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| The Samaritan Select medical plan |
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How will your medical plan support PEBB’s Vision of high quality, affordable care for you and your family?
This final in a four-part series highlights Samaritan Select, a community-based plan for members in Linn, Benton and Lincoln counties. Samaritan Select scored high in the Board’s medical plan selection process.
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Samaritan Select helps PEBB members safeguard their health through a healthcare system integrated throughout Linn, Benton and Lincoln counties. The plan strives to give members high quality, affordable care through
- Member choice
- Out-of-pocket savings
- Easy access to prevention
- Personalized service
- More help if you have a chronic condition
Member choice
You can choose where you get care through Samaritan Health Services’ network of hospitals, physicians and clinics. This mix of local and regional services gives you choices through all stages of your life. Samaritan Select has extended its network across Oregon, the U.S. and around the world so you can access care where and when you need it.
Out-of-pocket savings
This plan helps you control your out-of-pocket expenses. Here are two examples of how you can save on healthcare costs through Samaritan Select:
- Standard office visit with provider charge at $200:In Samaritan Select, you pay $10. In another plan, you would typically pay 15% of allowed charges, which will almost always be more than $10.
- Outpatient surgical procedure with surgeon and facility charges at $5,500: In Samaritan Select, you pay $10 for the surgeon and $10 for the facility – a total of just $20. That’s significantly less than the 15% of allowed charges you would typically pay in another plan.
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Easy access to prevention
Your Benefit Board asked your medical plans to bring down barriers to better health. In response, you pay nothing for most preventive services when you see a Samaritan Select preferred provider. If the doctor prescribes lab work, it costs you nothing when you use a Samaritan Select facility.
For 2008, Samaritan Select will also offer a new way to get insight on your health – an online health risk assessment. It helps you see life changes you can make right now to improve your health. You can also print the results to discuss them with your doctor.
Personalized service
Who do you call when you have questions about your coverage, billing or services? In Samaritan Select, you can sit down with a customer service person face-to-face for answers to your individual questions. Stop in Monday through Friday from 8 to 5 at their offices at 815 NW 9th Street in Corvallis.
More help if you have a chronic condition
For 2008, Samaritan Select will roll out a $Zero Co-Pay program. The program fully covers seven of the most-common generic drugs prescribed for three common conditions: diabetes, high blood pressure and high cholesterol. If you have one of these chronic conditions, you may be able to get some of your therapeutic drugs at no cost.
If you have diabetes or asthma, you and your doctor may be able to take part in a new incentive program. The incentives focus on helping you self-manage your disease. They also help your doctor follow best-practice guidelines in your treatment.
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Contact Samaritan Select
www.samaritanselect.com
Toll free at (800) 569-4616
Local at (541) 768-6900
815 NW 9th St, Corvallis
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| Sign up now for a free worksite health screening |
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Sign up now for a free health screening being scheduled at worksites this summer through fall. The screening will:
- Help you identify major health risks
- Offer individualized health education
- Refer you to a healthcare provider, if needed
- Help you learn about resources in your medical plan
You have two options
You have two screening options: fasting and non-fasting. The fasting screening produces more results about your cholesterol, triglyceride and blood sugar levels. Both options include screening for blood pressure and body mass index.
Quick and convenient
Both screening options take only about 15 minutes. Having a screening at your worksite saves time; you won’t have to take time off to see a doctor or go to a lab. In most cases, you won’t even have to leave your building.
What you can expect
After you fill out a short medical history, the screener will prick your finger for a small amount of blood and measure your height, weight and blood pressure. Then you’ll meet with a health educator to review results and get recommendations and referrals.
Check the schedule
Check the schedule. It’s updated weekly. Call the agency contact listed on the schedule to make an appointment. If a screening isn’t scheduled for your worksite, you may be able to find one nearby.
Requirements
These screenings are free to state employees covered by a PEBB medical plan: Kaiser Permanente, Kaiser Permanente Added Choice, Providence Choice, Regence BlueCross BlueShield of Oregon or Samaritan Select. You must schedule your screening appointment and have your medical plan ID card with you.
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| You can quit for life |
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If you use tobacco, your Benefit Board offers you no-cost access to Quit For Life through Free & Clear. Over the past 20 years, this program has helped thousands of people across the country quit for good.
Quit for Life offers one-on-one coaching from highly trained Quit Coaches, quit guides to help you stay on track between calls, and free nicotine patches and gum.
Take advantage of a proven program. Call1-866-QUIT-4-LIFE (784-8454). Tell them you’re a PEBB member, and learn how to start your own quitting plan. Or sign up online!
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| Flu shots coming soon to a site near you |
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To make it quick and easy to get your flu shot this fall, your Benefit Board is sponsoring FREE flu shot clinics at worksites around the state. Check the schedule on this Web site beginning mid-August.
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| Enhanced disability benefits for 2008 |
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The Standard Insurance Company will offer enhanced long term disability (LTD) and short term disability (STD) benefits in 2008 – all with no premium increase.
Long Term Disability
Rehabilitation Plan. You may be able to be in an approved rehabilitation plan, which could pay training, family care and job-related expenses.
Family Care Expense Adjustment. If you have to pay for care of a family member so you can go back to work, this program may help you cover some of that expense.
Assisted Living Benefit. Employees with severe long-term disabilities may get a one-time assisted-living benefit of up to $5,000.
Return to Work Incentive. This benefit change may increase the disability benefit you could receive when you return to work.
Short Term Disability
Claims by Phone. You can submit STD claims by phone, which streamlines the process and may help speed your payment.
Long & Short Term Disability
Reasonable Accommodation Expenses. This benefit may pay up to $25,000 of employer costs for workspace changes that help you get back on the job.
Pre-existing Condition Time. The plans will reduce the pre-existing condition period to 12 months before being insured with a “look back” for subsequent conditions of three months.
More Information
Find more information on each of these disability coverage benefits in Standard’s certificates of insurance on this Web site beginning this fall. The certificates explain the coverage in detail.
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| Watch for Your Benefit Statement |
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Watch the mail for your 2007 benefit statement at the beginning of September. Go over it to make sure your benefits are correct and to plan for Open Enrollment, Oct. 1-31, 2007. If you think you see an error on your statement, contact your agency.
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| New travel benefit for you and your family in 2008 |
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In 2008, a free travel benefit is available for employees enrolled in the employee basic life insurance. Called MEDEX Travel Assist, this program may help you and your dependents if you get sick while traveling more than 100 miles from home.
This program offers help to
- Find medical care
- Locate a translator
- Make hotel or travel arrangements
- Contact your medical plan
- Fill prescriptions.
You can also get travel-planning information on passports and visas, foreign currency exchange, and worldwide weather. Look for more information on the PEBB Web site in September.
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| Questions and answers about your 2008 dental plans |
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For 2008, your Benefit Board made changes to dental benefits. These changes fit the PEBB Vision for high quality, affordable healthcare. Here are questions and answers about the changes.
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Why did the Board change the frequency of coverage for dental cleanings?
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For some people – for example, those with advanced gum disease or diabetes or women who are pregnant – evidence indicates there may be a need for additional cleaning beyond two times per year. For children and adults with healthy teeth and gums, no research supports more than one cleaning per year. Talk with your dentist about your oral health.
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Will my benefits cover additional cleanings if my dentist thinks I need them?
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Talk to your dentist about your oral healthcare needs. Your dentist will work with your plan, and more frequent cleanings may be covered. For example, if you have braces or gum disease, you may be eligible for up to two cleanings per year. If you are diabetic, pregnant or have had gum surgery, you may be eligible for up to four cleanings per year.
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Why did the Board change the frequency of coverage for dental X-rays?
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Research shows that dental X-rays for most people are not needed every year. Radiation from X-rays accumulates over a lifetime and may increase your risk of cancer. Beginning in 2008, benefits will cover bitewings every 12 months for members younger than 15 and every 24 months for those 15 or older. You may be eligible for more frequent X-rays – for example if you have had two or more fillings in the last two years.
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Why did the Board change the Kaiser dental plan design?
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For 2008, the Board asked Kaiser Permanente to offer a plan design that is like the ODS traditional plan. This traditional plan design offers dental benefits that are in line with the latest research and that are less costly. Members will still access services through Kaiser dentists and facilities. Kaiser will also offer a traditional dental plan design for part-time employees and retirees.
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If I want to stay with the same dental plan, will I need to re-enroll or change dentists?
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No. If you don’t want to change your plan – whether it’s Kaiser, ODS or Willamette Dental – your current dental enrollment will continue through 2008, and you will be able to keep the same dentist.
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Why is the member coinsurance amount for implants higher in the Willamette Dental plan than in the other plans?
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The other plans have an annual benefit maximum, while Willamette Dental doesn’t. In the Kaiser and ODS plans in 2008, after you have used $1,750 worth of benefit, you must pay for additional services in full. The Willamette cost-share of 75 percent for implants offsets the lack of an annual benefit maximum, which helps to keep the plan affordable.
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| 2008 healthcare premium rates |
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Following are the premium rates for medical and dental coverage for PEBB active employees in 2008. Part-time and Retiree plans are available only to eligible part-time employees.
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2008 Employee Medical Plans Monthly Premium Rates
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Employee
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Employee & Spouse/Partner
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Employee & Children
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Employee & Family
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Kaiser Permanente HMO 1
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$734.29
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$983.95
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$844.44
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$1,005.98
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Kaiser Permanente Added Choice POS 1
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776.78
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1,040.90
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893.31
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1,064.21
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Providence Choice PPO 2
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741.84
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994.05
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853.12
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1,016.32
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Regence BCBSO PPO 2
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792.84
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1,062.31
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911.72
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1,086.09
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Samaritan Select PPO 2
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733.66
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983.10
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843.71
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1,005.13
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Kaiser Permanente Part-time & Retiree HMO 3
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621.61
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832.96
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714.85
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851.60
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Kaiser Permanente Added Choice Part-time & Retiree POS 3
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628.47
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842.15
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722.74
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861.01
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ProvidenceChoice Part-time & Retiree PPO 4
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592.35
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793.75
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681.21
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811.53
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Regence BCBSO Part-time & Retiree PPO 4
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635.24
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851.14
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730.49
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870.22
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Samaritan Select Part-time & Retiree PPO 4
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590.69
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791.53
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679.30
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809.26
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1 Kaiser Permanente HMO routine vision services
2 Routine vision services through VSP
3 Vision exam only.
4 No vision benefit
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2008 Employee Dental Plans Monthly Premium Rates
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Employee
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Employee & Spouse/Partner
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Employee & Children
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Employee & Family
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Kaiser Permanente Traditional Dental Plan Design
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$61.30
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$82.14
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$70.49
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$83.97
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ODS Preferred
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68.45
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91.73
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78.71
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93.78
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ODS Traditional
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74.10
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99.30
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85.22
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101.53
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Willamette Dental Group
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68.20
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91.39
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78.43
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93.43
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Kaiser Permanente Part-time & Retiree
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45.69
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61.23
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52.54
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62.60
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ODS Part-time & Retiree
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53.32
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71.46
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61.33
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73.06
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Note that PEBB plays no role in determining the monthly benefit amount provided by your employer. The monthly benefit amount is determined by the governor, the legislature, the Department of Administrative Services, and other agencies and branches of Oregon government.
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