Get Savvy About Health Insurance

Having a basic understanding of your health insurance empowers you when navigating health insurance processes and utilizing your coverage. The Benefits Office provides the following information to assist you with becoming savvy about your health insurance.

Know Your Options

During Open Enrollment, you can make changes to your benefit elections. Use the links below to explore your options.
Please note: 2019 plan summaries will be posted when they become available. In the meantime, the 2018 summaries provide a plan overview taking into consideration specific changes that take effect January 1, 2019.

Medical Plans

Vision Plan

Know the Changes

Benefits plans are evaluated every year by the Public Employees Benefit Board (PEBB). Plan changes are shared during Open Enrollment and become effective January 1 when the new plan year begins.

See 2019 Plan Changes

Know the Players

There are four key players in the health insurance model used at the University of Oregon.  Understanding the roles and responsibilities of each equips an employee to better understand the delivery of their health insurance.

Public Employee Benefits Board (PEBB)

PEBB is the organization that sets the plan designs and coverages for health insurance options.  They also establish rules and processes for employers and employees covered by their plans to follow.  Additionally, PEBB contracts insurance carriers.

Insurance Carrier

Insurance carriers are contracted with PEBB to process claims in accordance with plan design and within rules set by PEBB.

Employer

UO is an employer that participates in PEBB and is responsible for communicating with employees about the rules and processes determined by PEBB.  The UO Benefits Office helps employees understand their health options, including plan designs, and supports and assists employees with completing processes in accordance with PEBB guidelines.

Employee

The employee’s role and responsibility is to know and understand their benefits and abide by the timelines, rules and processes established by PEBB.

Essentially, PEBB determines which medical services and supplies are covered, and it establishes rules and processes for insurance carriers, employers and employees to follow. The employer and employee participate in the plans offered by PEBB and work together to adhere to PEBB guidelines and ensure coverage under elected plans.


Learn the Language

Learning the language of health insurance helps you better understand your benefits. Here are a few resources to help you learn common terms and differentiate between the types of health insurance plans available.

 


Know Your Benefit Elections

You are best equipped to effectively manage your health insurance when you know the health insurance plan you elected and understand the medical services, prescriptions, and supplies covered by your plan.

Login to your PEBB account to review your current elections:

Login to PEBB.benefits

PEBB provides a Summary of Plan Benefits & Coverage for each of the medical plans offered.  The summary document is an excellent resource to understand what is covered and what it costs.  Select the correct summary document based on your current election and utilize this resource to get to know your plan benefits:
*please note, part-time employees should refer to the part-time documents provided.


Glossary of Terms

Coinsurance
The percentage of the cost that you need to pay for a covered service.

Copay
The fixed dollar amount you pay to a health care provider for a covered service at the time care is provided.

Deductible
The dollar amount an individual or family pays for covered services before your plan pays any benefits within a calendar year. Your plan has both in-network and out-of-network deductibles. These deductibles accumulate separately and are not combined.

Deductible Carryover
A feature of your plan that allows for any portion of your deductible that is paid during the fourth quarter of a calendar year to be applied toward the  next year's deductible.

In-Network Services
Refers to services received from an extensive network of highly qualified physicians, and health care providers available to you by your plan.  Generally, your out-of-pocket costs will be less when you receive covered services from in-network providers.

In-Network Provider
A physician or provider of health care services who belongs to the health plan in-network provider panel. To find an in-network provider, refer to the  plan’s provider directory.

Out-of-Network Services
Refers to services you receive from a non-network provider. Your out-of-pocket costs are generally higher when you receive covered services from  non-network providers.

Out-of-Network Provider
Any health care professional who does not participate within your health plan’s in-network panel of physicians and providers of health care  services.

Out-of-pocket Maximum
The limit on the dollar amount you will have to spend for specified covered health services in a calendar year. Some services and expenses do not  apply to the out-of-pocket maximum. See your Member Handbook for details.

Prior Authorization
Some services must be pre-approved. In-network, your provider will request prior authorization. Out-of-network, you are responsible for obtaining  prior authorization.

Usual, Customary & Reasonable (UCR)
Describes predefined charges established by your plan for services that you receive from an Out-of-Network provider. When the cost of Out-of-  Network services exceeds UCR amounts, you are responsible for paying the provider any difference. These amounts do not apply to your out-of- pocket maximums or maximum cost share.


Medical Plan Characteristics

Preferred Provider Plan (PPO)

PEBB Statewide (Administered by Providence Health Systems)

  • Access to a nationwide directory of preferred providers
  • Does not require designated primary care provider
  • Co-insurance (percentage of usual, customary and reasonable rates)
  • Does not require referrals to specialists

Coordinated Care Plans

Providence Choice, Moda Synergy

  • Only available in certain counties
  • Requires pre-designation of medical home or primary care physician
  • Co-payments (fixed amount) and do not accrue towards Out-of- Pocket maximums
  • Requires referrals to specialists

Kaiser

  • Only available in certain counties
  • No deductible
  • Access care only through Kaiser approved facilities
  • Co-payments (fixed amount)
  • Requires referrals to specialists