Medical and Dental

You are encouraged to make changes to your coverage online whenever possible. Be sure to print the online confirmation once you have completed making changes. You will be able to make online changes for the following reasons:

• To choose a new medical or dental plan; or
• To waive/remove an eligible dependent from your current plan; or
• To add an eligible dependent previously covered on your plan; or

You are required to fill out a 2016 Open Enrollment/Change form and submit it to the Pullman HRS office for the following reasons: 

• To add a dependent to your medical/dental plan(s) that you have never covered before (dependent verification documents are also required). A dependent is a defined as a spouse, registered domestic partner, and child(ren).
• To remove a dependent who is no longer eligible to be on your coverage due to divorce, dissolution of domestic partnership, etc 
   

In 2014 State Legislature approved the addition of premium surcharges in some cases.

• A monthly $25-per-account surcharge will apply if the subscriber or one or more enrolled family members use tobacco products.
• A monthly $50-per-account surcharge will apply if a subscriber enrolls in a spouse or state-registered domestic partner, and the spouse or partner has waived enrollment in other employer-sponsored coverage that is comparable to PEBB medical coverage.

In 2016, only some employees will need to attest or re-attest.  You will need to attest or re-attest if:

• You add a new family member to your PEBB coverage.  If the person has been on your plan in the past, attestation can be done through the HCA MyAccount tool.  If the person is a new enrollee on your plan, this can be addressed in the 2016 Open Enrollment form.
• There has been a tobacco status change for any family member covered on your PEBB coverage.  This can be addressed at any time throughout the year. 
• If your spouse/registered domestic partner elected not to enroll in his or her employer-based group medical insurance in 2015, but you did not have to pay the premium surcharge because either: the spousal plan calculator indicated your spouse or registered domestic partner's coverage was not comparable to Uniform Medical Plan (UMP) Classic; the medical premium for your spouse or registered domestic partner's employer-based group medical insurance was $89.31 per month or more.

The attestation you make during open enrollment will be in effect for 2016 unless there is a change in your spouse or registered domestic partner's status that allows or requires you to re-attest.  If you do not re-attest during open enrollment, you will pay any applicable surcharges beginning January 1, 2016.

Premium Surcharge Q & A

Valid Dependent Verification Documents

List of Medical Plans Available by County - WA, OR, ID

Premium Payment Plan Election/Change

Declaration of Tax Status

2016 Medical Plan Benefits Comparison

• UMP Plus
  
  • Kitchen Table Toolkit
• Group Health Sound Choice
• New PEBB Medical Plan Options in 2016

• Beginning January 1, 2016 Uniform Medical Plan (UMP) will offer UMP Plus, a new accountable care medical plan. Members will be able to choose between the Puget Sound High Value Network or the UW Medicine Accountable Care Network.  Both networks are available in King, Kitsap, Pierce, Snohomish, and Thurston counties.  For more information on accountable care plans, visit the Health Care Authority (HCA) website.
• All non-Medicare UMP Plans will also:
  
  • Expand coverage for end-of-life counseling.
  • Provide coverage for short-term alcohol and substance abuse treatment in various settings, by various provider types.
  • Expand coverage for preventative services including:
    
    • Coverage for all medications and nicotine replacement therapy with a prescription
    • Coverage for eight new preventative services with no member cost-sharing:
      
      • Provide intensive behavioral counseling for sexually active adolescents and adults at increased risk for sexually transmitted infections
      • Screen sexually active women ages 24 or younger, and older women based on risk for chlamydia and gonorrhea
      • Screen non-pregnant adolescents and adults at high risk for hepatitis B
      • Prescribe fluoride at age six months when water supply is fluoride deficient
      • Screen men ages 65-75 via ultrasonography if they have ever smoked for abdominal aortic aneurysm
      • Screen pregnant women with no symptoms after 24 weeks of pregnancy for gestational diabetes mellitus
      • Use low dose aspirin after 12 weeks of pregnancy for women at high risk for preeclampsia
• All UMP Consumer Directed Health Plans (CDHP) will:
  
  • Pay 100% of covered benefits for individual family members who meet certain out of pocket limits, even if the family out of pocket limit has not been reached.  The out of pocket max will be increased from $4,200 in 2015 to $6,850 in 2016.
  • Allow additional contributions into a Health Savings Account.  The family contribution maximum has been increased from $6,650 in 2015 to $6,850 in 2016.  Subscribers ages 55 and older can continue to contribute $1,000 more in addition to these amounts.

• Beginning January 1, 2016 Group Health will offer SoundChoice, a new accountable care program.  SoundChoice will be available in King, Pierce, Snohomish, and Thurston counties.  For more information on accountable care plans, visit the Health Care Authority (HCA) website.
• All Group Health non-Medicare Plans will:
  
  • Cover cardiac rehabilitation under the physical, occupational, and speech therapy benefits with a combined limit of 60 inpatient days and 60 outpatient visits per year.
  • Group Health Classic co-pays will increase from $15 to $30, and Group Health Value co-pays will increase from $20 to $40 for the following provider types:
    • Audiologist
    • Enterostomal therapist
    • Massage therapist
    • Nutritionist
    • Occupational medicine
    • Occupational therapist
    • Physical therapist
    • Respiratory therapist
    • Speech therapist
  • Expand coverage for end-of-life counseling.
  • Provide coverage for short-term alcohol and substance abuse treatment in various settings, by various provider types.
  • Expand coverage for preventative services including:
    
    • Coverage for all medications and nicotine replacement therapy with a prescription
    • Coverage for eight new preventative services with no member cost-sharing:
      
      • Provide intensive behavioral counseling for sexually active adolescents and adults at increased risk for sexually transmitted infections
      • Screen sexually active women ages 24 or younger, and older women based on risk for chlamydia and gonorrhea
      • Screen non-pregnant adolescents and adults at high risk for hepatitis B
      • Prescribe fluoride at age six months when water supply is fluoride deficient
      • Screen men ages 65-75 via ultrasonography if they have ever smoked for abdominal aortic aneurysm
      • Screen pregnant women with no symptoms after 24 weeks of pregnancy for gestational diabetes mellitus
      • Use low dose aspirin after 12 weeks of pregnancy for women at high risk for preeclampsia
  • All Group Health Consumer Directed Health Plans (CDHP) will:
    
    • Pay 100% of covered benefits for individual family members who meet certain out of pocket limits, even if the family out of pocket limit has not been reached. The out of pocket max for individuals is $5,100 in 2016.
    • Allow additional contributions into a Health Savings Account.  The family contribution maximum has been increased from $6,650 in 2015 to $6,850 in 2016.  Subscribers ages 55 and older can continue to contribute $1,000 more in addition to these amounts.

• Beginning January 1, 2016 Kaiser Permanente Classic will increase it's annual deductible from $250 to $300 per person, and from $750 to $900 per family.
• Kaiser Permanente Classic co-pays will be increased as follows:
  • Hearing: $35
  • Mental Health: $25
  • Primary Care: $25
  • Specialty Care: $35
  • Spinal Manipulations: $35
  • Urgent Care: $45
  • Vision Care: $25
  • Ophthalmology Visits: $35

• Change emergency room cost-sharing to 15% coinsurance (annual deductible still applies)
• Add new cost-sharing for medications administered during an inpatient, outpatient, or office visit: 15% coinsurance (annual deductible and separate copay for type of visit still apply)
• Kaiser Classic and Kaiser CDHP will no longer be available to members in Lewis, Skamania or Wahkiakum counties.  Kaiser will continue to offer coverage to PEBB members who live or work in Clark or Cowlit
• Kaiser Permanente Consumer Directed Health Plan (CDHP) will:
  • Pay 100% of covered benefits for individual family members who meet certain out of pocket limits, even if the family out of pocket limit has not been reached.  The out of pocket max for individuals is $5,100 in 2016.
  • Allow additional contributions into a Health Savings Account.  The family contribution maximum has been increased from $6,650 in 2015 to $6,850 in 2016.  Subscribers ages 55 and older can continue to contribute $1,000 more in addition to these amounts.