More covered benefits, new SmartHealth website for 2015

The PEBB Program’s 2015 medical benefits are expanding to cover more of members’ health-care needs. Some benefit changes help PEBB’s medical plans better align with state and federal laws. In addition, PEBB’s health benefits will have a stronger connection with the new SmartHealth wellness program, to encourage employees to take advantage of their plans’ preventive care services and improve their health and well-being.

All changes described below are effective January 1, 2015, unless otherwise noted.

Medical benefits expand in 2015

The changes below affect all plans offered under each insurance carrier unless noted differently.

Other medical benefits won’t change in 2015; but keep in mind, costs for prescription drugs can change at any time as drugs move into different tiers. You can find medical benefit comparisons at www.hca.wa.gov/pebb and at the PEBB Program’s benefits fairs held in November.

Group Health will:
  • Cover residential mental health treatment programs.
  • Eliminate member costs for diabetic retinal screening.
  • Cover cardiac rehabilitation.
  • Cover surgical services for the treatment of gender dysphoria (transgender treatment), pending approval for a January 1, 2015 effective date by the PEB Board and state funding. (Non-surgical services and prescriptions are already covered.)
Kaiser Permanente will:
  • Apply members’ copays for prescription drugs toward the annual out-of-pocket maximum, based on requirements of the Affordable Care Act. (Kaiser Permanente Classic only; already applies to Kaiser Permanente CDHP)
  • Apply members’ copays for spinal manipulations toward the annual out-of-pocket maximum. (Kaiser Permanente Classic only; already applies to Kaiser Permanente CDHP)
  • Eliminate the deductible carryover (applying members’ out-of-pocket costs from the last quarter of 2014 toward the 2015 annual medical deductible). (Kaiser Permanente Classic only)
  • Charge members for post-surgical immunosuppressive prescription drugs.
  • Change the surrogacy coverage exclusion so that Kaiser will seek reimbursement from a member if she has received coverage and payment for surrogacy services from a third party.
  • Cover surgical services for the treatment of gender dysphoria (transgender treatment), pending approval for a January 1, 2015 effective date by the PEB Board and state funding. (Non-surgical services and prescriptions are already covered.)
Uniform Medical Plan (UMP) will:
  • Have a separate $2,000 per person annual out-of-pocket maximum for members’ prescription drug costs, as required under the Affordable Care Act. This is in addition to the $2,000 per person/$4,000 per family annual out-of-pocket maximum for members’ medical costs. (UMP Classic only)
  • Cover some non-preferred Tier 3 drugs (you pay 50 percent coinsurance) that don’t have generic equivalents at the Tier 2 level (you pay 30 percent coinsurance, up to $75 per 30-day supply) when medical criteria are met and the plan approves it. (UMP Classic only)
  • Cover (or expand coverage for) certain services and treatments that were previously excluded or had coverage limits. This includes:
    • Circumcision.
    • Orthotics to prevent complications associated with diabetes.
    • Genetic testing for family planning and testing for children to predict adult disease.
    • Home health services.
    • Massage therapy services for more than one hour, when medical criteria are met.
    • Temporomandibular joint (TMJ) disorder: Non-surgical services will be covered in addition to surgery.
  • Cover non-surgical services, surgical services, and prescriptions for the treatment of gender dysphoria (transgender treatment), pending approval for a January 1, 2015 effective date by the PEB Board and state funding.
For more details about your 2015 medical benefits, contact your plan.

For more details about your 2015 medical benefits, contact your plan.

Medical plan premiums change for 2015

Most employees will see small to moderate increases to their 2015 premiums, mostly due to the cost of claims. Group Health Classic premiums, however, will decrease next year.

See 2015 employee monthly premiums.
 

HSA contribution limits will grow for 2015

The annual health savings account (HSA) contribution limits will change in 2015 as follows:
 

HSA
contribution limits

Year
2014 2015
Subscriber under age 55 Individual $3,300 $3,350
Family $6,550 $6,650
Subscriber age 55 and older Individual $4,300 $4,350
Family $7,550 $7,650

These contribution limits include any voluntary contributions made by you, your employer, and the PEBB Program (including the $125 wellness incentive, if you are eligible to earn it in 2015).

Some life insurance premiums increase

Employees enrolled in PEBB’s supplemental life and accidental death and dismemberment (AD&D) insurance through ReliaStar Life Insurance Company will see an increase in their premiums in 2015, because excess reserves that have been used to keep these premiums low since 2011 have been spent. The basic dependent life insurance premium will also increase slightly. The basic employee life insurance premium will continue to be paid in full by your employer.

See 2015 life and AD&D insurance premiums.
 

Optional long-term disability insurance premiums increase

Employees enrolled in PEBB’s optional long-term disability (LTD) insurance through Standard Insurance Company will also see an increase in their premiums in 2015. This is because of a change that eliminates the gap between the end of the LTD insurance benefits and the beginning of the employee’s Social Security entitlement date. (Currently, LTD insurance benefits end at age 65.)

See 2015 optional LTD insurance premiums.
 

SmartHealth incentive and a new interactive website coming

In 2014, PEBB introduced its new wellness program, SmartHealth. By participating and responding to three requirements, subscribers were eligible for a $125 wellness incentive in 2015.

The PEBB Program will launch a new, personalized wellness program experience through an interactive website starting January 2015.
 

Can I also earn a wellness incentive for 2016?

Yes, as long as you meet the two criteria below both when you complete the required activities within the PEBB Program’s timelines in 2015, and when the incentive is distributed in 2016.

1. You (the subscriber) are enrolled in a PEBB medical plan.
AND
2. You are not enrolled in Medicare Part A and Part B as your primary coverage.

Eligible subscribers and their spouses or domestic partners enrolled in PEBB medical coverage can earn points by participating in a wide range of activities through the new SmartHealth website; however, only eligible subscribers will qualify for a wellness incentive in 2016.

You will receive more information about SmartHealth’s new website and incentive in the mail in early 2015.