Benefits: Open Enrollment Frequently Asked Questions

Does every benefits-eligible employee need to participate in the enrollment process?

Yes. Unlike past years where only those employees who wanted to make changes had to return a form, this year all employees must participate. This “positive enrollment” is required due to the changes in benefits; i.e., the source, the providers and the plans.

If I don’t plan to enroll in insurance through PCC, do I still need to go on line and fill something out?

Yes. While we refer to this annual event as “Open Enrollment,” even employees who are not enrolling in PCC insurance need to participate. One of the options during enrollment is to “opt out” of insurance. This is the equivalent of what PCC used to refer to as “waiving” insurance. For most employees who waive insurance, $200/month compensation is received from the college. For employees working less than 1.0 FTE (less than full-time), this compensation is prorated. Part-time faculty are not eligible for the “opt out” compensation.

Can anyone "opt out" of taking insurance?

No. Opting out of insurance requires that you have other group medical insurance coverage if you are not a part-time faculty member. Part-time faculty members must have other group or private medical insurance to opt out. Without another policy, you are required to take some level of PCC medical insurance coverage.

What will happen if I don’t go through the enrollment process?

Benefits eligible employees who don’t go on line to either enroll in insurance or to “opt out,” will be enrolled in default coverage for the employee only. The plan PCC selected as the default plan is ODS plan 8, which has a $1,000 deductible amount and is the least expensive of the four medical plan options.

How will we enroll in benefits this year?

Benefits enrollment this year will be online vs. our past paper approach. Open enrollment benefit meetings will include information re: the online enrollment system. In addition, the packets sent to employee homes will include an instructional sheet on the online enrollment process. HR/Benefits is working with TSS to make computer access available for those who don’t have a dedicated computer to do their jobs. For employees who can’t access a computer, contact HR/Benefits for a paper enrollment form.

I don’t work with computers and am uncomfortable doing an online enrollment. Will help be available?

Yes, HR/Benefits will be happy to work with anyone who would like assistance through the online enrollment process. As a first step to understanding how to go about enrolling online, employees are strongly encouraged to attend an Open Enrollment Benefits meeting. The schedule of meetings is available at the HR/Benefits website and was included in the Open Enrollment packet sent to employee homes. In addition, there will be enrollment instructions in the informational packets.

Will those instructions be prepared in non-English languages, such as Spanish, Russian, Chinese and/or Vietnamese?

No, we are sorry but none of the materials being provided will be in languages other than English. PCC HR/Benefits would be happy to work with managers and their employees if having an interpreter at an Open Enrollment Benefits meeting would be helpful. Please contact a Benefits Specialist to make your request. We will need to know which meeting will be attended (date, time, location) and need no less than one week’s lead time to make arrangements.

I’m going to be away for the entire enrollment period. How can I go about enrolling if I don’t have access to a computer during my absence?

Contact a PCC HR/Benefits Specialist. They can provide you a paper form to complete. The same September 15, 2008 deadline for enrollment applies, so you’ll need to return the form before you go or mail it to PCC for receipt before the deadline.

When is the Open Enrollment period?

Open Enrollment will run August 15 through September 15, 2008. All elections will be effective October 1, 2008.

How does the online enrollment system work?

That system is still being completed. We will provide further information in future communications.

What are the new medical plan options that are replacing the Regence plans we had and how do they compare?

In selecting the plans that PCC would offer to benefits eligible employees, the Joint Committee on Insured Benefits (JCIB) considered similarity to the Regence plans. The comparison is noted in the table below. Please note, we are giving you the general alignment of old to new plans, along with the deductible amounts. Employees need to be aware that the new ODS plans are not exactly like the former Regence plans. Employees are encouraged to review the specific plan information included in the Open Enrollment packages to draw your own comparison. This is especially true if you or a family member requires a specific type of care or service.

Medical (deductible amounts are in parentheses)

Old Plans	Regence A-100 ($100)	Regence PPO ($100)	N/A	Regence C-1000
New Plans	N/A	ODS Plan 3 ($100)	ODS Plan 6 ($300)	ODS Plan 8 ($1000)

Your chart has no comparable plan for the A-100 and has added a plan with a $300 deductible. Why were these changes made?

In reviewing medical plan options, the JCIB discussed at length the opportunity to address some other concerns regarding our Benefits program. The concern was that we’d previously offered two $100 deductible plans and had no option between the $100 plans and the C-1000 plan with the $1,000 deductible. The JCIB made a conscious decision to provide an option with a lower premium than ODS’ plan 3, but without the risk of having to cover a $1,000 deductible if something happened. Finally, the A-100 was a traditional indemnity plan, something that OEBB didn’t provide as a medical plan option.

Can I just use the comparison chart above and roll into the comparable new plan?

You could do that, but we’re strongly urging all employees to take the time to review all of the information we’re providing in the Open Enrollment packages, to make a thoughtful and informed decision in selecting medical insurance coverage. As noted, the plan provisions are not identical. The differences that exist might be enough to make you select a different option. Also, over time, employee needs for insurance may have changed. This is an opportunity to revisit your situation relative to the plan offerings to ensure your plan selection will best meet your needs.

If we select a plan and later change our minds, can we change plans?

If you change your mind before the end of the open enrollment period, August 15 through September 15, you can go back in the online enrollment tool and make a change to your selections. If, however, you change your mind after September 15, 2008, you will have to wait until next year’s open enrollment to change your plans. It is for this reason that we want to encourage all eligible employees to review all of the available information before making a decision.

Is Kaiser still an option for medical coverage?

Yes, PCC recognizes that a high percentage of PCC employees are enrolled in Kaiser for medical insurance, so Kaiser remains an option. The two Kaiser plans, the former and the new, are not identical in terms of plan coverage, however. If you want to stay with Kaiser, we’d still encourage you to read through the material so you understand any differences which may cause you to rethink your decision.

If we were with Regence BC/BS are we going to have to change doctors?

You will not have to change doctors. Many of the doctors on the Regence network are also on the ODS Plus network. If you have a doctor that is not on the ODS Plus network, you may still go to that doctor, but you may have to pay more for their services. The ODS Plus network will be adding Legacy hospitals and clinics to their provider list before October 1st.

I see that there are still three dental plan offerings. Are the provisions of three options the same as what we’ve had before, especially for Willamette Dental and Kaiser?

As with the medical plans, the dental plans are not exactly the same, but they are comparable. Employees should review the plan summaries before making their plan selection. The three dental options are Willamette Dental, Kaiser Dental and ODS dental plan 5.

Does the ODS dental plan have the graduated scale of benefits, 70% in year one, 80% in year two, etc. or are preventive services paid at 100% for everyone, regardless of years on the plan?

The ODS plan that PCC is offering provides 100% coverage for preventive or routine services such as cleanings, periodic x-rays and other services as outlined in the information provided in your packet.

I don’t see any reference to orthodontia? Why?

In the past, PCC provided orthodontia through Willamette Dental only. That was permitted through OSBA (Oregon School Board Association). OEBB (Oregon Employers Benefit Board), our new source for benefits, has a different requirement. That is, if one plan has orthodontia coverage, then all three dental plans need to offer orthodontia. That increases premium costs for all employees taking dental coverage, regardless of whether their family utilizes orthodontia services. Based on the JCIB sense that orthodontia isn’t often utilized, a decision was made to drop that coverage from the dental plans, but include a question about orthodontia use in an upcoming employee survey. The issue regarding orthodontia coverage will be reviewed again next year.

For kids or employees already with braces (banded), will Willamette Dental continue to see those patients?

Yes, they would be pro-rated depending how far along they are in treatment and UCR (usual and customary) fees would then apply. Contact Willamette Dental (1-800-460-7644) for more information.

Will employees or their family members still be able to continue their orthodontia care with a Willamette Orthodontist? Does this depend upon whether they have their regular coverage through Willamette?

They can continue with orthodontia through WDG (Willamette Dental Group) on a prorated basis, even if they do not have dental coverage with WDG.

What will happen if I’ve already paid for the orthodontia care in full, including services that have not been received yet?

Because PCC did not select the orthodontia provisions for dental coverage, you would be required to begin paying at the UCR (usual and customary) rate throughout the remaining time in treatment. OEBB tells HR/Benefits that as long as they are still in treatment, the new fees would apply even if they paid their Orthodontia co-pay in full. The co-pay amount paid will be credited to the pro-rated amount. If the patient chooses not to continue orthodontic treatment with WDG, any credit for treatment remaining would be refunded.

If the employee has not paid for the orthodontia services in full, will the services be pro-rated based on where they are in their treatment, or will the cost be determined some other way?

What the patient has paid toward orthodontic treatment has nothing to do with how the treatment is prorated. The proration is based on estimated length of treatment and what the usual orthodontia fee is. Proration is always done when the there is a change in orthodontia benefit coverage.

How do the costs for these plans compare with the plans we had before?

The cost associated with the OEBB insurance plans are priced very favorably. In some cases the benefits premiums may even be lower than what was paid last year. For example, if you elect the new Kaiser plan for yourself and spouse/domestic partner, you will experience a 20% decrease in monthly premium compared to our current Kaiser plan. This savings also includes adding Kaiser vision. In addition, OEBB makes four “tiers” of coverage available: Employee only, Employee + spouse or domestic partner, Employee + child(ren), and Employee + family (spouse or domestic partner + children). The employee + child(ren) tier is a great new development for employees covering only themselves and a child or children. It has lower premiums than family coverage, which had to be purchased if the employee had more than one child, and also has lower premiums than the employee + spouse or domestic partner level of coverage.

The lower premiums and even the modest increases in benefit premiums are a pleasant surprise. How is it that the premiums seem more reasonable this year? They seem to have gone up a lot every year in the past.

There are a couple of things happening that helps contain costs. First, the OEBB requires all K-12 districts to access their benefits through OEBB and many of the community colleges have also joined. That has created a very large member population which spreads the utilization across more people, thus lowering the premium costs. Cost was also a consideration on the part of PCC and the JCIB (Joint Committee for Insured Benefits) when selecting the plans to offer. In fact, it’s why we’ve opted to introduce a $300 deductible plan (ODS plan 6). The deductible is higher, but the premium is lower.

Is the college’s contribution towards benefit premiums (the “cap”) increasing this year?

Yes, the caps are going up this year as follows:

$520 (self only medical),
$765 (self plus spouse/partner medical),
$765 (self plus child or children medical),
$860 (self plus family medical),
$520 if opting out of medical, but electing vision and/or dental only.

Part-time faculty will get a $260 cap for all levels of coverage, half the Employee (self) only cap. Part-time non-faculty will get a pro-rated cap based on their full time equivalency (FTE). For example,.75 FTE x $520 = $390.

Will copays go toward the plan deductible and out-of-pocket requirements?

Copays under the Kaiser medical plan will count towards the maximum out-of-pocket. Copays made under the ODS Health Plans will not count toward the deductible or the out-of-pocket maximum.

When do employees need to make their benefit decisions?

The open enrollment period runs August 15 through September 15, 2008. Benefits eligible employees must complete the online form before the deadline or will they will be enrolled in PCC’s default medical plan, ODS plan 8 with a $1,000 deductible.

When does coverage under the new plans begin?

The effective date for plan coverage is October 1, 2008. The plan year continues through September 30, 2009.

When will plan membership cards be sent to employees so they have a record of being insured, as requested by providers?

After an employee selects their carrier (ODS or Kaiser) and the open enrollment period ends, the carrier will send them an ID card within 30 days, usually much sooner.

How can I learn more about what is covered under each of the plan options?

HR/Benefits has assembled a comprehensive package of information for employees to review prior to making their enrollment decisions. For the latest information, check PCC’s HR/Benefits website which will be updated as new information becomes available.

Will the new plans cover pre-existing conditions?

There will be no new pre-existing condition limitations; however a waiting period will apply for Dental and Vision services that are not considered preventative if the following applies: Coverage for previously OEBB-eligible employees or a previously OEBB-eligible dependent enrolling in the dental and/or vision plans during a future open enrollment period will be limited to routine and preventive care for the first 12 months. Eligible employees who enroll in the dental or vision plans, or add previously OEBB-eligible dependents to the dental and vision plans, due to a loss of other coverage will not be subject to waiting periods.

What is the eligibility age of dependents?

Biological, step and adopted children under age 19 are eligible for coverage under OEBB benefit plans. Eligible employees also may obtain coverage for dependent children that are legal wards of the court or that they, their spouses, or domestic partners are required to support.

Dependent children age 19 up to 26 are eligible for coverage if they are:

Attending school full time, excluding foreign students; or
Living in the home of the eligible employee more than six months of the calendar year, and the eligible employee provides over half the yearly support; or
Incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability.

Dependent children older than age 26 are eligible for benefit coverage if they are incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability and were covered under a college plan prior to reaching the age of 26. There are some exceptions please contact the Benefits Office for more information.

Dependent children of all ages must be unmarried and not have a domestic partner to participate in OEBB-sponsored benefit plans.

A complete version OEBB’s eligibility rules are available on their website.

What does "opt out" mean?

“Opt out” is OEBB’s terminology for what PCC has historically referred to as waiving coverage. OEBB uses “waive” in another way, so all information and references this year will be to “opting out” of coverage. For employees with other group medical coverage the “opt out”incentive compensation remains at $200 per month if you are full time, and is prorated for part time employees with the exception of part time faculty who are not eligible for opt out incentive compensation. Part time faculty may still opt out if they have other group medical coverage, but they will not receive the incentive compensation.

Why is the college changing benefit plans?

Regence insurance was available to the college through the Oregon School Board Association (OSBA) which decided to end its insurance offerings given the introduction of the Oregon Educators Benefit Board (OEBB). The college investigated all reasonable alternatives to secure benefits and concluded that OEBB offerings and costs were the best for us. Regence is not available through OEBB.

Why are there four tiers now and how do they work?

The OEBB plans have 4 tiers: employee only, employee plus spouse or domestic partner, employee plus child or children, and family (includes spouse or domestic partner and child or children). If you cover yourself plus two or more children without covering a spouse or domestic partner, then you will no longer enroll in the family level of coverage, but rather will enroll in the new employee plus child or children tier. If you cover yourself plus one child, then you will also be in this new employee plus child or children tier. If you cover only yourself plus a spouse or domestic partner, then you will enroll in the self plus spouse tier.

Frequently Asked Questions

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