Key Changes This Year
Premium and Cap Changes
All health insurance plans will have premium changes as of October 1, 2012. The College Contribution, called the Cap, is increasing as of October 1, 2012. Please see enclosed cost sheet for more information.
Medical Plan Changes
All OEBB Medical Plans (Kaiser and ODS)
- Bariatric Surgery benefit added for primary subscribers
- All OEBB medical plans will cover bariatric (gastric bypass, not lap banding) surgery. This benefit will only be available to the primary subscriber on the plan and requires a $500 additional copayment. Spouses/domestic partners and children will not have access to this benefit this year. Specific criteria must also be met in order to qualify for this benefit. These criteria can be found on the OEBB website at: www.oregon.gov/OHA/OEBB/docs/MeetingAttachments/2012/BariatricSurgeryCriteria.pdf.
- Preventive care benefit expanded to include certain contraceptives
- Due to federal healthcare reform requirements, certain contraceptive devices and services will be covered at 100 percent under the preventive care benefits on all OEBB medical plans effective October 1, 2012. More details on the specific services and devices that will be covered can be found in the Plan Handbooks which are available by calling your carrier or visiting their website:
Kaiser Permanente Customer Service ODS Customer Service 1-866-223-2375 1-866-923-0409 http://my.kp.org/nw/oebb http://www.odscompanies.com/oebb
- Pharmacy Plan Changes
- Kaiser: no changes for the 2012-13 plan year.
- ODS: PHARMACY OPTION A WILL NO LONGER BE AVAILABLE. Pharmacy Option B will be attached to all ODS medical plans (plans 3, 6 and 8).
- Value Tier and Generic prescription copays will remain the same, as will the non-preferred brand name coinsurance.
- Preferred brand name prescriptions will have a $25 copay for a 31 day supply, and $50 for a 90 day supply through mail order.
- Specialty preferred brand name prescriptions will have a $50 copay for a 31 day supply.
- Vision Plan Changes
- There are no vision plan changes for the 2012-2013 plan year.
- Dental Plan Changes
- Kaiser Dental Plan 8
- Orthodontia coverage will be included in this plan as of October 1, 2012.
- Orthodontia copayment will be $20 per visit.
- Members will no longer be required to be enrolled in a Kaiser medical plan to enroll in a Kaiser dental plan.
- ODS Dental
- Plan 4 will have orthodontia coverage included as of October 1, 2012.
- Newly available Plan 6 is similar to ODS plan 4, but has a $1,200 yearly benefit limit and does not offer orthodontia.
- Willamette Dental
- No changes for the 2012-13 plan year.
- Employee Optional Life Insurance Guarantee Issue Amount Changing
- Effective October 1, 2012, OEBB’s Optional Employee Life Insurance plans through The Standard will guarantee up to $100,000 in coverage for employees who enroll when they first become eligible for coverage. Guarantee Issue (GI) means that coverage can be selected without the employee having to provide proof of insurability, including medical history. Employees currently enrolled in a coverage amount less than $100,000 can increase their coverage during this open enrollment period by either $10,000 or $20,000 without providing proof of insurability until the maximum GI of $100,000 is reached. Previously eligible employees electing coverage for the first time will need to provide proof of insurability and receive approval from The Standard before coverage will become effective, as will employees requesting more than $100,000.