4J BENEFITS AND WELLNESS NEWSLETTER
Prepared by Julie Wenzl • 541-790-7682 • wenzl@4j.lane.edu • June 14, 2017 • Issue Number 297
OEBB MANDATORY OPEN ENROLLMENT – FALL 2017
OEBB will end all current medical, vision, and dental plans effective September 30, 2017. Members who wish to have medical, vision, and dental coverage for the October 1, 2017 – September 30, 2018, 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, 2017, and will remain open through September 15, 2017.
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. OEBB will send information about plan designs and offerings, but rate information and other details specific to 4J employees will come from 4J.
2017-18 MEDICAL/PHARMACY PLANS
During this fall’s mandatory open enrollment window, 4J employees and retirees will continue to have 3 Moda medical plans to choose from: the Birch plan ($800 in-network deductible), the Cedar plan ($1,200 in-network deductible, and the Dogwood plan ($1,600 in-network deductible). Each medical plan has a separate deductible for out-of-network providers, and that deductible is two times the in-network deductible. The new plan year will start October 1, 2017, and will run through September 30, 2018.
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 CCM 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 CCM 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 – the requested change will take effect the first of the month following the notification of the new election. Pharmacy expenses for CCM Synergy network plans accrue toward the annual medical out-of-pocket (OOP) limit.
Members who opt for a PPO 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 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 CCM Synergy and PPO 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: OEBBinfo.com
2017-18 VISION PLAN
4J employees will have a new vision plan provider available effective October 1, 2017. All 4J employees who opt for medical coverage will now enroll in the OEBB VSP Choice Plus vision plan. Vision exams, frames, and lenses are available every 12 months. Additional details about the new vision plan will be included in your open enrollment materials.
Don’t need prescription glasses? The VSP plan offers the Suncare benefit. With a $20 copay, members can receive a $300 allowance for ready-made non-prescription sunglasses instead of prescription glasses or contacts. The Suncare benefit is available every 12 months.
OEBB will no longer apply the 12-month waiting period restrictions for members who waived vision coverage at initial eligibility. Members enrolling in vision benefits during the upcoming open enrollment will have full benefits, regardless of prior vision enrollment or eligibility.
2017-18 DENTAL PLANS
OEBB opted to consolidate the Delta Dental plans (formerly ODS) for the upcoming plan year and the current ODS Dental Plan 4 will no longer be available. 4J employees will have 3 dental plans to choose from for the plan year that begins October 1, 2017: Delta Dental Premier Plan 5, Delta Dental Premier Plan 6, and the Willamette Dental Plan.
Delta Dental Premier Plan 5 has an annual maximum of $1700; an incentive plan design (70% – 100%) for preventive, basic restorative, and periodontal services; and includes orthodontia. Delta Dental Premier Plan 6 has an annual maximum of $1200, does not have an incentive plan design, and does not include orthodontia. Both Delta Dental plans use the Delta Dental Premier network of providers. The Willamette Dental Plan, which is currently available in 4J, has removed the $52 buy-up charge for large, enamel colored fillings on back teeth. This change will allow members and the dentist to choose the filling material that is best suited for their needs. The Willamette Dental Plan includes orthodontia.
All three dental plans will have coverage for athletic mouth guards. At Willamette Dental, athletic mouth guards will be covered with a $100 copay, plus the office visit copay of $20 per visit. This benefit will be available to Willamette Dental enrolled members every 12 months. On the Delta Dental plans, athletic mouth guards will be covered at 50%, after the $50 deductible. Additional details about all of the dental plans will be included in your open enrollment materials.
Remember, 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 licensed 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 additional benefits. All retirees who opt to enroll in medical coverage will have access to 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, 2017 and October 15, 2017. If you cover a spouse or domestic partner on your 4J insurance, he/she will no longer be required to complete a Health Assessment in order to fulfill the Healthy Futures requirement. The Health Assessment is only required of the OEBB-enrolled employee or retiree. However, your spouse/partner is always welcome to complete a Health Assessment. To review the details of the Healthy Futures program requirements, please visit: OEBBincentive.com.
You can access the Health Assessment by logging into your myModa account: https://www.modahealth.com/oebb/members/.
MANGO SORBET
Nutrition Action Newsletter suggests this recipe for a taste of summer.
In a food processor, purée 3 cups chopped mango, 2 cups chopped pineapple, 2 bananas, and ½ cup unsweetened canned coconut milk until very smooth. Pour into a large sealable bag, lay flat, and freeze until solid, 3 – 4 hours. Break into chunks and process until smooth and creamy, about 5 minutes. Makes 10 half-cup servings.
SUMMER BREAK
Like all teachers, I will be out of the office after June 23rd. However, I will be periodically checking voicemail and e-mail during the summer. If you need to reach me, please call or send an e-mail, and I will get back to you as soon as I am able.
I wish you all a fantastic summer break!
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.
