Changes To PEBB Benefits For 2023 Important Dates - Hca.wa.gov
Public Employees Benefits Board (PEBB) ProgramState and higher-education employee edition October 2022exclamation-triangle The PEBB Program’s open enrollment is November 1–30Changes to PEBB benefits for 2023Important datesduring a special open enrollmentand stay with KPNW. This does notapply to the consumer-directedhealth plan. Introduce Advanced Care atHome, which will offer members achance to recover at home ratherthan in a hospital when clinicallyappropriate.Early OctoberAnnual open enrollment informationis available on the HCA website athca.wa.gov/pebb-oe. Get the schedulefor webinars to help you learn aboutyour options.The PEBB virtual benefits fair isopen 24/7 at hca.wa.gov/vbf-pebb.All changes are effective January 1,2023, unless otherwise noted. For2023 monthly premiums, see page3. Learn more about the changeslisted below and other changes onthe Open enrollment webpage athca.wa.gov/pebb-oe.Changes to all health plans: Limit the amount members willpay to no more than 35 per monthfor covered insulin to comply withinsulin affordability legislation. Increase the deductible forconsumer-directed health plans to 1,500 for single subscribers and 3,000 for all other subscribers.This deductible increase is requiredto maintain compliance with IRSrules, so that a subscriber can makeeligible health savings account(HSA) contributions in 2023.Kaiser Permanente Northwest(KPNW) will: Increase the maximum out-ofpocket amount for the Classic planto 2,500 for a single subscriber and 5,000 for all other subscribers. Transfer certain accumulators, suchas deductibles and out-of-pocketlimits, for the existing plan yearwhen subscribers and their enrolleddependents change between thePEBB Program and the SchoolEmployees Benefits Board ProgramHCA 50-0658 (10/22)Kaiser Permanente Washington(KPWA) will: Transfer certain accumulators,such as deductibles and out-ofpocket limits, for the existing planyear when subscribers and theirenrolled dependents changebetween the PEBB Program and theSchool Employees Benefits BoardProgram during a special openenrollment and stay with KPWA. Implement the First Fill programfor maintenance drugs only, whichallows the first prescription to befilled at any in-network pharmacy.Subsequent refills must be filledvia mail order or at a KaiserPermanente retail pharmacy. Introduce Advanced Care atHome, which will offer members achance to recover at home ratherthan in a hospital when clinicallyappropriate.(Continued on next page)October 25 to November 10In-person benefits fairs are scheduled atnine locations around the state. Look forone near you on page 5 and see moredetails at hca.wa.gov/pebb-fairs.November 1Annual open enrollment begins forcoverage in 2023. Forms are posted athca.wa.gov/pebb-oe.November 3Tune in for a Facebook Live Q&Aabout open enrollment from4 to 5 p.m. at facebook.com/wahealthcareauthority.November 30Last day to make changes to youraccount. Open enrollment closes at11:59 p.m.Last day for most subscribersto qualify for the SmartHealth 125wellness incentive for 2023 (if you’reeligible) at smarthealth.hca.wa.gov.January 1, 2023New plan year begins. Open enrollmentchanges become effective.
(Continued from previous page)DeltaCare will:Uniform Medical Plan (UMP) will: Transfer certain accumulators,such as deductibles and out-ofpocket limits, for the existing planyear when subscribers and theirenrolled dependents changebetween the PEBB Program and theSchool Employees Benefits BoardProgram during a special openenrollment and stay with UMP. Provide coverage before meetingthe deductible for a specific listof high-value drugs for the UMPconsumer-directed health plan. No longer apply out-of-networkamounts paid for dialysis servicestoward the medical out-of-pocketlimit. Like other benefits, theplan will pay for dialysis servicesbased on the allowed amount andnetwork status of the provider. Provide myStrength, a self-paced,online behavioral health program,in addition to existing behavioralhealth options. Add Costco as a network mail-orderpharmacy option in addition to thecurrent option, Postal PrescriptionServices. Increase pediatric coverage to 100percent for children through age 19,less applicable copays. Remove optional treatment feesfor elective materials, such ascomposite fillings for rear teeth.Rule changesAll changes to PEBB rules will beavailable on the HCA website athca.wa.gov/pebb-rules and takeeffect January 1, 2023. Here are somechanges that might affect you: If you are called to active duty inthe uniformed services and youlose eligibility for the employercontribution toward PEBB benefits,you regain eligibility for theemployer contribution towardPEBB benefits the day you returnfrom active duty. Your employerpaid PEBB benefits will begin thefirst day of the month in which youreturn from active duty. If you are eligible for the employercontribution toward PEBB benefitsand waive enrollment in a PEBBmedical plan when you are enrolledin TRICARE, Medicare, or otheremployer-based group medicaland are not enrolled in SchoolEmployees Benefits Board (SEBB)medical, you may waive your PEBBdental only if you are enrolled inboth a SEBB dental plan and aSEBB vision plan as a SEBB-eligibledependent. If you are on a leave of absence andmaintain eligibility for the employercontribution, you will have youremployee-paid long-term disability(LTD) insurance premiums waivedfor the first 90 days. When an employee’s dependenthas a change in their ownemployment status that affectsthe dependent’s or anotherdependent’s (such as a dependentchild) eligibility for the employercontribution toward thedependent’s employer-based grouphealth plan, it creates a specialopen enrollment.Other changes The IRS raised the health savingsaccount (HSA) annual maximumcontribution to 3,850 for singlesubscribers and 7,750 for families.Members age 55 and above maycontinue to contribute 1,000 morein addition to these amounts. The annual maximum contributionfor Medical and Limited PurposeFlexible Spending Arrangements(FSAs) increased to 2,850.Two times you can change your coverageOnce you are enrolled in the PEBB Program, you can change your coverage:During annual open enrollmentThe annual open enrollment happens every fall. This yearopen enrollment starts November 1 and continues throughNovember 30. Open enrollment provides an opportunity foryou to change your medical and dental plans, and to addor remove dependents (see How to make changes duringopen enrollment on page 4). Those changes are effective onJanuary 1 of the following year.2During special open enrollmentA special open enrollment happens when you have a lifeevent, such as getting married or having a baby. Dependingon the event, certain changes are allowed outside of openenrollment. The Internal Revenue Service has rules aboutwhat events qualify and what changes you can make. Tolearn more, visit hca.wa.gov/pebb-employee and selectChange my coverage.
2023 PEBB employee medical monthly premiumsEffective January 1, 2023, for state agency and higher-education employees. You do not pay premiums for dental, basic life,basic accidental death and dismemberment, and employer-paid long-term disability insurance benefits.PlansKaiserPermanenteNorthwest1Kaiser Permanente assicCDHPSelectUMPPlus3Subscriberonly 172 25 167 25 46 94 135 29 59 97Subscriber &spouse4 354 60 344 60 102 198 280 68 128 204Subscriber &children 301 44 292 44 81 165 236 51 103 170Subscriber,spouse,4 &children 483 79 469 79 137 269 381 90 172 277Premium surchargesTwo premium surcharges may apply, in addition to yourmonthly medical premium. You will be charged for them if theconditions described below apply, or if you do not attest tothe surcharges. A monthly 25-per-account premium surcharge willapply if you or any dependent (age 13 and older)enrolled in PEBB medical uses tobacco products.1234Uniform Medical Plan (UMP)2 A monthly 50 premium surcharge will apply if you enrolla spouse or state-registered domestic partner and theyhave chosen not to enroll in another employer-basedgroup medical plan that is comparable to UMP Classic.For more guidance on whether these premium surchargesapply to you, see the PEBB Premium Surcharge Attestation HelpSheet on the HCA website at hca.wa.gov/pebb-employeeunder Forms & publications.Kaiser Foundation Health Plan of the Northwest offers plans in Clark and Cowlitz counties in Washington and select counties in Oregon.Administered by Regence BlueShield and Washington State Rx ServicesUMP Plus includes UMP Plus–Puget Sound High Value Network and UMP Plus–UW Medicine Accountable Care Network. The premium is thesame for both.Or state-registered domestic partnerDon’t confuse these dental plansThe PEBB Program offers two dental plans that are oftenconfused. Sometimes members intend to enroll in one DeltaDental plan but accidentally enroll in the other. During openenrollment, be careful to choose the one you want.DeltaCare (Group 3100) is a managed-care plan witha narrow network. You must choose a primary care dentistwithin the network or you will be assigned a primary caredentist. Your primary care dentist must give you a referral to seea specialist. This plan will not pay claims if you see a provideroutside of their network.3Uniform Dental Plan (UDP) (Group 3000) is apreferred-provider plan. You may choose and change anydental provider at any time, but you will usually have lowerout-of-pocket costs if you see in-network providers.Compare your dental plan options on HCA’s websiteat hca.wa.gov/pebb-employee and select Dental plans &benefits. Before you enroll in a dental plan, check with theplan (DeltaCare or UDP, not the provider) to see if yourprovider is in the plan’s network and confirm the groupnumber. You can call the dental plan’s customer service or usethe plan’s online directory.
How to make changes during open enrollmentYou can make the changes listed below during the PEBBProgram’s annual open enrollment, November 1 through 30.Changes are effective January 1, 2023.If you do not want to change health plans, and they arestill available in your county for next year, you do not have totake action to remain enrolled in the same plans.Some changes can be made in PEBB My Account athca.wa.gov/my-account and must be completed beforemidnight on November 30.Change your medical or dental planLog in to PEBB My Account or submit the PEBBEmployee Enrollment/Change form.Add a dependentSubmit the PEBB Employee Enrollment/Change form. You must provide proof of yourdependent’s eligibility. A list of documentsto prove eligibility is available on HCA’s website athca.wa.gov/pebb-employee under Verify & enroll mydependents.Remove a dependentLog in to PEBB My Account or submit the PEBBEmployee Enrollment/Change form.Waive medical or dental coverageLog in to PEBB My Account or submit thePEBB Employee Enrollment/Change form.You must have other employer-based groupmedical coverage, a TRICARE plan, or Medicare to waivemedical coverage.You can only waive PEBB dental coverage ifyou enroll in School Employees Benefits Board(SEBB) medical, dental, and vision coverage, and inspecific situations. Learn more on the HCA websiteat hca.wa.gov/pebb-employee under Waive mymedical coverage.If you can’t use PEBB My Account, forms will be available November 1 on our Open enrollment webpage athca.wa.gov/pebb-oe. Your payroll or benefits officemust receive your forms by November 30. (WashingtonState University and University of Washington employeesmust use Workday to make changes.)Enroll in medical coverage if youpreviously waivedLog in to PEBB My Account or submit the PEBBEmployee Enrollment/Change form.Enroll in an FSA or DCAPEnroll in a flexible spending arrangement (FSA)or the Dependent Care Assistance Program(DCAP) on the Navia Benefit Solutions websiteat pebb.naviabenefits.com or submit the Navia OpenEnrollment form to Navia. You must enroll in thesebenefits again every year if you want to participate. Seereminders on page 8.Reattest to the spouse or stateregistered domestic partner coveragepremium surchargeThe PEBB Program will mail you a letter if youmust reattest for 2023. You can also check whether youneed to reattest in PEBB My Account starting November 1.Reattest in PEBB My Account or submit the PEBB PremiumSurcharge Attestation Change Form.Questions?Visit our Open enrollment webpage at hca.wa.gov/pebb-oeor contact your payroll or benefits office.Your medical plan can help you kick tobaccoYou’ve heard all the reasons tobacco is bad for you, but we know quittingis difficult. Your medical plan can help you live tobacco free and save 25 a month by not having to pay the tobacco use premium surcharge.You and your enrolled dependents 18 and older can sign upfor a tobacco cessation programthrough your medical plan. Visitour Living tobacco free webpage athca.wa.gov/tobacco-free for how toget started.4For enrolled dependents 17and under, contact your medicalplan for programs the y offer.Additional resources are available atteen.smokefree.gov.
Meet us at the in-person benefits fairsDuring open enrollment, you can learn more about your health plan and other insurance options by attending one of the PEBBProgram benefits fairs. All are from noon to 3 p.m., except Pasco, which is 11 a.m. to 2 p.m. Additional retirement overviews areheld after the fairs end. Find maps, parking information, mask requirements, and additional details at hca.wa.gov/pebb-fairs.Please check the website for any late changes before you go. If you have had COVID-19 symptoms or a positive COVID test withinthe past five days, please help keep others healthy by attending the virtual benefits fairs instead of the in-person ones.BellevueNovember 10Bellevue CollegeMain Campus, Building CBellinghamNovember 9Western Washington UniversityViking Union Building 565OlympiaNovember 8Lacey Community CenterPascoNovember 2Columbia Basin CollegeH BuildingSeattle (sponsored by University ofWashington)October 25Harborview Medical CenterMaleng BuildingVancouverNovember 7Clark CollegeMain CampusPenguin Union BuildingOctober 26UW Medical CenterHealth Sciences BuildingWenatcheeNovember 4Wenatchee Valley CollegeMish ee Twie BuildingOctober 27UW SeattleHusky Union BuildingSpokaneNovember 1Spokane Community CollegeLair Student CenterYakimaNovember 3Yakima Convention Centerhand-point-ribbon And don’t forget the virtualbenefits fair is open 24/7 athca.wa.gov/vbf-pebb.Share Your Story SpotlightWe asked our community of members — public and school employees, retirees, and continuationcoverage members — to share some of the ways their benefits have impacted their lives.Thank you to those who have shared their stories! We received a great response, and we hopeyou enjoy the story we featured. Would you like to share your story and inspire others? Visithca.wa.gov/share-your-story to get started.Lauren, Tri-Cities, WA“When I moved, I was worriedabout switching primary careproviders. In my first meetingwith my new nurse practitionerspecialist, not only did she askabout my health history, sheasked about my health goals.Together we made a plan for meto reach a lifelong goal to climbMount Kilimanjaro! My trip is thisSeptember, and as I count downthe days, I know I’ll be ready forthe challenge.”5
New website alert! See what’s changedHCA’s website recently got a new look. The sitewas reorganized, based on data and testingprovided by users like you. Visit our refreshed site athca.wa.gov/pebb-employee.What you can expectcompass Navigation. You’ll find information that’s right for youthrough a large expandable menu. Look under Employeeand retiree benefits and select Public employees.shapesSimplified content. We know your benefits areimportant to you, and we value your time. We revisedthe webpages to make it easier to scan for relevantinformation.[1] Colorways. To help you know you’re in the right sectionof the website, we added color to identify member types.Public employees are green.Try these online tools and resourcesDrop by the virtual benefits fairIt’s a great way to learn about your benefits anytime, day ornight, without leaving your home. You’ll find links to videosand plan comparisons to help you choose the right benefitsfor you and your family.Attend webinarsRegister and attend live and recorded webinars hosted byour medical and dental plan carriers.Change your coverage easily usingPEBB My AccountVisit the Open enrollment webpage Find your premiums. Find your forms. Compare medical and dental plans benefits andpremiums. Change your plans and attest to the spouse or SRDPpremium surcharge using PEBB My Account. Register for a webinar. Read the Summary of Benefits and Coverage (SBC) fordetails about medical plan benefits.During open enrollment, if applicable, make changes andattest to the spouse or state-registered domestic partner(SRDP) coverage premium surcharge using PEBB MyAccount. (UW and WSU employees use Workday.)Quick linksOpen enrollmenthca.wa.gov/pebb-oe6Virtual benefits fairhca.wa.gov/vbf-pebbPEBB My Accounthca.wa.gov/my-accountEmployee andretiree benefitshca.wa.gov/erb
Who to contact for helpContact your plan carrier if you have questionsabout the topics below. For phone numbers and webaddresses, visit hca.wa.gov/pebb-employee andselect Get help and Contact the plans. BenefitsID cardsClaimsChecking if your provider is in their networkChoosing a providerMaking sure your prescriptions are coveredatWould you like tostay informed of PEBBoard meetings andpolicy decisions?Join our email list.1. Visit hca.wa.gov/peb-board-meetings.2. In the Want to receivemeeting notices? box, clickSign up to receive emails.3. Submit your emailaddress. If you are signedup for other emails,you can also changeor remove them underPreferences.Contact your employer’s payroll or benefits officefor questions about: Eligibility and enrollmentPremium surchargesChanging your name, address, or phone numberFinding formsAdding or removing dependentsPayroll deductionsEligibility and enrollment for life and long-termdisability insuranceenvelopes-bulkWould you like toreceive For YourBenefit and othergeneral updates inyour inbox? Sign upfor email delivery.1. Visit PEBB My Account*at hca.wa.gov/my-account.2. Go to the My medical/dental coverage tab.3. Under SectionA — Subscriber AccountInformation, selectSubscribe/unsubscribe toemail service.*UW and WSU employeesmust use Workday7mailboxIs your mailingaddress up to date?Certain account information, including eligibility orpayment deadlines, can’tbe emailed.Contact your payroll orbenefits office. You can’tupdate your mailing addressin PEBB My Account.
Your FSA funds may carry over to 2023If you are enrolled in a Medical Flexible Spending Arrangement (FSA) or a Limited Purpose FSA for 2022, unusedfunds up to 570 may carry over to 2023. If you don’tenroll in an FSA for 2023, any amount over 570 or under 120 will be forfeited to the Health Care Authority afterDecember 31, 2022.To carry over your unused funds up to 570, you musteither enroll in the Medical FSA or Limited Purpose FSA for2023 or have at least 120 left in your 2022 balance.Deadlines for claimsFSA and DCAP reminders 250 Medical FSA contributionYou must enroll in the Medical FSA, Limited Purpose FSA,or Dependent Care Assistance Program (DCAP) each yearyou want to participate. Enroll in these benefits duringannual open enrollment, November 1 through 30, onNavia’s website at pebb.naviabenefits.com. (Universityof Washington and Washington State University employeesuse Workday.)For the Medical FSA and Limited Purpose FSA, you choosehow much to contribute each year — between 120 and 2,850 for 2023.Please note that you cannot enroll in both a Medical FSAand a consumer-directed health plan (CDHP) with a healthsavings account (HSA) in the same year, but you can enrollin a Limited Purpose FSA if enrolled in a CDHP. You cannotenroll in both the Medical FSA and the Limited Purpose FSAin the same year. The Limited Purpose FSA is for eligibledental and vision expenses only.8Medical and Limited Purpose FSA expenses must beincurred by December 31, 2022. You must submit allclaims to Navia Benefit Solutions for reimbursement byMarch 31, 2023.DCAP enrollees have until December 31, 2022 to incurexpenses and submit claims against their 2021 or 2022 DCAPfunds. (This extra 12 months for 2021 enrollees is a one-timeleniency because of the COVID-19 pandemic.)Are you a represented employee whose rate of pay onNovember 1, 2022 is 50,004 a year or less? If so, you maybe eligible to receive a 250 Medical FSA contribution fromyour employer in January 2023. This is part of your collective bargaining agreement. It will not come out of yourpaycheck. No action is required on your part. If you enrollin a CDHP for the 2023 plan year and still have at least 120left over from the previous year, the leftover amount will beconverted to a Limited Purpose FSA.Find out more on HCA’s website at hca.wa.gov/pebb-employee under Life, home, auto, AD&D, LTD, FSA &DCAP benefits.Questions?Visit Navia’s website at pebb.naviabenefits.com or call1-800-669-3539 between 5 a.m. and 5 p.m., Mondaythrough Friday.
Required federal noticeSummary of benefits and coverage available to youThe Affordable Care Act requires the PEBB Program andits medical plans to provide a Summary of Benefits andCoverage (SBC). These documents help you comparemedical plan benefits, terms, and your costs for care fromnetwork and out-of-network providers.To get an SBC for your current PEBB medical plan,go to the Medical plans and benefits webpage athca.wa.gov/pebb-employee (or the plan’s website) to viewor print it. Or, call your plan to ask for a paper copy at nocharge. Your plan can also provide copies translated intoother languages.For other PEBB medical plans, call the PEBB Program at1-800-200-1004 (TRS: 711).Required federal noticeAnnual notice of creditable prescription drug coverageYou will receive this notice each year in this newsletter,and you will also receive this notice if your PEBB coveragechanges. You may request a copy of this notice at anytime by calling the PEBB Program at 1-800-200-1004(TRS: 711).If you or a family member is (or will soon be) enrolled inMedicare, you may hear about your opportunity to enroll inMedicare Part D for prescription drug coverage.Premera Blue Cross Medicare Supplement plans do notprovide creditable prescription drug coverage. If you enrollin one, you will need to enroll in a Medicare Part D planoutside of PEBB.All other PEBB medical plans provide creditableprescription drug coverage, so you do not have to enrollin Medicare Part D. The prescription drug coverage offeredby these PEBB medical plans is expected to pay out, onaverage, as much as Medicare Part D coverage.When you enroll in Medicare, you can keep your PEBBmedical plan with creditable drug coverage and not pay apenalty if you enroll in Medicare Part D later.9If you enroll in a Medicare Part D plan, your PEBB medicalplan may not coordinate prescription drug benefits withMedicare Part D.If you lose or terminate your currentPEBB medical planTo avoid paying a higher Medicare Part D plan lateenrollment penalty, you should enroll in a MedicarePart D plan within 63 days after your PEBB medicalplan ends. If you enroll after the 63-day deadline,your Part D plan’s monthly premium may increase,depending on how long you didn’t have creditableprescription drug coverage.For questions about Medicare Part DVisit the Centers for Medicare & Medicaid Services website atmedicare.gov or call 1-800-633-4227.
PO Box 42684Olympia, WA 98504-2684Here’s yourThis is youronly 2023 openenrollmentnoticeThe information youneed is inside.newsletter
hca.wa.gov/pebb-employee . hca.wa.gov/pebb-rules . 2023 PEBB employee medical monthly premiums. Effective January 1, 2023, for state agency and higher-education employees. . During open enrollment, you can learn more about your health plan and other insurance options by attending one of the PEBB Program benefits fairs. All are from noon to 3 .
limited to a single enrollment in medical and dental plans (PEBB Program) or medical, dental, and vision (SEBB Program). If they are a PEBB employee who waives PEBB medical and dental for SEBB medical, they must also enroll in SEBB dental and vision. Relationship to subscriber 1 This field is required for health care services.
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 Assoc
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