Medical plans by county. > See PEBB Retiree Enrollment Guide for information and how to get started. Medical benefits . 0000040603 00000 n
2021 Employee Health Benefits Enrollment Guide 2021 Retiree Health Benefits Enrollment Guide UHC Retiree Virtual Education Center 2020 Employee Health Benefits Enrollment Guide 2020 Retiree Health Benefits Enrollment Guide United Healthcare Tier 1 Providers Information about the Spouse Medical Plan Surcharge. 0000003983 00000 n
Preferred … 0000038499 00000 n
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Premiums reflect how much PEBB will charge the employer. ô�‰zXv¬7ïŞÀ{¼¬Îë›Æ_•…÷lUd+⻽o±Ül¾Ùdë~y| …¿I¯Î‹ë^x�=4ïjyqÆ
?ĞÉV©ÛçÅSͽ †ECØÏT>{�tºâóŞlı{ŠıE¢Wx¶¶�Ä0Fpì³míÊàGËé�ıË~puŸïèË^‡©,ñÔÏ~bÊœ©DEÉò,sµ§K¼ø. premium rates are found in the PEBB Retiree Enrollment Guide for Non-Medicare Medical plans. 0000040381 00000 n
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At the end of the guide. Quick start guide. 2021 Benefit Information; About Us; Contact Carriers; Contact PEBB; Forms; Retiree, COBRA, Self-Pay; The Board; Wellness Central; Related Sites. 2021PEBB Retiree Open Enrollment Election/Change Form Complete this form to make changes during the PEBB Program’s annual open enrollment. 0000028438 00000 n
PEBB information Public Employees Benefit Board 2021 Enrollment uide 36 Retiree member information — continued 2021 Retiree medical plan monthly premium rates Retiree Retiree & spouse/ partner Retiree & children Retiree & family Children only9 Kaiser Traditional1 $831.90 $1,663.79 $1,414.23 $2,246.12 $668.88 Kaiser Deductible1 $763.63 $1,527.27 $1,298.18 $2,061.82 $618.00 0000034314 00000 n
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endobj
This form replaces all retiree enrollment/change forms submitted in the past. DEFER YOUR ENROLLMENT. 4 0 obj
comparison. Approved by: Position: Director of the PEBB Program . PEBB information Public Employees Benefit Board 2021 Enrollment uide 34 COBRA member information — continued 2021 COBRA medical plan monthly premium rates Self Self & spouse/partner Self & children Self & family Children only7 Kaiser Traditional2 $836.34 $1,672.69 $1,421.78 $2,258.13 $672.45 Kaiser Deductible2 $767.71 $1,535.43 $1,305.12 $2,072.85 $621.29 0000023643 00000 n
AT RETIREMENT: IF YOU/DEPENDENTS ARE UNDER AGE 65 PEBB-RETIREE NON -MEDICARE MEDICAL PLANs. endobj
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Employee Enrollment Guide Your PEBB Benefits for 2020. If you enroll as a newly PEBB benefits-eligible employee, enrollment begins the first of the month following the date you become eligible for benefits. To estimate your portion, visit the Payroll Deduction Estimator below. 0000034385 00000 n
36 . Complete Section I — Employee Information. 0000007707 00000 n
Visit Us. We invite you to connect with us and take advantage of our virtual open enrollment from your home or workplace. Plan Year: 1/1/2020–12/31/2020 with Medical FSA Grace Period through 3/15/2021 Instructions 1. Back to uhcretiree.com » IMPORTANT DATES. Kaiser permanente wa medicare advantage (pebb) retirees evidence of coverage 2020 classic non certificate (coc) benefits summary 2021 nw reitrees retiree enrollment guide 3. HCA Contact; 1-800- 200-1004 Mailing Address. %����
Medical benefits . How to enroll. SMARTHEALTH > If you have medical coverage which qualifies to defer PEBB retiree coverage – Check “Defer my Coverage” box and select the appropriate eligible deferral option box immediately below. Pages 31–40. %PDF-1.5
Pages 8–12. > Preferred Provider Organization Plans > Managed Care Plans > Consumer Directed Health Plans (CDHP) You pay the HCA monthly premium for you and eligible dependents. PEBB Website: • Deferring Coverage . Group retiree benefits for the Washington State Public Employees Benefits Board (PEBB) Program. This is not my group. ŠÁ¶L¤�Ñ•:À�ƒ@W±ÓѶԺ�êìªëi»›/È�Õ�nggçl»_îıŞûó¾÷¹ïó¾7ç €öØ`�l˜)l Ãc=äAú9º›ĞSI)f:øÕ)TË/§Ğ°¸ú´�:“+œõbD¦é{J¨ÀmO›et±FêÂõ¶ŠE‘[Kª\I <>
Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. 0000005823 00000 n
Guía de inscripción 2021; Summary of Benefits 0000028254 00000 n
Eligibility . NON-MEDICARE SUBSCRIBERS ONLY. page 6 . 2. Who to contact for help. PEBB members can conveniently get open enrollment information from Kaiser Permanente. “OE and HEM Quick Guide” • Medical Not Enrolled • Medical Opt Out • New Hires • Didn’t Participate in HEM but want to for 2021 • Flexible Spending Accounts • New $5/month Double Coverage Surcharge • OE Correction Timeline. Complete Section III — Signature. 0000040095 00000 n
Public Employees’ Benefit Board – 2021 Enrollment Guide PEBB information 1. Staff are available by email or by calling 503-373-1102. Kaiser Permanente Wa Medicare Advantage Pebb Retirees Evidence Of Coverage. 2021 PEBB Employee Enrollment/Change Form. 0000028173 00000 n
2021 PEBB Employee Enrollment/Change for Medical Only Groups Subscriber’s last name Social Security number 2 Spouse or state-registered domestic partner (SRDP) List an eligible spouse or state-registered domestic partner (SRDP), as defined by WAC 182-12-109, you wish to enroll in medical coverage. Need help deciding whether to complete open enrollment? State of Nevada seal link to nv.gov. To enroll children, please complete Section 7, located at the end of the form. Wa 98225-5996 illegible information may delay coverage for Washington public Employees Self-pay page or www.pebp.state.nv.us... Enroll children, please visit the Retiree enrollment Guide for information and how to get started postpone PEBB... Pebb Retiree insurance coverage Full benefits package premiums premiums are effective January 1 through December 31, 2021 December! School Employees ( SEBB ) Phone: 360.725.0440 or 800.200.1004 Temporary change to the Retiree, COBRA, rates... Illegible information may delay coverage with other providers in the plans below have committed to: PEBB... For complete information, please refer to your Summary of benefits Full benefits package premiums premiums effective... The rates the employee pays 516 High Street, MS 9054 Bellingham, Wa 98225-5996 enrollment, Medical. Your portion, visit the Retiree enrollment deadline UNDER AGE 65 PEBB-RETIREE NON -MEDICARE Medical plans form to make during! Estimate your portion, visit our Help with My Account webpage Employees ( SEBB ) Phone: 360.725.0440 or Temporary... 30, 2021 information and how to get started your home or workplace Street, MS 9054 Bellingham Wa... May delay coverage inaccurate, incomplete, or illegible information may delay coverage cover! By calling 503-373-1102 to: • PEBB Retiree enrollment Guide ; Medical, and! High Street, MS 9054 Bellingham, Wa 98225-5996 the plans below have committed:. 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