4J BENEFITS AND WELLNESS NEWSLETTER
Prepared by Julie Wenzl • 541-790-7682 • wenzl@4j.lane.edu • May 31, 2016 • Issue Number 289
OEBB MANDATORY OPEN ENROLLMENT – FALL 2016
OEBB will end all current medical, vision, and dental plans effective September 30, 2016. Therefore, members who wish to have medical, vision, and dental coverage for the October 1, 2016 – September 30, 2017, plan year will be required to log into the MyOEBB system during open enrollment in order to register for that coverage. The mandatory OEBB open enrollment period will begin August 15, 2016, and will remain open through September 15, 2016.
You will receive updated and detailed information as it is available – watch for updates in this newsletter, on the 4J website, in your e-mail inbox, and via US Mail over the summer. As always, OEBB will send information about plan designs and offerings, but rate information and other details specific to 4J employees will come from 4J.
2016-17 MEDICAL/PHARMACY PLANS
OEBB has redesigned and renamed the medical plans for the upcoming plan year. During this fall’s mandatory open enrollment window, 4J employees and retirees will have 3 Moda medical plans to choose from: the Birch plan ($800 deductible), the Cedar plan ($1,200 deductible, and the Dogwood plan ($1,600 deductible). The new plans will start October 1, 2016, and will run through September 30, 2017.
In addition to selecting a medical plan, members must opt for either an OEBB Moda Connexus network plan or a Synergy Network plan. Synergy network plans operate under a coordinated care model (CCM) and Connexus network plans are preferred provider organization (PPO) plans.
Members who enroll in a Synergy Network plan will be required to select a medical home, and any covered dependents will need to choose a medical home as well. Each family member may select a different medical home and must use that designated medical home for preventive and primary care needs in order to receive in-network benefits. Individuals who are currently enrolled in a Synergy network plan and who have already selected a medical home will not need to re-select a medical home unless they want to make a change to that designation. Individuals may change a medical home designation during the plan year. Effective October 1, 2016, pharmacy expenses for Synergy network plans accrue toward the annual medical out-of-pocket (OOP) limit.
Members who opt for a Connexus network plan do not need to name a Moda medical home, but do need to see in-network providers to receive the highest level of benefits. Pharmacy expenses will continue to accrue toward the annual maximum cost share limit but not toward the medical OOP.
This is not a complete summary of the differences between the Synergy and Connexus network plans. Please watch for additional plan details and differences, which will be included in the information coming from OEBB prior to open enrollment. A wealth of information is also available on the OEBB website, which will be updated on an as-needed basis: http://www.oregon.gov/oha/OEBB/pages/index.aspx
2016-17 VISION PLAN
In addition to the medical plan changes, OEBB has redesigned and renamed the vision plans for the upcoming plan year. As a result, OEBB Vision Plan 3, the plan currently offered to 4J employees, will no longer be available. All 4J employees who opt for medical coverage will now enroll in the OEBB Pearl vision plan. The Pearl vision plan has a plan year maximum benefit of $400. Vision exam and hardware benefits are all subject to the plan-year benefit maximum.
Remember that OEBB rules require a 12-month waiting period for late enrollments to a vision plan. If you didn’t enroll yourself or a dependent in vision coverage when initially eligible, then choose to enroll during an Open Enrollment period, whoever is being added to coverage will only be eligible for routine eye exams for the first full 12 months of coverage – no lenses or frames.
2016-17 DENTAL PLANS
4J employees will continue to have both ODS Delta Dental plan 4 and Willamette Dental Group dental plan 8 as options for dental coverage, both of which include orthodontia. Members who elect Willamette Dental plan 8 must receive care from a Willamette Dental Group dentist or specialist for benefits to be payable.
Effective October 1, both dental plans available in 4J will have coverage for occlusal (night) guards. On the ODS Delta Dental plan, occlusal guards will be covered once every five years at 50%, up to a $150 maximum benefit. On the WDG plan, the benefit is covered at 100% with the $20 (per visit) copay. Under the WDG plan, lost or stolen appliances can be replaced once every two years, and damaged appliances can be replaced as needed.
As with vision coverage, OEBB rules require a 12-month waiting period for late enrollments to a dental plan. If you didn’t enroll yourself or a dependent in dental coverage when initially eligible, then choose to enroll during an Open Enrollment period, whoever is being added to coverage will only be eligible for diagnostic and preventive services for the first full 12 months of coverage – no restorative services or orthodontia.
ADDITIONAL BENEFITS
4J employees and retirees will continue to have the Employee Assistance Plan (EAP) and 4J Wellness Clinic as part of the benefits package. Individuals who seek counseling services through the EAP will have up to 5 sessions of assistance per issue at no cost. Active employees will also have long-term disability insurance, basic life insurance ($50,000), and basic accidental death and dismemberment ($50,000) coverage as part of the total benefit package.
All benefits eligible active employees will be enrolled in these benefits. All retirees who opt to enroll in medical coverage will be enrolled in the EAP and the Wellness Clinic.
HEALTHY FUTURES PROGRAM
The Healthy Futures program will continue for members who wish to participate. Part of the requirement for completion is the Health Risk Assessment, which must be completed between August 15, 2016 and October 15, 2016.
You can access the Health Assessment by logging into your myModa account: https://www.modahealth.com/oebb/members/
WELLNESS CLINIC REFERRALS
The 4J Wellness Clinic Team has asked me to share the following message with you:
The health of the District employees is the number one concern for providers at the 4J Wellness Clinic. As a patient centered medical home, we actively treat, monitor and follow-up on a diversity of health issues for patients. At times, as is true in all health clinics, we make a determination that it is in the patient’s best interest to refer care to another provider or clinic for testing or treatment. We do not make referrals lightly, in fact, last year only 16% of visits resulted in a referral. We recognize and take into account the financial hardship of those referrals (deductibles, co-pays, etc.); with every referral we balance the importance of the health of the employee and the financial impact. We want to encourage patients to follow-through on referrals in those rare occasions they are made. It remains our pleasure to provide quality care to 4J employees and their families.
FAMILY HEALTH PORTRAIT
Because family health history is such a powerful screening tool, the Surgeon General created a free website to help make it fun and easy for anyone to create a portrait of their family’s health. My Family Health Portrait is a secure tool that takes about 20 minutes to create a unique family health portrait.
After completing the questions, the website creates a personalized “family health tree” that can be saved to a home computer. From there, families may update the information at any time. The tool can be shared with other family members, who can add their health information to the portrait. The portrait also can be an informative tool to share with a health care provider. All information remains private. The federal website does not retain the information once the tool has been used to assemble it. To learn more, please visit familyhistory.hhs.gov.
MUSCLEWIKI
Whether you are just starting out with strength training or the weight room is a second home, you may want to check out MuscleWiki. Pick a muscle group from the interactive body map, and the website will show you a list of moves (with GIFs).
Check it out at https://musclewiki.org/Main_Page
The information in this newsletter has been summarized. It is presented as information – not advice or counsel. In all instances, the benefits, conditions, and limitations as outlined in the 4J Master Contracts prevail over this representation. Please refer to your Benefits booklet or master contracts available at the District offices for additional information regarding your benefits plans.
