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PEBB offers benefit eligible employees several medical plan choices from Group Health, Kaiser,
and Uniform Medical Plan and UMP based on their county of residence.
Regardless of the plan you choose, all PEBB medical plans offer about the same comprehensive
coverage. The plans offer annual preventive care, vision
care, and hearing exams, as well as, prescription drug coverage, hospitalization, and doctor
visits. There is no waiting period for pre-existing
health conditions. Not all plans are available in every county.
This map shows the plan availability by county. The yellow and white striped areas show the
counties and zip codes within a county where Group Health and UMP are available.
The blue and white striped areas show the counties and zip code areas within a county
where Kaiser and UMP are available. UMP is available in all counties in Washington,
represented on the map with the plain white areas, as well as nationwide and worldwide.
If you live outside of Washington, refer to the Employee Enrollment Guide for additional
plan availability. In most cases you must live in the plan area
to enroll in the plan.
Each of the vendors, Group Health, Kaiser, and UMP offer two to three types of plans.
The types of plan include Classic, Value, and the Consumer Directed Health Plan or CDHP.
If you choose one of the classic plans from Group Health, Kaiser, or UMP you can expect
to pay a higher monthly premium but, less out of pocket when you require services.
If you choose the Value plan from Group Health, the monthly premiums will be lower than the
classic plan, but you will pay more out of pocket than the classic plan when you require
services. If you choose a CDHP from Group Health, Kaiser,
or UMP you will pay a significantly lower premium, but you will pay more out of pocket
than the classic or value plans when you require services.
The CDHP has two components: a high deductible health plan and a Health Savings Account or
HSA. The high deductible health plan is exactly
what it sounds like; you will pay more out-of-pocket before the plan will begin to pay.
The HSA is a tax-exempt savings and spending account used to pay for qualified medical
expenses and helps off-set the higher out-of-pocket costs of the plan. The HSA is administered
by Health Equity, Inc. Qualified medical expenses are determined
by the IRS and are typically health care costs that can be taken as a deduction on your tax
return. For a list of qualified medical expenses, visit the Health Equity website at www.healthequity/pebb
or review IRS publication 502, available on the IRS website.
The IRS has set guidelines as to who is eligible for an HSA. If you are not eligible for an
HSA based on these guidelines, you are not eligible to enroll in the CDHP.
The IRS eligibility requirements are: You must be enrolled in a qualified high deductible
health plan. That is the CDHP option that PEBB is offering.
You cannot have other comprehensive group coverage that is not a high deductible health
plan. You cannot be enrolled in Medicare.
You cannot be claimed as a tax dependent on someone else’s tax return.
You cannot have received care from the VA or one of their facilities, including prescriptions,
in the last 3 months before your CDHP enrollment begins.
You cannot be enrolled in Tricare, and you or your spouse cannot have a Flexible Spending
Account or FSA.
Your employer will help fund your HSA by contributing $58.33 per month for a total of $700 per year
if you are enrolled in the CDHP as an individual. If you choose to enroll one or more family
members on the CDHP your employer will contribute $116.67 per month for a total of $1,400 per
year to your HSA. In addition, you have the option to make contributions
to your HSA. If you are an employee of a state agency your employer offers the option of
payroll deduction. Employees of higher education institutions, employer groups and school districts
should contact their personnel, payroll, or benefits office to find out if payroll deduction
is an option. You also have the option to directly deposit
money into your HSA by electronic bank transfers or mailing Health Equity a check.
There is a maximum contribution allowed for the year that is set by the IRS. The maximum
includes the amount your employer is contributing and the amount you contribute.
If you are enrolled as an individual in the CDHP, the maximum is $3,100. Your employer
is contributing $700 of that for the year, so you could contribute up to an additional
$2,400 in 2012 to your HSA. If you are enrolled with one or more family
members on your account, the maximum is $6,250. Your employer is contributing $1,400 of that
for the year, so you could contribute up to an additional $4,850 for 2012.
If you are age 55 or older, the IRS offers a “catch-up” provision that allows you
to contribute an additional $1,000 for the year to your HSA.
The funds in the HSA belong to you and carry over from year-to-year. If you should leave
employment or retire, the HSA account goes with you to be used to pay for qualified medical
expenses. When you enroll in the CDHP you will receive
a debit card from Health Equity. This allows you to pay for qualified medical expenses
directly from your HSA or you can pay by another means and reimburse yourself from the HSA.
You, as the owner of the HSA, are responsible for maintaining a record of the funds withdrawn
from your account and how those funds are used. In the event of an IRS audit, you may
be asked to provide documentation, such as receipts and the explanation of benefits your
plan provides to prove the money was spent on qualified medical expenses.
If you have questions about the HSA, Health Equity or a qualified tax advisor can help.
To enroll in the health plan of your choice, you must submit the Employee Enrollment/Change
form no later than 31 days after the date you become eligible for benefits to your personnel,
payroll, or benefits office. You may choose to waive your medical coverage
if you are enrolled in other comprehensive group medical coverage.
Failure to return the enrollment form within the 31 days will result in enrollment in Uniform
Medical Plan Classic as a single subscriber. In addition, UMP will deny your claims until
you submit the form. You would have the opportunity to change your
plan and add your dependents during the next annual open enrollment.