Key Changes This Year
A significant number of changes in our health insurance plans will be occurring effective October 1, 2008. The following information highlights the primary changes. Please reference enclosed plan documents for details and other benefits information.
- New health/dental plans
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Employees will be able to choose from four medical plans: three ODS preferred provider option (PPO) plans, and one Kaiser HMO plan. The distinguishing feature between the ODS plans is the amount of deductible (e.g., $100, $300, or $1000), as well as copay and coinsurance differences. There will be three dental plans from which to choose: an ODS plan (similar to Regence Plan 1), a Willamette Dental plan, and a Kaiser plan.
- Additional tier
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The OEBB plans have 4 tiers rather than the 3 that we currently have. The additional tier is employee plus 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.
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The four tiers will be:
- Employee only
- Employee plus spouse or domestic partner
- Employee plus child or children
- Family (employee, spouse or domestic partner, and child or children)
- Separate vision plan
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In the past, the vision benefit was bundled with the medical plan you selected for both Kaiser and Regence. If you want both medical and vision coverage with the new plans, then you will need to elect each one separately. You cannot elect Kaiser vision and dental without enrolling in Kaiser medical. Kaiser medical may be elected in conjunction with ODS vision and dental.
- Vision now available on all plans
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You may now choose vision coverage if enrolling in the ODS high deductible plan. In the past, enrollees in the Regence high deductible plan did not have a vision option. Since the vision plans are now separate from the medical plans, you may elect them separately.
- No dollar maximum for preventive services
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In the past, Regence plans gave subscribers a $500 per year maximum allowance for preventive services based on a frequency schedule. ODS does not have an annual dollar limitation and services will be paid at 100% on a frequency schedule.
- Both copay and coinsurance provisions
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For ODS plans, some benefits have a copay requirement while others have a coinsurance provision (refer to glossary).
- Lower pharmacy copays
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Generic prescriptions with ODS will have a $5 copay rather than $10 with the Regence plans. The ODS plans also have a mail order benefit similar to the Kaiser plan. You may get a 90 supply for generic prescriptions through mail order and only pay two copays (save one copay). With Kaiser, the mail order benefit is for both generic and preferred prescriptions. So you will only pay two copays for a 90 day supply whether the prescription is generic or preferred.
- No orthodontia services
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The new dental plans will not have an orthodontia benefit. Provisions have been made by OEBB for employees and/or their dependents to continue current treatment. Restrictions apply, so please contact Willamette Dental (1-800-460-7644) for more information.
- Different timelines to meet
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With the OEBB plans, meeting the annual out-of-pocket maximum and yearly deductibles (refer to enclosed glossary) will be based on the benefits plan year (October 1 to September 30) rather than the calendar year.
- Added provision for dependent children eligibility
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OEBB plans cover dependent children up to age 26 who are attending school full-time, or living in the home of the eligible employee over six months of the calendar year, and the eligible employee provides over half the year support.
- Increase in PCC monthly contribution (aka “Cap”)
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PCC makes a monthly contribution towards your medical, vision and dental premiums. This is called the “Cap.” For part-time faculty the 2008-09 Cap will be $260.
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For all other benefits eligible employees the 2008-09 Cap will be:
- $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 employees (excluding part-time faculty) have a pro-rated Cap based on their full-time equivalency (FTE). For example, an employee working .50 FTE would have a cap of $260 per month if electing self only medical coverage (0.5 x $520 = $260).
- Waiting period for dental and vision services may apply
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A waiting period will apply for dental and vision services that are not considered preventive if the following is applicable: coverage for previously OEBB-eligible employees or a previously OEBB-eligible dependent enrolling in the dental and/or vision plans during an 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 plan due to a loss of other coverage will not be subject to waiting periods.
- Provider network differences
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The ODS Participating Provider network is different from the Regence network. ODS recently added Legacy hospitals to their preferred provider list, but the providers that are affiliated with Legacy may or may not be in the ODS network. ODS frequently updates their provider listings. You are encouraged to use their online provider search to see which providers are in their network.
- No family co-insurance maximum
- The annual out-of-pocket maximum will apply to each individual covered under the plan separately.
Questions?
Check out the Frequently Asked Questions. If they don't appear there, email your questions to HR/benefits. And don't forget to attend an Informational Meeting.