PEBB Frequently Asked Questions

I've been hearing about the time-saving online services that Group Health provides. What's available?
MyGroupHealth for Members lets you refill prescriptions, securely e-mail your doctor, get test results, view your online medical record, check your child's medical record through age 12, and more. Plus, now you can better manage your health care costs by tracking your spending toward deductibles, out-of-pocket expenses, and lifetime maximums. (Some services are available only when care is received at a Group Health medical center.)
See our online tour for more information.
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What's the difference between Group Health's Classic and Value plans?
Our Value plan is designed to keep your monthly premium low (in fact, it's the the lowest monthly premium available to PEBB employees). For 2010, Value plan rates are just $22 per month for a single employee, $54 for employee and spouse, $39 for employee and children, and $71 for families.* As a Value plan member, you'll get all of the the same valuable services as the Classic plan, while spending less on your monthly premiums. A competitive annual deductible and copays paired with fully covered preventive care services provide you with a comprehensive and affordable medical plan. And, remember, there is no plan coinsurance so your medical expenses will always be predictable. Learn more about the Value plan rates and benefits.

Our Classic plan for PEBB employees offers lower copayments and a lower annual deductible than the Value plan, but it has a higher monthly premium. Preventive care services are still covered in full and, like the Value plan, there is no plan coinsurance to worry about so your medical expenses will always be predictable. Learn more about Classic plan rates and benefits.

*Source for 2010 rates: Washington State Health Care Authority. School district and employer group employees need to contact their payroll or personnel office regarding 2008 rates.

When is PEBB open enrollment?
The 2010 open enrollment starts Oct. 26 and ends on Nov. 30, 2009. See the PEBB Web site for details and enrollment forms.

Where can I get Group Health Certificates of Coverage (COCs)?
In January 2010, all members will be mailed a COC request card. If you'd like a printed copy of the COC, please return the request card or call Group Health Customer Service at 1-888-901-4636.

You can also download the COC and find summaries of our Classic and Value plan benefits on our rates and benefits page. Or, you can use the PEBB plan benefits comparison tool on the PEBB Web site.

Do I need a referral from my primary care doctor to see a specialist?
In many instances, you won't need a referral. You can self-refer to most specialists when you receive your care at a Group Health medical center. If you want to see a specialist who is contracted with Group Health but does not practice at a Group Health medical center, you'll need a referral from your personal physician.

My son or daughter is a student and will turn 24 soon. What are his/her choices for coverage?
Dependent children are eligible for PEBB coverage through age 19. Eligibility may continue through age 23 if they are attending high school or are registered students at an accredited secondary school, college, university, vocational school, or school of nursing. Additionally, unmarried children age 20 through 24 may also be eligible as adult dependents; however, the state does not make a contribution toward the coverage of these adult dependents. PEBB dependents who lose eligibility may qualify for continued coverage; contact the Washington State Health Care Authority for more information. If your dependent no longer has PEBB coverage, please call 1-800-358-8815 to learn about Group Health's Individual and Family plans.

What are my out-of-area benefits?
You're covered for urgent and emergency care worldwide. If you're traveling in an area with a Kaiser Permanente clinic, medical center, or hospital, you're covered for routine, urgent, or emergency care. Your out-of-area benefits also include routine and urgent care at any Kaiser Permanente clinic, medical center, or hospital.

How do I enroll in a Group Health plan?
Visit the PEBB Web site, where you can select "Change my Coverage" to make a plan change online, or download an enrollment form.

How do I choose a personal physician? Is my doctor in your network of providers?
Call Group Health Customer Service at 1-888-901-4636 or use our online Provider Directory to find available physicians in your area or to see if your current personal doctor is available through Group Health. Remember, you'll have a choice of a broad network of Group Health physicians, and each member of your family can have a different doctor if you wish. Our Customer Service representatives can help you choose a doctor based on his/her location, special interests, gender, or other factors that are important to you — and you can change doctors at any time.

Where do I go for my care?
Receive care at any of Group Health's 26 medical centers. You can also see a Group Health contracted provider in your community. Call Group Health Customer Service at 1-888-901-4636 or use our online Provider Directory to find available physicians in your area.

I'm going to be eligible for Medicare soon. What do I need to do?
When you receive your Medicare card, send a copy of it to the Health Care Authority indicating the effective dates of your Medicare Parts A & B coverage. You will also need to send a Medicare Advantage election form to Group Health. You won't need to enroll in Part D of Medicare, since your PEBB plan provides comparable prescription drug benefits.

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