Insurance

A CDHP is a high-deductible health plan (HDHP) with a health savings account (HSA). CDHPs offer lower premiums, a higher medical deductible, and a higher medical out-of-pocket limit than other types of health plans.

Kaiser Permanente WA, and Uniform Medical Plan (UMP) all offer CDHPs. Visit benefits and coverage by plan for coverage details.

Other features

If you cover yourself and one or more dependents, you must pay the entire family medical deductible before the plan begins paying benefits.
Your medical and prescription drug costs count toward the annual deductible and out-of-pocket maximum.
You can enroll in a Limited Purpose Flexible Spending Arrangement (FSA) and the Dependent Care Assistance Program (DCAP).

What is a health savings account (HSA)?

An HSA is a tax-advantaged account, which means money you contribute is not taxed. When you enroll in a CDHP, you are automatically enrolled in an HSA. The PEBB Program also contributes to your HSA each month.

With an HSA you can pay for:

IRS qualified out-of-pocket medical expenses (like deductibles, copays, and coinsurance) including some expenses and services that your health plans may not cover.
Qualified expenses for your spouse or other tax dependents, even if they aren't covered on your medical, dental, and vision plans.

Your HSA balance can grow over the years, earn interest, and build savings that you can use to pay for health care as needed. The money is yours, even if you change health plans, get a new job, or retire.

After you’re 65, you can withdraw HSA dollars for any expense – you’ll just need to pay income taxes.

Am I eligible?

You must meet certain eligibility requirements to enroll in a CDHP with an HSA. If you are not eligible and enroll, you may be liable for tax penalties.

To be eligible to enroll in a CDHP, you cannot be enrolled in:

Medicaid or Medicare Part A or Part B.
Another health plan that is not an IRS-qualified high-deductible health plan — for example, on a spouse’s or state-registered domestic partner’s plan — unless the health plan coverage is limited coverage, such as dental, vision, or disability coverage.
A Voluntary Employee Beneficiary Association Medical Expense Plan (VEBA MEP), unless you convert it to a limited health reimbursement account (HRA) coverage. (This includes you or your spouse or state-registered domestic partner.)
A TRICARE plan.
A Medical Flexible Spending Arrangement (FSA) or Health Reimbursement Arrangement (HRA). This also applies if your spouse has a Medical FSA, even if you are not covering your spouse on your CDHP. This does not apply if the Medical FSA or HRA is a limited purpose account, or for a post-deductible Medical FSA. The Limited Purpose FSA is compatible with an HSA.
You also cannot be claimed as a dependent on someone else’s tax return.

Other exclusions apply. Check IRS Publication 969—Health Savings Accounts and Other Tax-Favored Health Plans, contact your tax advisor, or call HealthEquity at 1-877-873-8823 (for Kaiser members) or 1-844-351-6853 (for UMP members) to verify whether you qualify. See The Complete HSA Guidebook for full details.

What contributions are allowed?

Employer contributions

After your HSA is established with HealthEquity, you can start to receive employer contributions.

The contribution goes into your HSA in monthly installments over the year on the last day of each month (the entire HSA amount is not available on January 1).

The Health Care Authority will contribute the following amounts to your HSA:

People covered on CDHP	Monthly deposit into HSA	Total deposited by the end of the year
Just you	$58.34 x 12 (months)	$700.08
You and your family If you have at least one other family member on your CDHP, then you qualify for the family contribution.	$116.67 x 12 (months)	$1,400.04

People covered on CDHP

Monthly deposit into HSA

Total deposited by the end of the year

Just you

$58.34 x 12 (months)

$700.08

You and your family

If you have at least one other family member on your CDHP, then you qualify for the family contribution.

$116.67 x 12 (months)

$1,400.04

You will get an additional $125 in your HSA (deposited at the end of January in the following calendar year) if you qualify for the SmartHealth wellness incentive.

Your contributions

The IRS has annual limits for contributions from all sources into an HSA.

For 2023, the contribution limit for an HSA is $3,850 (subscriber only) and $7,750 (subscriber and one or more dependents).
Members ages 55 or older, you may contribute up to $1,000 more annually in addition to these limits.

How do I contribute?

You can choose to contribute to your HSA in one of two ways:

Contact your payroll or benefits office to set up pretax payroll deductions. You'll need to submit an Employee Authorization for Payroll Deduction to Health Savings Account to your payroll or benefits office.
Call HealthEquity to set up direct deposits to your HSA.

To make sure you do not go beyond the limit, consider your employer’s contributions, your contributions, and the SmartHealth wellness incentive in January (if you qualify). Use the HSA contribution calculator.

> Medical FSA. Limited Purpose FSA, & Dependent Care (DCAP)

Medical Flexible Spending Arrangement (FSA)

The Medical FSA allows you to pay for out-of-pocket health care costs like deductibles, copays, coinsurance, medications, menstrual care products, dental care, vision services, and more (see eligible expenses).

You can use your Medical FSA to pay for expenses for you, your spouse, or your qualified tax dependents, even if they are not enrolled in your PEBB medical or dental plan. FSA participation is only valid for the plan year in which you enroll and does not continue automatically. You must enroll or re-enroll each year during the PEBB Program's annual open enrollment period.

In 2023 you can contribute a minimum annual amount of $120, up to a maximum annual amount of $2,850.

Limited Purpose Flexible Spending Arrangement (FSA)

The Limited Purpose FSA allows you to pay for out-of-pocket dental and vision costs like glasses, contact lenses and solution, dentures, dental copays, orthodontia, and more (see eligible expenses). This plan is only for employees enrolled in a consumer-directed health plan (CDHP) with a health savings account. Participation is only valid for the plan year in which you enroll and does not continue automatically. You must enroll or re-enroll each year during the PEBB Program's annual open enrollment period.

In 2023 you can contribute a minimum annual amount of $120, up to a maximum annual amount of $2,850.

What is carryover? (Medical FSA & Limited Purpose FSA)

If you have not spent all the funds in your FSA by December 31, and you are still employed and didn't lose eligibility for the FSA, you may be able to take advantage of the carryover feature, where certain unspent funds may "carry over" into the following year without affecting annual maximums.

To carryover your unspent funds:

You must enroll in either the Limited Purpose FSA or Medical FSA for the following year, or
Have at least $120 left in your FSA balance.

Unused funds up to $570 will carryover to the next plan year. Any funds above $570 will be forfeited.

Additional carryover information

Dependent Care Assistance Program (DCAP)

The DCAP allows you to set aside money from your paycheck on a pre-tax basis to help pay for qualifying child care or elder care expenses while you (and your spouse or state-registered domestic partner) attend school full-time, work, or look for work.

A qualifying dependent must be:

Age 12 or younger and live with you.
or
Age 13 or older, physically or mentally incapable of self-care, and regularly spend at least eight hours each day in your household.

DCAP contributions are limited to:

$5,000 annually for a single person or married couple filing a joint income tax return.

How to enroll in an FSA and/or DCAP:

To enroll or re-enroll visit Navia Benefits Solutions.
Re-enrollment for the next plan year happens during November's Open Enrollment. Each year you can re-enroll online with Navia or return the Navia Enrollment Form to the Benefits Office SHW 318 before Nov. 30th.

Submit claims to Navia:

When you incur an eligible expense, you can submit a claim online, use the mobile app, or send a claim form by fax, mail, or email to request reimbursement. You also can sign up for a debit card.

Deadline to spend down your DCAP account:

For 2022 DCAP funds and beyond, DCAP expenses must take place by December 31 each year. You must submit all claims for reimbursement to Navia Benefit Solutions no later than March 31 of the following year.

After that date, your account will be closed and any balance remaining will be forfeited to the Health Care Authority. Once the money is forfeited, you will not be able to claim it. This is called the "use-it or lose-it" rule.

> Medical Plan Types

Medical plan types

The PEBB Program offers three types of medical plans:

Managed-care plans

Managed care plans may require you to select a primary care provider (PCP) within its network to fulfill or coordinate all of your health needs. The plan may not pay benefits if you see a non-contracted provider.

Preferred provider organization health plans

PPO’s allow you to self-refer to any approved provider type in most cases, but usually provide a higher level of coverage if the provider contracts with the plan.

Consumer-directed health plans (CDHPs)

CDHPs let you use a health savings account (HSA) to help pay for out-of-pocket medical expenses tax free, have a lower monthly premium than most other plans, and a higher deductible and a higher out-of-pocket limit. See Health plans with health savings accounts (HSAs).

> Medical Plan Options

Medical plan options

You may choose from the plans listed below. Your options are limited to the plans available in your county. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan.

Managed-care plans

Kaiser Permanente WA Classic
Kaiser Permanente WA Value

Preferred-provider plans: UMP plans are administered by Regence BlueShield

UMP Classic
UMP Select
UMP Plus

Consumer-directed health plans (CDHPs)

Kaiser Permanente WA CDHP
UMP CDHP, administered by Regence BlueShield

Visit the PEBB plan sites for more information: Kaiser Permanente WA plans or Uniform Medical Plan (UMP) plans.

To add or remove a dependent from your health insurance, you must complete a new Employee Enrollment Change Form and return it to the Benefits Office. Be sure to complete the form in its entirety - this will replace all previous forms. Usually this must be done within 30 days of the qualifying event.

> Plan Summaries & Certificates of Coverage

Medical Plan Summaries

Kaiser Permanente Plans

2023

2022

Uniform Medical Plans

2023

2022

Medical Plan Certificates of Coverage

The certificates of coverage (COCs), also called benefits booklets, are produced by the health plans to provide detailed information about plan benefits and what is and is not covered.

Kaiser Permanente WA

2023

2022

Uniform Medical Plans

2023

2022

> Plan Differences to Consider

Deductibles

All medical plans require you to pay a certain amount of plan costs, such as fees for office visits, before the plan pays for covered services. This is known as the deductible. Medical plans may also have a separate annual deductible for specific prescription drugs. Covered preventive care services are exempt from the medical plan deductible. This means you do not have to pay your deductible before the plan pays for the covered preventive service.

Coinsurance or copays

When you receive care, some plans require you to pay a percentage of an allowed fee, called coinsurance. Other plans require you to pay a fixed amount, called a copay. These amounts vary by plan and are based on the type of care received.

Out-of-pocket limit

The annual out-of-pocket limit is the most you pay in a calendar year for covered benefits. Some plans have a separate out-of-pocket limit for prescription drugs. Once you have reached the out-of-pocket limit, the plan pays 100 percent of allowed charges for most covered benefits for the rest of the calendar year. Certain charges (such as your annual deductible, copays, and coinsurance) may count toward your out-of-pocket limit. Others, such as your monthly premiums, do not count toward your out-of-pocket limit.

Monthly Premiums

Medical Premiums for 2023

Medical Premiums for 2022

Medical benefits comparison tool

> When Can I Make Changes

How to make changes

You must submit the Employee Enrollment/Change form to the Benefits Office during the annual open enrollment or when a special open enrollment event occurs, within the PEBB Program’s timelines.

To make a change during annual open enrollment:
The Benefits Office must receive the Employee Enrollment/Change form between November 1-30. You may also make some changes using My Account.

To make a change when a special open enrollment event occurs:
Events that create a special enrollment include. The benefits office must receive the Employee Enrollment/Change form no later than 60 days after the event that created the special open enrollment.

Changes you can make any time

You can make some changes during the year without a special open enrollment event.

Change your name and/or address. Use the Employee Enrollment/Change form.
Remove dependent(s) from coverage due to loss of eligibility (required). Your benefits office must receive a complete Employee Enrollment/Change form no later than 60 days after the event.
Start, stop, or change your contribution to your health savings account (HSA). Use the Employee Authorization for Payroll Deduction to Health Savings Account form.
Change your HSA beneficiary information. Use the Health Savings Account Beneficiary Designation form.

Dental Coverage

Choosing a Dental Plan

During the first 31 days of eligibility and during the annual open enrollment, employees may choose among two managed care dental plans and one fee-for-service plan, the Uniform Dental Plan.

2023 Dental Plan Comparison Chart

> Dental Plan Options > Plan Differences to Consider > Find Providers

> Dental Plan Options

Dental plans

DeltaCare and Willamette Dental Group are managed-care plans.
You must choose a primary dental provider within their networks.

Uniform Dental (UDP) is a preferred provider plan.
You may choose any provider, but will generally have a lower out-of-pocket costs if you see network providers

Visit the plan sites for more information: DeltaCare, Willamette Dental Group, or Uniform Dental Plan.

> Plan Differences to Consider

Managed Care vs Preferred Provider

Managed care dental plans require that you use their facilities and/or dentists for all of your services. By doing this, they control their costs, and you pay less for services. Fees are usually a flat co-payment as listed in the plan book.

The Uniform Dental Plan (group#3000) is a fee-for-service plan with a preferred provider network option. You may use any dentist you wish. If you use a preferred-provider, your dentist will bill within the rate schedule, and you will only pay the employee share. This plan is managed by Washington Dental Service, the claims administrator for the plan.

Compare Benefits and Coverage

Compare the dental plans and benefits here.

> Find Providers

Life Insurance Coverage

EWU provides basic life insurance to all employees eligible for full benefits. During the first 31 days of eligibility employees can enroll in optional and AD&D life insurance.
Online: MetLife MyBenefits
Account Sign In: PEBB Benefits - State of Washington
Phone: 1-866-548-7139, benefits specialists available Monday through Friday, 5 a.m. to 8 p.m EST.
MetLife Enrollment/Change Form

> Basic Life Insurance > Optional Life Insurance > How Much Do I Need and What Will it Cost? > How to Enroll/Make Changes > Updating Beneficiaries

> Basic Life Insurance

Basic Life Insurance (Employer Paid)

EWU provides basic life insurance through MetLife at no cost to the employee. It provides:

$35,000 for death from any cause.
An additional $5,000 in case of accidental death or dismemberment.

As an employee, your basic life insurance covers you and pays your designated beneficiaries in the event of your death. Your basic life insurance includes accidental death and dismemberment (AD&D) insurance, which provides extra benefits for certain injuries or death resulting from a covered accident.

> Optional Life Insurance

Optional Life Insurance
(Employee Paid)

For Employee (Subscriber)

Employees may enroll in optional term life insurance in increments of $10,000 up to $500,000 guaranteed issue*, up to a maximum of $1,000,000 with Medical Evidence of Insurability.

For Spouse or state-registered domestic partner

Increments of $5,000 up to $100,000 guaranteed issue*, up to a maximum of $500,000 with Medical Evidence of Insurability. Coverage cannot exceed 50% of employee's optional life insurance.

For Child(ren)

Increments of $5,000 up to $20,000 (Ages: 14 days up to 26 years).

*Guaranteed issue is the amount of coverage an employee may select when initially eligible for coverage, within the required deadlines below, without submitting a statement of health for carrier approval.

Optional Accidental Death and Dismemberment (AD&D) Insurance

Optional AD&D Insurance never requires evidence of insurability, and you can apply at any time.

For Employee (Subscriber)

Employees may enroll on AD&D insurance in ncrements of $10,000 up to $250,000. Optional AD&D insurance does not cover death and dismemberment from non-accidental causes.

For Spouse or state-registered domestic partner

Increments of $10,000 up to $250,000

For Child(ren)

Increments of $5,000 up to $25,000

> How Much Do I Need and What Will it Cost?

The amount you need, if any, is specific to you and your responsibilities and lifestyle. Many people find that as they get older they need less life insurance. If your home is paid for, your children are grown and not dependent on your income, etc, you may find that you need very little or no life insurance. To determine your insurance needs, evaluate your current and future assets and expenses such as:

costs of staying in your home.
child care costs, elder care costs, and/or college expenses.
SSDP currently working at home.
costs of assisting a disabled family member.

Life Insurance Premiums

Find out the monthly cost for optional life and accidental death and dismemberment (AD&D) insurance here.

> How to Enroll/Make Changes

How to enroll or make changes

You may enroll within 31 days of becoming eligible for PEBB benefits. You can complete a MetLife Enrollment/Change Form or create an account on MetLife’s MyBenefits portal.

To create an online account with MetLife

Visit MetLife’s MyBenefits portal.
In the Account Sign in box type "PEBB Benefits - State of Washington"
This will take you to a Welcome to MyBenefits screen where you can log into your account.
First Time User? Click the Register Now! button.
Complete the registration form.

After registering for an account you will receive a thank you email from MetLife that includes a link back to the MyBenefits page. If you have questions about the MetLife website, please contact MetLife at 1-866-548-7139.

> Updating Beneficiaries

Long-Term Disability Coverage

Information about LTD is available:

In the Long Term Disability Booklet
On the HCA’s website’s Long-Term Disability insurance page
LTD insurance premium rates on the HCA’s website
Decision Support Tool on The Standard’s website

EWU provides basic long-term disability (LTD) insurance to employees eligible for full benefits. All benefit eligible employees will be auto enrolled in the Employee Paid LTD benefit with a 90 day waiting period at a 60% monthly benefit. Employee's have the option to change their benefit to a 50% monthly benefit or opt out of the benefit all together.

Standard Insurance Co
Customer Service: 1.800.368.2860
Long-Term Disability Enrollment/Change Form

> What is LTD? > Employer Paid (Basic) LTD insurance > Employee Paid LTD Insurance > Terminate/Change Optional LTD > Faculty LTD

> What is LTD?

Long-term disability (LTD) insurance is designed to help protect you from the financial risk of lost earnings due to serious injury or illness. When you enroll in LTD coverage, it pays a percentage of your monthly earnings to you if you become disabled.

What is considered a disability?
Being unable to perform with reasonable continuity the duties of your Own Occupation as a result of sickness, injury, or pregnancy during the benefit waiting period and the first 24 months for which LTD benefits are payable.

> Employer Paid (Basic) LTD insurance

Employer Paid (Basic) LTD insurance

EWU pays for a basic Long Term Disability policy for all employees. This Basic LTD Plan provides:

Benefit: 60 percent of the first $400 of your predisability earnings (your monthly base pay), reduced by any deductible income.
Minimum: $50/month
Maximum: $240/month

Benefits start after 90 days or the period of sick leave (excluding shared leave) for which you are eligible under the employer’s sick leave plan (whichever is longer), and continue during disability up to the maximum benefit period.

> Employee Paid LTD Insurance

Employee Paid LTD

You can build on your basic coverage with the employee paid LTD Plan. Employee paid LTD provides:

Benefit: you may choose either a 50% benefit or a 60% benefit of the first $10,000 of your predisability earnings, reduced by any deductible income, and any benefits paid under the basic plan.
Minimum: $50/month
Maximum: $6,000/month

Benefits start after the end of the 90 day waiting period or the period of sick leave (excluding shared leave) for which you are eligible under the employer’s sick leave plan (whichever is longer), and continue during disability up to the maximum benefit period. The maximum benefit period is based on the age of the enrollee when he or she becomes disabled.

Requests to enroll after the first 31 days of employment require insurance company approval. Any prior medical problems (e.g., back pain, knee pain, diabetes, cancer, etc.) may result in a denial of coverage.

Premiums are based on a percentage of your monthly salary. The rates vary with the benefit percentage you choose and on your retirement plan eligibility. See premiums costs here.

The LTD Booklet is available at the link or you may request a copy from the Benefits Office at 359-2488.

> Terminate/Change Optional LTD

To terminate your employee paid LTD coverage, you will need to complete a new LTD Enrollment/Change Form . Once you have it completed, please return it to the EWU Benefits Office.

To increase your benefit percentage or re-enroll after declining the employee paid LTD coverage, you will need to complete a new Enrollment/Change Form and complete the Evidence of Insurability Form. The new coverage will be in effect once Standard has approved your request based upon their criteria.

> Faculty LTD

Self-Pay Benefits While On Leave

As an employee on Leave without Pay, you are entitled to PEBB continuation coverage (LWOP coverage). Employees may continue medical and dental benefits, life insurance, and in some cases, long-term disability insurance. You must enroll in continuation coverage to enroll your eligible dependents.

> Eligibility > What Insurances May I Continue via Self-pay? > How Long May I Continue Insurance on Self-Pay? > Do I have to Self-Pay for All My Insurances? > What Happens If I Don't Self-Pay? > Life Insurance Premiums > Long Term Disability

> Eligibility

You are eligible to self-pay your medical, dental & life insurance, and in some cases long term disability (LTD) if you are on approved leave from an otherwise eligible position.

> What Insurances May I Continue via Self-pay?

> How Long May I Continue Insurance on Self-Pay?

You may continue on self-pay:

While on an approved leave of absence, but in no case longer than 29 months.
During the period of layoff or re-employment rights as defined by the personnel rules or labor contract covering your position.
If there are no re-employment rights for your position (i.e., faculty and professional staff) but your employment ended due to lack of work or lack of funds, then you will have up to 24 months of self-pay layoff status.

If a leave is fully or partially covered by the Family and Medical Leave Act (FMLA), some coverages may not require self-pay. Contact the Benefits Office for information about how your personal benefits will be impacted by FMLA.

> Do I have to Self-Pay for All My Insurances?

> What Happens If I Don't Self-Pay?

If you do not self-pay while on leave:

Medical and dental end as of the last day of the month in which there were at least 8 hours pay and are not reinstated until the first of the month following the return to an eligible appointment (unless the date of return is also the first business day of the month)
- Employees re-hired from layoff who did not self-pay may not choose a new plan or add new dependents. Exception: if an open enrollment has occurred between the last period of coverage and the re-hire date, or a marriage, birth or an adoption has occurred.
Life insurance ends as of the last day of the month in which the full monthly premium was paid; on return from leave or layoff, no optional coverage is reinstated unless applied for and approved by MetLife.
LTD ends as of the last day in pay status and is reinstated on return as long as the enrollment form is completed within 10 days of return from leave; only those employees on an approved educational leave may continue LTD on a self-pay basis.
- If you allow your optional (employee-paid) life insurance and, if on approved education leave, your LTD insurance to lapse, you must re-apply for coverage on return and provide proof of good health to the insurance company.

> Life Insurance Premiums

> Long Term Disability

LTD can only be self-paid while on an approved educational leave of absence. Employees on other types of leave may not self-pay, but the optional coverage can be reinstated if you apply within 10 days of your return to an eligible position. If an educational leave is partially paid, deductions will be taken from the partial salary. Benefits, in the event of a claim, would be based on the partial salary unless arrangements are made to pay the difference and continue premiums as though in regular appointment pay status. Contact the Benefits Office for more information and to arrange deductions.

COBRA and Continuation Coverage

Enrollment and benefit information specific to COBRA coverage for subscribers and their dependents is available here.

> What is COBRA? > 18 Months of COBRA eligibility is available if: > 36 Months of COBRA eligibility is available: > You are not eligible for COBRA continuation if: > What Coverage May I Continue? > To enroll in COBRA:

> What is COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that gives you and your covered dependents the right to continue group health coverage on a self-paid basis if eligibility for the employer-sponsored group medical and dental is lost.

> 18 Months of COBRA eligibility is available if:

> 36 Months of COBRA eligibility is available:

> You are not eligible for COBRA continuation if:

> What Coverage May I Continue?

> To enroll in COBRA:

How to Enroll:

HCA will send you a Notice of qualifying event packet when EWU reports your separation to them.
Send the form and payment to the state Health Care Authority at the address enclosed in enrollment packet no later than 60 days after the date your employer-sponsored coverage ends . Premiums must be paid retroactive to the first day of the month following the qualifying event.
Click here to see current COBRA rates.

Affordable Care Act

Visit HealthCare.gov for additional information.

> How Does the Affordable Care Act Affect Me at Eastern Washington University? > Employer Notification (including Employer Plan Information documents) > Affordable Care Act Resources

> How Does the Affordable Care Act Affect Me at Eastern Washington University?

With coverage being available under the Affordable Care Act (ACA), beginning January 2014, most individuals will be required to have health insurance coverage.

Benefits offered to benefit-eligible Eastern Washington University (EWU) faculty and staff, have been determined to meet and/or exceed the standard identified by the ACA including premium affordability and acceptable health coverage levels of coverage. The regular student plan may also be a viable option.

However, employees and students currently not eligible for or covered by benefits through EWU may need/want to review the coverage options available through the Marketplace, a new way to buy health insurance under the ACA. This webpage provides basic information about the Marketplace as well as benefits offered through EWU, and its intended to assist in evaluating options for you and your family.

> Employer Notification (including Employer Plan Information documents)

This notice specifically addresses the requirements of the ACA Employer Notification, but will also provide links to additional information that individuals and their families may find helpful. This notice serves as a household employer notification and should be provided to household members as well.

This notice has been provided to all existing employees as of September, 2013 and will be provided to all future employees starting October 1, 2013.

Employer Notification - Faculty and Staff

Employer Notification - Students

> Affordable Care Act Resources

318 Showalter Hall

email: benefits@ewu.edu

phone: 509.359.2488

fax: 509.359.2874

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