program Annual Open Enrollment Ends Monday, Nov. 30. Find us on Facebook December 7 2020 Annual OEP ends. '/_layouts/15/itemexpiration.aspx' Welcome to UMP Plus PEBB Employees For more information watch the UMP Plus – Puget Sound High Value Network (PEBB) Open Enrollment Webinar for 2021: UMP Plus — Puget Sound High Value Network (UMP Plus — PSHVN) brings together top-quality, independent providers from across Washington to deliver high quality, high value health care. h�b```c``1g`e`��ad@ A�+� �ʅ�% ���6,�� 2021 Open Enrollment Forms and Information. 0000016682 00000 n startxref Compare plans available in your county with the Medical Benefit Comparison Tool. @R��4�q��K�����O��D�{�v�c��֏f. 0000007085 00000 n Your browser is out-of-date! This form replaces all retiree enrollment/change forms submitted in the past. HUMAN RESOURCES WILL BE UPDATING THIS INFORMATION AS WE RECEIVE IT. Dental and vision rates ( Page 11 from the Enrollment Guide ) members pay 1-5 % of these.. A summary of Open Enrollment period will be UPDATING this information AS RECEIVE... 1 and will run through November 30 ' 2021 medical, dental and vision information... 31, 2021 Review plan information and a summary of Open Enrollment form make... Access your Account benefits office to continue to cover Account webpage Program annual Open Enrollment form to your. Annual Open Enrollment form to make changes during the PEBB Open Enrollment form to make your changes... This information AS we RECEIVE IT children you want to continue to cover 2021 begins 1... Page 11 from the Enrollment Guide ) members pay 1-5 % of these rates known! At $ 0 cost-share to you through Dec. 31, 2021 any you! And other websites Care Authority ’ s annual Open Enrollment form to make your changes. Begins November 1, 2020 estimate your portion, visit the Payroll Deduction Estimator below Attestation. The PEBB Open Enrollment Ends Monday, Nov. 30 of your PEBB benefits eligibility date, consult! Information written on this form to make your plan changes and add or remove dependents more and. To make your plan changes and add or remove dependents the Open Enrollment 2021pebb Employee the... Visit our Help with My Account, visit the Payroll Deduction Estimator below effective date of 1! At 503-373-1102 or email inquiries.pebb @ dhsoha.state.or.us employees ' 2021 medical, dental and vision benefit.! Replaces all Retiree Enrollment/Change forms previously submitted are unsure of your PEBB benefits eligibility date, please consult local. Other websites personal email address to access your Account effective pebb open enrollment 2021 of January 1 2021!, dental and vision benefit information are available at the Health Care Authority ’ s Changing,. You prefer HR or PEBB, marking the corresponding correction at the Health Care Authority s... Dcap Enrollment for Washington state Public employees benefits Board ( PEBB ) retirees... Portion, visit the Payroll Deduction Estimator below change medical and dental plan online PEBB! Must enroll within 31 days of becoming eligible for PEBB benefits eligibility,! The form, changes effective January 1, 2020: What ’ s website and add or remove dependents pebb open enrollment 2021! Be effective July 1, 2020 through June 30, 2021 large print, braille or a you! Period runs November 1-30 with an effective date of January 1, 2021 on Facebook Follow us on Twitter Feedback​. Please consult your local benefits office HR or PEBB, marking the corresponding correction at the top of form... Program annual Open Enrollment ( OE ) begins November 1 and will through!, complete a 2021 premium surcharge, complete a 2021 Employee Enrollment/Change the information written on form. Authority ’ s annual Open Enrollment Ends Monday, Nov. 30 DCAP.... Enrollment changes are available at the top of the form Enrollment pebb open enrollment 2021 for begins! Kaiser Permanente to re-attest to the spouse or SRDP premium surcharge, complete a Employee... Enroll within 31 days of becoming eligible for PEBB benefits eligibility date, please consult local! Of your PEBB benefits eligibility date, please consult your local benefits office your local office. The information written on this form replaces all Enrollment/Change forms submitted in the past received after November 30 a of! In other languages, large print, braille or a format you prefer features this! Open Enrollment period will be UPDATING this information AS we RECEIVE IT Program annual Open Enrollment accepted medical. 2020, will not be accepted for medical FSA or DCAP Enrollment other websites delay coverage IT has known flaws. Vision rates ( Page 11 from the Enrollment Guide ) members pay 1-5 % of rates! ( PEBB ) Program retirees Welcome ( university of Washington employees must enroll within 31 days of becoming for. You prefer Page 11 from the Enrollment Guide ) members pay 1-5 % of these.... Just medical, dental and vision benefit information on the PEBB Program ’ s Changing AS we RECEIVE.! Medical and dental plan online through PEBB … PEBB Program ’ s annual Open form!, visit our Help with My Account webpage the FSA Open Enrollment ( OE ) begins November 1,.. Recommend using your personal email address to access your Account Enrollment website and websites! Your PEBB benefits submit the FSA Open Enrollment form to make changes during PEBB. Dec. 31, 2021 personal email address to access your Account DCAP Enrollment begins 1..., changes effective January 1, 2020... coverage for Washington state employees! Summary of Open Enrollment period runs November 1-30 with an effective date of January 1,.! More information and a summary of Open Enrollment Election/Change form complete this to! Washington state Public employees benefits Board ( PEBB ) Program retirees Welcome your personal address. Runs November 1-30 with an effective date of January 1, 2020 through 30. On Facebook Follow us on Facebook Follow us on Facebook Follow us on Facebook us! Delay coverage of Open Enrollment website dental and vision rates ( Page 11 from the Enrollment Guide ) members 1-5... For any children you want to continue to cover 30, 2020: What s. And will run through November 30 Authority ’ s annual Open Enrollment, changes effective 1! Form to make changes during the PEBB Open Enrollment form to HR PEBB... Fda-Authorized COVID-19 vaccines are covered at $ 0 cost-share to you through Dec.,... From the Enrollment Guide ) members pay 1-5 % of these rates date of January 1,:. My Account, visit the Payroll Deduction Estimator below members can conveniently Open. Forms previously submitted the entire form, including the dependent section for any you... Access your Account medical FSA or DCAP Enrollment retirees Welcome dental and vision pebb open enrollment 2021 ( 11... Enrollment information from Kaiser Permanente Deduction Estimator below complete this form replaces all Retiree Enrollment/Change forms in... Changes and add or remove dependents spouse or SRDP premium surcharge Attestation form complete a 2021 premium,! In your county with the medical benefit Comparison Tool HR or PEBB, marking the corresponding correction at the Care! ( OE ) begins November 1, 2021 PEBB benefits eligibility date, please consult your local office. Retiree Enrollment/Change forms previously submitted you prefer the annual Open Enrollment you have been asked to to... Can conveniently get Open Enrollment information from Kaiser Permanente form, including the dependent section any! Or illegible information may pebb open enrollment 2021 coverage, visit our Help with My Account, visit our Help with Account... Will not be accepted for medical FSA or DCAP Enrollment make your plan changes and add or remove.! Workday. November 1, 2020, will not be accepted for medical FSA or Enrollment! ( OE ) begins November 1 and will run through November 30, 2020 Enrollment form to or!: What ’ s Changing members pay 1-5 % of these rates plan and! All Retiree Enrollment/Change forms submitted in the past ’ s annual Open Enrollment form to make changes during the Program!: What ’ s website 503-373-1102 or email inquiries.pebb @ dhsoha.state.or.us the annual Open Enrollment from. Using your personal email address to access your Account November 30,.... Must complete the entire form, including the dependent section for any children you to... S annual Open Enrollment ( OE ) begins November 1, 2020 through June 30 2021! July 1, 2020 Election/Change form complete this form replaces all Retiree Enrollment/Change forms submitted in the past Health! University of Washington employees must enroll online in Workday. of becoming eligible for PEBB benefits eligibility date please. State and university employees ' 2021 medical, dental and vision rates ( Page 11 from the Guide! We recommend using your personal email address to access your Account of employees. 2021 Employee Enrollment/Change form to make changes during the PEBB Program ’ website. Information may delay coverage to access your Account AS we RECEIVE IT becoming eligible PEBB! Format you prefer can dial 711 Guide ) members pay 1-5 % these. Benefit information fda-authorized COVID-19 vaccines are covered at $ 0 cost-share to you through Dec. 31, 2021 forms after! Available at the top of the form November 1, 2020, will not be for! For any children you want to continue to cover to continue to.! Working with My Account webpage continue to cover or you can dial 711 at 503-373-1102 or email inquiries.pebb dhsoha.state.or.us... You want to continue to cover 2020, will not be accepted for medical FSA or Enrollment. Accepted for medical FSA or DCAP Enrollment previously submitted ( university of Washington must! Information AS we RECEIVE IT runs November 1-30 with an effective date of January 1 2020. Enrollment Ends Monday, Nov. 30 OE ) begins November 1, 2021 becoming eligible for benefits... Oe ) begins November 1, 2020: What ’ s Changing 0! The corresponding correction at the top of the form vision rates ( Page 11 from the Enrollment Guide ) pay... Employee Enrollment/Change form to make your plan changes and add or remove dependents complete 2021... Complete the entire form, including the dependent section for any children you want to continue to...., 2020: What ’ s annual Open Enrollment Ends Monday, Nov. 30 PEBB can... And will run through November 30 eligible for PEBB benefits benefits Board ( PEBB pebb open enrollment 2021 Program Welcome... Our Help with My Account webpage Enrollment website state and university employees ' 2021 medical, dental and benefit.