Benefit Plan Information

Documents

Do I need to do anything during Open Enrollment for 20011-12 if I want to keep my same benefits?

No. But it is important to note that this year some of the plan options have changed. The Licensed and Classified groups will no longer have coverage with Providence Medical Plan 2 or ODS Dental Plan 2. Employees subscribing to these plans must enroll in an available plan option to receive coverage.

To enroll in benefit plans, access the MyOEBB enrollment system at https://myoebb.org/oebb/!pb.main and register (if you are a first-time user) or log in (if you are a returning user).

What is a composite vs. tiered rate?

A composite rate is a group rate. A tiered rate is a rate based on the number and type of enrollees in the plan such as, Employee Only, Employee & Spouse, Employee & Child(ren) and Employee & Family. For Association members, the Benefits Committee elected to provide composite rates for the medical plan and offer the dental and vision plans using tiered rates.

What is the difference between "opting out" and "waiving benefits"?

Opting out means that an individual elects not to enroll in a medical plan and is eligible to receive a district paid contribution deposited in to a Health Reimbursement Account (HRA). To qualify for the HRA contribution the employee must have proof of other group medical insurance coverage. Enrollment in dental and/or vision plans is permitted.

Waving benefits means that an individual elects not to enroll in any of the benefit plans available under the OEBB-sponsored benefits program and is not eligible to receive any portion of a cash contribution or other type of remuneration.

What is the dependent eligibility age?

Biological, step and adopted children under age 26 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 26 or older are eligible for coverage if they are incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability and were covered under an educational entity plan prior to reaching the age of 26. There are some exceptions, please see a complete version of OEBB’s eligibility rules at www.oregon.gov/DAS/OEBB/administrative rules.shtml.

Where do we find the provider lists (doctors, specialist, dentists, ophthalmologists and so forth) that are in the Providence and ODE networks?

The list of doctors for ODS Health Plans can be found at http://www.odscompanies.com/oebb/members/providers.shtml

The list of doctors for Providence Health Plans at http://www.providence.org/healthplans/pdfs/oebb/medical-homes.pdf

You can also find these links on the OEBB website at www.oregon.gov/DAS/OEBB/index.shtml.

I would like to have more details about medical plans than is available in the summaries the ESD provided. Will we receive member handbooks at the All Staff Inservice?

Vendors do not provide member handbooks to employees prior to enrollment in a specific plan.

Member handbooks for ODS plans can be found online at http://www.odscompanies.com/oebb/members/handbooks.shtml

Member handbooks for Providences plans can be found online at myProvidence at www.providence.org/php/getstarted

Are the premiums listed in the benefit summaries annual rates or monthly rates?

Premiums are monthly rates. To obtain your out-of-pocket costs you would subtract the ESD contribution of $1,010 per month which includes the pooled savings of $110 from 2010-11, per the LESD-LCEA Contract Extension Memorandum of Understanding.

What should I do if I am a current employee who is eligible for insurance but did not receive a packet from OEBB in mid-August or have misplaced my packet from OEBB?

If you moved after the deadline for submitting employee information to OEBB, your packet was most likely sent to your old address.

You can still register, even if you have not received the packet from OEBB with the registration directions. This packet was generic information and has nothing that is personally identifiable in the packet.

Go to the OEBB website http://www.oregon.gov/DAS/OEBB/index.shtml and click on the link that says "Enroll in Benefits." When you register, you will be able to correct the address information.

If I am currently opting out of medical insurance and want to continue to opt out, do I still need to register with OEBB?

Yes, you still need to register for two reasons. First, the enrollment process is the way you communicate to OEBB and Lane ESD that you are opting out of medical insurance. Second, even though you are opting out of medical insurance you may be enrolling in vision and/or dental insurance.

If I want to waive insurance benefits do I still need register?

Yes, you still need to register. The enrollment process is the way you communicate to OEBB and Lane ESD that you are waiving insurance. Please note that selection of "waiving insurance" waives medical, dental and vision coverage.

Can I enroll in the medical plan as employee and child and in a dental plan for employee only?

LCEA members can enroll in dental (and vision) plans as employee only, even if you enroll family members in a medical plan. Medical plan coverage is a composite rate and is the same for employee only, employee and spouse, or family enrollment.

All plans for Administrators are composite.

What if I opt out of medical, dental, or vision coverage and wish to enroll in the future?

Each year during open enrollment employees will have the option of enrolling in medical, dental, or vision coverage. There is no pre-existing condition exclusion period for medical coverage. For some plans there may be a waiting period imposed for certain types of services such as transplants.

How do I sign up for just the dental plan?

To sign up for a dental plan complete the registration process; select opt out of medical coverage (you must have other medical coverage), then select the dental plan coverage of your choice.

Can I sign up for pharmacy (Rx) coverage only?

No. Pharmacy (Rx) is part of the medical plans and is not available as a standalone option.

Are the insurance plans offered to Lane ESD Administrative staff of greater benefit than those offered to LCEA members?

The Benefits Committee is comprised of both LCEA members and Lane ESD administrators. OEBB provides that districts could select for each of their employee groups (bargaining unit members and administrators) four plans from the nine medical insurance plan designs; three plans from the five dental plan designs and one plan from the three vision plan designs. The committee reviewed all the information about plans together and LCEA members of the Benefits Committee made choices for the bargaining unit members and the Administrative members of the Benefits Committee made the choice of plan offerings on behalf of the Administrators group. Both groups have the same insurance cap.

What if I do not enroll in dental or vision coverage and decide to enroll next year?

Members who do not enroll in the dental and vision plans when originally eligible, and later elect to enroll during open enrollment, will be eligible for preventive services only for the first 12 months of coverage. Dental coverage will allow preventive services only and no orthodontia coverage during the 12-month period. Enrollment in a vision plan will be covered only for a vision exam for the first 12 months.

Is there any additional cost for adding a domestic partner as a dependent?

The cost of covering a domestic partner may result in “imputed income” that is taxable to the employee. Imputed income is the difference between the cost of providing the insurance to the employee with and without the cost of covering a domestic partner (contact HR for more details).

What are the OEBB office business hours, if I need to contact them with questions?

OEBB office staff are available by phone or e-mail Monday through Friday (except holidays) from 8:00AM to 5:00PM.

Now that I have completed the OEBB registration process, when will I be receiving insurance cards?

OEBB tells us that insurance cards will be issued by the first week in October during the Open Enrollment Period or within 7-10 business days during other times of the year. If an employee needs to go to the doctor before their card is received, the "E" number off of the Benefit Statement should be used. The Benefit Statement is the document employees were instructed to print after completion of the OEBB enrollment process.

Medical Coverage

Is (therapeutic) massage covered on the medical plans?

No. Alternative care does not include massage.

Does the total deductible amount need to be met before the insurance will begin paying at 80%?

Yes.

Regarding coordination of benefits with my spouses plan - how do I know whose plan is primary?

You are primary on the plan you enroll in via your employment at Lane ESD. Your spouse is primary on the plan available through his/her employer. For dependents the primary carrier is associated with the spouse whose birthday comes first.

In some cases how coordination is implemented would be specific to the plan and benefits. In this case, it would be best to contact OEBB with your specific situation.

Is there a limit on the number of visits that can be made to an alternative care provider?

There is no limit on the number of visits; however, the payment for alternative services is capped at $2,000 (all plans). This benefit maximum (cap) is per person.

Are lab tests/x-rays that are ordered as part of an annual exam covered with the deductible waived (applicable to all plans)?

No. Only the exam is considered part of the preventative service with the deductible waived - any additional services identified as part of a preventative service are covered based on the type of service.

Are cornea transplants covered immediately?

This service is not subject to any waiting period and would be covered immediately.

Can you explain the ESD contribution to the Health Reimbursement Account (HRA)? Why is the plan with dental HRA amount so much less than with dental compared to the cost of dental on the page 4 chart?

The chart on page 4 lists the costs of various plans. The HRA information (page 6) is associated with enrollment in Plan 9, with the amount of the HRA dependent on enrollment in various plan combinations. Enrollment in Plan 9 has no out-of-pocket premium.

Are the Health Reimbursement Account (HRA) amounts associated with Plan 9 monthly or annual amounts?

The HRA amounts lists on page 7 are monthly amounts. For example, option 3 provides a $260.00 per month HRA.

Is the Health Reimbursement Account (HRA) amount associated with Plan 9 per person?

The HRA contribution does not vary based on employee only or family enrollment.

If I have money left in my Health Reimbursement Account (HRA) from last year, and don't choose Plan 9, can I spend remaining HRA funds on my monthly insurance premium?

No. Any insurance premium contribution is deducted from the employee's paycheck, pre-tax as authorized. The HRA remains accessible to you for health related expenses.

However, if you terminate employment with Lane ESD after two years of continuous eligibility for benefits you may use any remaining balance to pay COBRA or Retiree COBRA premiums.

If I have money left in my Health Reimbursement Account (HRA) from last year, and don't choose Plan 9, do I need to do anything to keep this account active?

No, this account remains accessible to you for health related expenses. There is nothing you need to do. You are responsible for any administrative fees.

Can I still have a benefits card if I select Plan 9 and have a Health Reimbursement Account (HRA)?

Employees will continue to have the option of a benefits card to use with their HRA or with Section 125/cafeteria plan. The employee is responsible for the monthly fees ($1.50) associated with the benefits card.

Plan 8 has a family deductible of $3000 and an out-of-pocket maximum of $2200. Wouldn't you hit the maximum before meeting the deductible?

Deductibles must be satisfied before any insurance benefit will be paid. After the deductible is met you are still responsible for co-insurance requirements up to the plan maximum. Note that one household member could meet the individual deductible and the co-insurance requirements for this individual would then be applied towards the out of pocket maximum.

If you choose plan 9 will the Health Reimbursement Account (HRA) contributions be added to your HRA account from last year’s high deductible plan?

Yes, if you have a HRA and select plan 9, the HRA contributions are added to your HRA, which is administered by American Fidelity. This company also administers the Section 125/cafeteria plan accounts.

How does the deductible and maximum out-of-pocket for Plan 9 work?

The deductible for Plan 9 works differently than the other ODS plans. A description of how the deductible and plan out of pocket maximums are applied on this plan are located on pages 5 and 6 of the member handbook which is available at http://www.odscompanies.com/oebb/members/handbooks.shtml. Note the items that are applied to the deductible and maximum out-of-pocket are different on Plan 9 than on other plans. Member handbooks for all other ODS plans (medical, dental, vision) are also available.

Dental Coverage

Since ODS Dental Plan 2 has been replaced with ODS Dental Plan 1 beginning October 1, 2011 will I have to start over at the 70% level of coverage again this year?

No, both of these plans have the same eligibility and incentive requirements. If you enroll in ODS Plan 1 you will remain eligible for the same level of coverage reached while on ODS Dental Plan 2. For example, if during the 2010-11 plan year you were eligible for 90% coverage and you met the eligibility requirements during the year to increase your coverage for the 2011-12 plan year you will be covered at 100%.

Does Willamette Dental include orthodontia coverage?

Yes, orthodontia is available with this plan. Complete details about this plan are located on page 33 of the insurance summary packet.

If I select Plan 9, is there a particular dental plan I need to choose or can I select from all the plans available?

There is no particular dental plan associated with Plan 9 and you can choose from all those available.

With the dental plans - do the amounts paid for preventative care count against the benefit maximum?

Yes.

On dental plans what is the difference between the benefit maximum and the plan year maximum?

The benefit maximum and the plan year maximum are just two different ways of describing the same thing - the maximum benefit amount that will be paid within the plan year. All ODS plans have a benefit/plan year maximum. The Willamette Dental plan does not have a maximum.

Why do we have to have orthodontia as part of our dental plan rather than as a separate option?

OEBB required that if orthodontia was included, it be applied to all plans. The benefits committee had to select three dental plans to offer and whether orthodontia was included or not. Their decision was to include orthodontia.

Vision Coverage

With the vision plan, does the $350 plan year maximum include exam costs?

Yes.

Is the $350 plan max for vision "per person" (employee, spouse, child) or a total for the whole family if you enroll in the family vision plan? i.e. why pay $40.11 a month (or $481.32 per year ) for only $350 coverage?

The $350 plan is "per person" so this way you would be paying $40.11 a month to cover your whole family. (i.e. $481.32 per year for 3 family members which would be $1,050.00 of coverage).

Life Insurance

How do I sign up for life insurance?

There is nothing that you need to do to enroll in life insurance. You will automatically be enrolled in a $25,000 life insurance plan.