[MyOEBB] OEBB -- IMPORTANT information about the upcoming plan year (Rate renewals and plan design changes)!

[MyOEBB system updates]

Dear Superintendents, Business Managers and Benefit Representatives:



The OEBB Board continues to work diligently to ensure that the vision of OEBB is fully realized for its members.  This year's renewal is a reflection of the ongoing effort to provide choice of comprehensive, affordable insurance options which encourage members to seek appropriate health care and to use providers who deliver high-quality health care.  Key program changes include the introduction of a new slate of Moda Health (formerly ODS) medical plan offerings which:



*       Provides members with a broader array of plan choices, particularly at deductible levels and premium price-points which have become more popular in the last couple of years;

*       Encourages member access to primary care services through the introduction of a Systems of Care provider tier in which primary care services are provided on a copay basis in all plans (except H, the Health Savings Account (HSA) high deductible health plan, per federal law) and an additional wellness visit is provided at no member cost when using a provider recognized as a Patient-Centered Primary Care Medical Home (PCPCMH);

*       Adds a new member support program called Comprehensive Care Coordination for OEBB members with significant health care needs;

*       Enhances the pharmacy benefit by no longer requiring a copayment for prescriptions on the Value Tier and allows members to receive 90-day supplies of Value Tier medications at participating retail pharmacies and purchase 90-day supplies of Select Generics at participating retail pharmacies for three copays;

*       Modifies the pharmacy benefit by introducing per-prescription copayment maximums in lieu of an overall annual out-of-pocket maximum in order to limit large cost-sharing at the beginning of the year;

*       Continues to encourage procedures supported by evidence of medical effectiveness by adding two new procedures subject to copayment on the additional cost tier (viscosupplementation and lumbar discography);

*       Removes cost barriers for substance abuse treatment for both inpatient and outpatient services;

*       Achieves an overall increase of 2.94 percent for the Moda Health (formerly ODS) plans (well below the current marketplace trend).



There will also be some changes to the medical plans available through Kaiser Permanente that:



*       Remove cost barriers for substance abuse treatment for both inpatient and outpatient services;

*       Increase copayments for many services by $5.00 and increase deductibles and annual maximum out-of-pocket amounts slightly; and

*       Achieve an overall increase of 5.76 percent for the Kaiser plans (also below the current marketplace trend).



It is also important to note that the new slate of medical plans available through Moda Health includes a restriction that the HSA-compliant high deductible health plan (Plan H) can only be used in conjunction with a Health Savings Account (HSA). This plan can no longer be used along with a Health Reimbursement Account or Health Reimbursement Arrangement (HRA), or as a standalone or secondary coverage plan without participating in a qualified HSA.  Plan G, under the new options, can be used by OEBB members wishing to use a medical plan with a higher deductible, and thus a lower premium, as a standalone medical plan or in coordination with an HRA or another medical plan.  Plan G is not an HSA-compliant health plan and cannot be used with an HSA.



Plan G was designed to allow employees access to a lower-cost, higher-deductible health plan that still provides them with the ability to receive care from a primary care provider with a low office visit copayment and that has copayments on prescription medications versus having to meet a deductible and pay a percentage of the total cost of a medication.  These features are not allowed on HSA-compliant health plans, like Plan H.  The creation of Plan G also allowed for a lower rate increase on Plan H.  One of the philosophies behind HSA-compliant health plans is to encourage consumers to be more aware of health care costs by allowing the consumer to have a stake in the payment for more of the upfront costs.  Pre-tax dollars in an HSA account, whether contributed by the employer or employee, which are not used in one plan year roll to the next plan year and can be used for future qualified medical expenses.  These dollars belong to the employees. Individuals with HRAs, or using this type of plan in conjunction with another medical plan, don't have the same incentive for using health care more wisely.  This has resulted in a higher rate of use than should be anticipated on OEBB's HSA-compliant health plan and therefore higher premium increases than desired.  An employee that is currently enrolled in Plan 9 who does not currently have or plan to start an HSA for the 2013-14 plan year can elect to enroll in Plan G and will experience a premium increase of 12.86 percent over today's Plan 9 rates.  On the other hand, an employee who chooses to start an HSA and opts for Plan H will only experience a 2.14 percent premium increase over today's Plan 9 rates.  While the increase when considering Plan G seems like a pretty significant increase, it is important to note the substantial enhancements to both the medical and pharmacy coverage available under Plan G, as mentioned earlier in this paragraph.



The 2013-14 OEBB Dental and Vision Plan Renewals also support OEBB's vision, providing choice of comprehensive, affordable insurance options and encouraging members to seek appropriate care.  Following is an overview of the rate renewals and plan changes for the OEBB dental and vision plans:



*       No changes to the Kaiser Dental and Vision plans;

*       Limited changes to ODS Dental plan options (X-ray frequency and removal of Vizilite coverage);

*       The introduction of a Proactive Outreach Program for the Willamette Dental plan (members will receive a mailer encouraging them to seek preventive services at no additional cost to the member);

*       No rate increases for the ODS and Kaiser dental plan options (well below marketplace trend);

*       A rate reduction of 3.25 percent for the Willamette Dental plan option (well below marketplace trend);

*       No rate increase for the Kaiser vision plan (well below marketplace trend); and

*       A rate increase of 3.88 percent for the Moda Health vision plan options (in line with marketplace trend).



We are working on more detailed plan summaries and rate sheets reflecting these changes and hope to post the 2013-14 rates on the OEBB website late today (May 1, 2013) or early tomorrow, and post the detailed plan summaries on our website by the end of this week.  I hope this information and update is helpful to you as you begin to prepare for the upcoming plan year.


Sincerely,

Denise L. Hall
Denise L. Hall, Deputy Administrator
Oregon Educators Benefit Board
http://egov.oregon.gov/OHA/OEBB<http://egov.oregon.gov/DAS/OEBB>
(503) 378-5133
(503) 378-5832 FAX

OEBB encourages all members to stay healthy and be happy!!!!     Pass it on.....
http://www.oregon.gov/OHA/OEBB/pages/welllinks.aspx




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