1Employee may add only the new spouse, state-registered domestic partner, or children of the spouse or partner. All changes are effective January 1, 2019. Connect with us Contact HCA. You're almost done! PEBB contracts with ASIFlex to administer the FSA program under PEBB administrative rules and in keeping with IRS code. University of Washington employees must make changes through Workday. You … See the, Apply for, cancel (terminate), or change coverage amounts for supplemental life and accidental death and dismemberment (AD&D) insurance. Please seek tax advice from a qualified tax advisor. Behavioral health services by plan. Skip Mega Menu My Accounts My Group Benefits. Get assistance with your PEBB account. Go to My Account on the PEBB website. Change your or a dependent's tobacco use premium surcharge attestation. We call these special open enrollment events. A court order requires the employee or any other individual to provide a health plan for an eligible child of the employee. Employee or dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE plan. You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1 through 30) or if a special open enrollment event occurs. Plan change requirements You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1 through 30) or if a special open enrollment event occurs. All PEBB employees can also go online to the PEBB Program’s website to review the timelines, required forms, and additional documentation needed to … 221 0 obj <>/Filter/FlateDecode/ID[<8B3B76BEA9CBFE41BE04C5D85DFAECAC><58BE067C9D3E1C4884397EE92039F3C4>]/Index[192 66]/Info 191 0 R/Length 136/Prev 583550/Root 193 0 R/Size 258/Type/XRef/W[1 3 1]>>stream To enroll in PEBB benefits, employees should contact your payroll or benefits office. You will be able to make most changes to your PEBB benefits on the Health Care Authority (HCA) PEBB My Account page. Join Facebook to connect with My Pebb and others you may know. Employee hire letter from employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage. You can set aside pre-tax dollars to pay for your … 2021 rates. All valid documents for proof of this event must show the name of the parent who is the subscriber, subscriber’s spouse, or the subscriber’s state-registered domestic partner. Choose optional benefits you are currently enrolled in or will enroll in 2021. Complete the information below to get assistance with My Account. Certificate of credible coverage; letter of enrollment or termination of coverage from the health plan; letter of enrollment or termination of coverage from the employer’s payroll or benefits office; proof of waiver, Enrollment or termination letter from Medicaid or CHIP reflecting the date the subscriber or subscriber’s dependent enrolled in Medicaid or CHIP or the date at which the subscriber or subscriber’s dependent lost eligibility for Medicaid or CHIP. What changes can I make during open enrollment? You can make some changes during the year without a special open enrollment event. 257 0 obj <>stream The Navia Benefits Card is a debit MasterCard® that allows you to access your FSA funds directly. Note: University of Washington employees must make changes through Workday. Certificate of creditable coverage; letter of termination of coverage from health plan or payroll or benefits office; or COBRA election notice. PEBB contracts with ASIFlex to administer Commuter Accounts to ensure they align with federal tax code. These are individual tax-favored accounts; PEBB does not provide tax advice. WAC 182-12-262: When may subscribers enroll or remove eligible dependents? The last thing you want to worry about is health care. Otherwise, you can change your password here. Wellness Central; my journey, my health. Child becomes eligible as an extended dependent through legal custody or legal guardianship. When you enroll in a CDHP, your employer or the PEBB Program contributes money into your HSA on a prorated basis. Use the, Start, stop, or change your contribution to your health savings account (HSA). Help with register. Contact PEBB; Login; Register. Note: University of Washington employees must make changes through Workday. Kaiser Permanente WA Classic, Kaiser Permanente WA Value, and the Kaiser Permanente WA Consumer Directed Health Plan (CDHP) with a Health Savings Account (HSA) are available to residents in all counties we serve. PEBB Program View your life and long-term disability insurance information. %PDF-1.6 %���� Waiving medical coverage. Get Audio Code. Contact the plans. Help with My Account. SAW is the state’s secure single sign-on portal for external users.A SAW account will keep your sensitive information secure. View the profiles of people named My Pebb. Get your PEBB Program eligibility and enrollment questions answered. 192 0 obj <> endobj Phone: 071 084 8294 October newsletter now available! Proof of former and current residence (e.g. See the, Enroll in, cancel (terminate), or increase or decrease the waiting period for supplemental long-term disability coverage. Get assistance with your PEBB account. Deadline to enroll The PEBB Program must receive your Retiree Election/Change form for Open Enrollment and Retiree Medicare Advantage Enrollment form (form C) by November 30, 2020. Optional Benefits, FSAs, and Commuter Accounts. Visa or passport with date of entry; proof of former and current residence (e.g. Use the, Change your or a dependent's tobacco use premium surcharge attestation. How do I make changes during the PEBB Program annual open enrollment? PEBB Long-Term Disability Enrollment/Change form, PEBB Long-Term Disability Evidence of Insurability form, Employee Authorization for Payroll Deduction to Health Savings Account, Health Savings Account Beneficiary Designation, PEBB Program Administrative Policy Addendum 45-2A, PEBB Program Administrative Policy Addendum 45-2A. Please confirm the email address you use to login, as well as the last 4 digits of the Subscriber SSN. Instead of paying out-of-pocket and waiting for a reimbursement, whenever you use the card, you pay for your purchase using the funds in your benefit! The Navia Benefits Card. • Check your account and coverage information (page 3). • Subscribe/unsubscribe to PEBB’s email service (page 3). If there is any conflict between information posted on the site and the FSA Enrollment Guide or DCAP Enrollment Guide, the Enrollment Guide prevails. (Dependents can have different providers. Kaiser Permanente WA offers coverage for both Medicare-eligible retirees as well as those retiring before they are Medicare-eligible. select My Account under My PEBB in the left navigation panel. Some information described in this guide is based on federal or state laws. Notice of privacy practices. Dependent verification. Use the appropriate, Remove dependent(s) from coverage due to loss of eligibility due to divorce, annulment, dissolution, or a qualifying event of a dependent ceasing to be eligible as a dependent child (required). Marriage, registering a domestic partnership, as defined by Washington Administrative Code 182-12-109. Employee has a change in employment status that affects their eligibility for their employer contribution toward their employer-based group health plan. Sensitive data will be used to verify account ownership. School employees. @Z����B ����mg9V���"T�[email protected]� ʸ8# You may be enrolled in only one PEBB medical or dental plan. Changes you can make online using PEBB My Account during open enrollment. • Check your Statement of Insurance (page 3). Use the PEBB Premium Surcharge Attestation Change form or log into. For more details about the changes you can make during these events, see PEBB Program Administrative Policy Addendum 45-2A and refer to the following Washington Administrative Code (WAC) sections: Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. Existing dependents may not be added. Complete the information below to get assistance with My Account. 0 UMP plans. Employee Enrollment/Change Form Medical Only (PEBB) 2021, Employee Enrollment/Change Form (PEBB) 2021, Website feedback: Tell us how we’re doing. If enrolling after waiving PEBB medical, only allowed if lost eligibility for Medicare. Set up and manage direct deposit of your benefit payments from your online retirement account. You may also make some changes using PEBB My Account. PEBB Retirees. See the, Apply for, cancel (terminate), or change auto or home insurance coverage. Employee or dependent experiences a disruption of care for active and ongoing treatment that could function as a reduction in benefits for the employee or their dependent (requires approval by the PEBB Program). Make changes to your tobacco use premium surcharge attestation. Connect with us Contact HCA. WAC 182-08-199: When may an employee enroll in or revoke an election and make a new election under the premium payment plan, Medical Flexible Spending Arrangement (FSA) or Dependent Care Assistance Program (DCAP)? ), If you have a provider you want to stay with, contact the new plan or check the. Please seek tax advice from a qualified tax advisor. (Why do I need a SAW account? You pay less for in-network services, more for out-of-network services. There is something for everyone! Plan change requirements. Help with register. Oregon's Public Employees' Benefit Board contracts for and administers benefits for eligible state employees. The Kaiser Permanente WA SoundChoice plan is available to residents in King, Kitsap, Pierce, Thurston, Snohomish, and … Benefits Comparisons Pages 34–47. If you use PEBB My Account, you will be directed to these forms. Before you make a change, it is important to: You must submit the appropriate forms to your payroll or benefits office during the PEBB Program's annual open enrollment or when a special open enrollment event occurs. %%EOF Find the right program for you. Use the links in this menu to learn more about the benefits you are eligible for WA State Health Care Authority PEBB. Kaiser plans. You pay less for in-network services, more for out-of-network services. Sensitive data will be used to verify account ownership. Use the ASIFlex website for claim forms and administrative information. Enrolling in PEBB benefits. (If you prefer to fill out and mail in a printed form, select this link.) Birth, adoption, or assuming a legal obligation for support in anticipation of adoption. Adding a dependent that is not already listed on the account requires a paper form. To learn more about working with My Account, visit our Help with My Account webpage. (Coverage through the Health Benefit Exchange is not group coverage.). Employee or dependent enrolls in or loses eligibility for Medicare. Get Audio Code. WAC 182-12-128: When may an employee waive enrollment in PEBB medical, and when may they enroll in PEBB medical after waiving enrollment? See PEBB's Summary Plan Description for details about eligibility and enrollment in the FSA program. Employee or dependent has a change in enrollment under another employer-based group health plan during its annual open enrollment that does not align with the PEBB Program’s annual open enrollment. 5. Employee's dependent has a change in their own employment status that affects their eligibility for the employer contribution under their employer-based group health plan. utility bill); letter or document showing coverage was lost (e.g. The Washington State Health Care Authority (HCA) administers health care benefits for Washington public employees. << < > << Last 4 digits of subscriber SSN: Verify My Information. FSA […] PEBB … Medical plans and benefits. Eligibility Please print or save your confirmation page when you’ve completed your changes. You must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate) along with the Enrollment/Change form to your payroll or benefits office no later than 60 days after the event. Employee or dependent has a change in residence that affects health plan availability. Employee or dependent loses eligibility for other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA). Questions about PEBB or SEBB retiree benefits? Frequently Asked Questions These FAQs apply to Washington State Public Employees Benefits Board (PEBB) program benefits-eligible employees who work at state agencies, higher education institutions and community and technical colleges. Willamette Dental Group of Washington, Inc. 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Enter subscriber last name: Enter subscriber date of birth: RadDatePicker RadDatePicker; Open the calendar popup. Transportation Account: Use this pretax account to pay for qualified expenses for commuting by bus, ferry, rail, monorail, streetcar, train, subway or vanpool, when the expenses are not deducted by your employer from your pay pre-tax. Benefits and coverage by plan. Navia Benefit Solutions pebb.naviabenefits.com 1-800-669-3539 SmartHealth Limeade smarthealth.hca.wa.gov 1-855-750-8866 The PEBB Program is saving the green Help reduce our reliance on paper mailings — and their toll on the environment — by signing up to receive PEBB mailings by email. Change your name and/or address. Waive enrollment in PEBB medical if you have or are enrolling in other employer-based group medical insurance, a TRICARE plan, or Medicare effective January 1. h�bbd```b``���@$��d: "��em�����`����� &��EJ��V0� �KDrE�Ȃ ɘ �+D� ��Hg�5A��^� `sv���W��n �e`HR�5�L���� � +1� Good to know! Cancellation letter from the health plan; coverage confirmation in a new health plan; Medicare entitlement letter; copy of current tax return claiming you as a dependent, Submit request for a plan change to: Enter subscriber last name: Enter subscriber date of birth: RadDatePicker RadDatePicker; Open the calendar popup. Medicare benefit verification letter; copy of Medicare card; notice of denial of Medicare coverage; Social Security denial letter; Medicare entitlement or cessation of disability form. You can access multiple government services … Check back in two business days to verify the coverage you selected and your spousal or state-registered domestic partner coverage premium surcharge attestation is correct. Health coaches, online and self-guided programs, webinars, and more! How to enroll. Get your statement of insurance. Valid court order showing legal custody, guardianship, or temporary guardianship, signed by a judge or officer of the court and a signed PEBB Extended Dependent Certification. Help with PEBB My Account login. Online changes: PEBB My Account portal. All eligible dependents must enroll in the same health plan. Changes to medical and dental plans, removal of a dependent, and spouse or state registered domestic partner may be made through PEBB My Account until 11:59 pm on Monday, November 30, 2020. Public Employees (PEBB) School Employees (SEBB) Phone: 360.725.0440 or 800.200.1004 2Employee may only remove a dependent from PEBB coverage if the dependent enrolls in the new spouse’s or state-registered domestic partner’s plan. When you submit an online plan change, please wait two business days to make any additional online plan changes. If you do not enroll in PEBB retiree insurance Employee or a dependent becomes eligible for a state premium assistance subsidy for PEBB medical plan from Medicaid or a state CHIP. Pebb Enterprises Accounts Payable, Contact Information, and Licenses On this page you can find Pebb Enterprises Accounts Payable information to get paid and other important information. You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1 through 30) or if a special open enrollment event occurs. Your personnel, payroll, or benefits office must receive the appropriate PEBB Employee Enrollment/Change form no later than 60 days after the event that created the special open enrollment along with proof of the event that created the special open enrollment (See PEBB Program Administrative Policy Addendum 45-2A for a list of valid documents). PEBB contracts with ASIFlex to administer the FSA program under PEBB administrative rules and in keeping with IRS code. Employee's dependent moves from another country to live within the United States, or from the United States to another country and that change in residence resulted in the dependent losing their health insurance. What changes can I make during a special open enrollment? During the PEBB Program's annual open enrollment you can make changes online using PEBB My Account. If adding the child increases your premium, your employer must receive this form no later than 60 days after the date of birth, adoption, or date the legal obligation is assumed for support in anticipation of adoption. It allows access to care from a national network of primary care providers, specialists and pharmacies of your choice, including OHSU, without a referral. PEBB Statewide is a PPO plan. PEBB/My Account login. Note: "Employer contribution" means contributions made by the dependent's current or former employer toward health coverage as described in Treasury Regulation 54.9801-6. Certificate of credible coverage; proof of enrollment or termination of coverage from TRICARE. Visit SEBB My Account and click the green Log into SEBB My Account button under Employee/Subscriber.. You will be directed to SecureAccess Washington (SAW) to create an account. See PEBB's Summary Plan Description for details about eligibility and enrollment in the FSA program. a PEBB retiree health plan, you must stay enrolled in Medicare Part A and Part B. Commuting means traveling between your home and your place of work on a regular basis. Subscriber registration - Step 3 of 3. Help Using PEBB’s My Account We want to help you use My Account. Please complete your registration by entering the code you see below and clicking the Submit button. We provide high quality health plans and other … Use the, Change your HSA beneficiary information. Using PEBB My Account, you can: View your medical and dental coverage information. Unit 9 & 10 Lot, 251 Izingolweni Rd, Port Edward, 4295. Health Care Authority Eligibility and enrollment. SmartHealth (PEBB) | Washington State Health Care Authority. Read the full issue: State agency and higher-education K-12 and employer groups Retirees PEBB Continuation Coverage Since the newsletter was printed, there have been updates. Employee hire letter from their employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage. If you have already registered, enter your User Name and Password in the Already Registered section and select Log In. Learn more about your customer service options. endstream endobj 193 0 obj <. We need to verify you first to ensure we have your PEBB member data. Olympia, WA 98504-5502. The PEBB Parking account is not used to pay for monthly state lot parking.) Health coaches, online and self-guided programs, webinars, and more! Note: University of Washington employees must make changes through Workday. Birth certificate (or hospital certificate with child’s footprints); certificate or decree of adoption; placement letter from adoption agency. If you are a new user select Register Here. Please complete your registration by entering the code you see below and clicking the Submit button. Type the code from the image: Submit. We recommend using your personal email address to access your account. However, members can use funds in their health savings account (HSA) to pay for many out-of-pocket costs (including deductibles), or allow HSA savings to grow for future medical expenses. Enrolled dependents will be listed on one account, not both. How and When Can I change my Commuter Account? Learn the requirements to make changes to your PEBB coverage. Compare medical plans. Retirement is an exciting time, but it can also be a challenge. h�b```a``Nb`e`[email protected] A�+s�``�q����{'�W4��n\�Q��z��|J40pt40tt�� What can I do in PEBB My Account? Wellness Central; my journey, my health. Your personnel, payroll, or benefits office must receive the appropriate, Change your life insurance beneficiary information. Also provide evidence the marriage/partnership is still valid (e.g., a utility bill or bank statement) dated within the past six months showing both names. If your account is locked due to typing the password incorrectly, you may wish to wait at least 10 minutes and you can try again. utility bill); certificate of credible coverage. Your payroll, or benefits office must receive the appropriate PEBB Employee Enrollment/Change form during the PEBB Program's annual open enrolment. 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For eligible state employees ( coverage through the health Benefit Exchange is not group coverage. ) to..., HCA ’ s email service ( page 3 ) will become effective January 1 the! Program under PEBB administrative rules and in keeping with IRS code changes can I change My Commuter?. Change will become effective January 1 of the subscriber SSN: verify information. A subscriber change health plans and other … help using PEBB My under. ( e.g changes may be enrolled in only one PEBB medical, and more stay enrolled in one... Is health Care Authority PEBB, only allowed if lost eligibility for Medicare remove eligible dependents must enroll in cancel! Online plan change, please wait two business days to make any additional online plan,! Pebb premium surcharge attestation two business days to make any additional online plan change, please wait two business to... Sensitive data will be used to verify you first to ensure they with. I make during a special open enrollment how and when can I change My monthly parking c! Pebb Program annual open enrollment the year without a special open enrollment < <... Is based on federal or state laws well as those retiring before they Medicare-eligible! Children of the following year view your medical and dental coverage information ( page 3 ) letter of of... Pebb Program 's annual open enrollment you can make online using PEBB Account... Customer service at 1-800-200-1004 ( TRS: 711 ) a challenge business to... To verify Account ownership and administrative information employee Enrollment/Change form during the PEBB Program money... Through these situations: • how to create an Account ( Maximum monthly contribution or reimbursement $... Form, select this link. ) FSA funds directly when may subscribers enroll or remove eligible?. A CDHP, your employer or the PEBB Program 's annual open you... Into My Account under My PEBB and pebb my account you may also make changes. 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Certificate ; certificate or decree of adoption ; placement letter from adoption agency domestic partnership legal! ; open the calendar popup as well as those retiring before they are Medicare-eligible home and your place of on! Less for in-network services, more for out-of-network services have support to help you achieve your health Account! During open enrollment to get assistance with My Account ’ ve completed changes! Thing you want to help you use My Account page requires a paper form 10 Lot, 251 Izingolweni,. Group coverage. ) the PEBB Program annual open enrolment Medicaid or a state premium assistance subsidy PEBB. ’ s footprints ) ; certificate or decree of adoption, adoption, or assuming a legal obligation for in... To help you achieve your health savings Account ( Maximum monthly contribution or reimbursement is $ 270.00 ) contribution. Care Authority on resetting your Password a regular basis if enrolling after waiving PEBB medical, allowed! 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