Plan Year {{config.planYear}}: {{config.siteName}}

Complete the information in all tabs to obtain the most accurate estimated monthly deductions below.

• 1. Basic Info

  Enter information about your employment type, employment status, and the county in which you live or work. This information is used to determine plan availability and employee premium percentages.

  Employment Type:

  • State employee includes employees of Oregon state government agencies, local government, and semi-independent state agencies.
  • University employee includes employees of Oregon’s seven public universities.

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  University Entity:

  Please choose the university where you work.

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  University Entity:

  Employment Classification for University Employees:

  Your classification impacts the total percentage of premium that you pay for core benefits. If you’re unsure of your classification, contact your university Human Resources department.

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  Employment Status:

  Refer to PEBB’s summary plan description to determine if you are an eligible full-time or part-time employee.

  {{input.basic.empStatus.label}}

  Enter the percent of full-time that you typically work in a month:

  This is the percentage of time you work compared to a full-time schedule. If your actual percentage is above the displayed range, then you may need to change your employment status from part-time to full-time instead.

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  Percent of full-time:

  ZIP code in which you live or work:

  The medical plans available to you are based on your ZIP code. You may want to look at both your home and work ZIP codes as medical plan options may vary.

  You must enter a 5-digit ZIP code.

  Your current monthly salary:

  It is not necessary to enter your salary for core benefits (medical, dental, and vision coverage). However, monthly salary is needed for calculating short-term and long-term disability benefits on this estimator.

  If you don’t enter your monthly salary, you will not be able to choose disability coverage (on tab 3) and see estimated deduction costs in the summary below.

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• 2. Core Benefits

  Select the health care benefits in which you are interested in enrolling. You also need to indicate who will be covered under these plans. Learn more about PEBB’s core benefits in their benefits guide and the health care plan summary of benefits.

  Medical Tier:

  Select the eligible dependents you want to cover in addition to yourself. The tool will show you estimated deductions for ALL medical plans available to you. (The medical plan(s) available to you depend on where you live or work, and your employment status.) You will also be able to see your costs if you choose to opt out of medical coverage.

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  Who will be covered:

  Dental Tier:

  Select the eligible dependents you want to cover in addition to yourself. Also, select the dental plan in which you want to enroll. (The dental plan(s) available to you depend on where you live or work, and your employment status.)

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  Who will be covered:

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  Plan:

  Vision Tier:

  Select the eligible dependents you want to cover in addition to yourself. Also, select the vision plan in which you want to enroll. If you choose the Vision Plus plan, the premium deductions for this plan will appear in  "Surcharges/HEM/VSP Plus" below. This plan includes enhanced coverage, which has higher premiums.

  {{input.core.visTier.label}}

  Who will be covered:

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  Plan:

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• 3. Life & Disability Benefits

  Select the optional benefits in which you are interested in enrolling. These include optional life insurance for you, your spouse/domestic partner, and your children; optional accidental death and dismemberment insurance; short-term disability; long-term disability; and long-term care. Learn more about PEBB’s life and disability benefits on their website.

  Optional Employee Life:

  Optional life insurance provides a lump-sum payment on top of your basic life insurance benefit. You may purchase optional life insurance in increments, up to {{session.misc.ddMax.eeOptLifeAmounts.label}}. You may need to provide EOI (or proof of good health) before your coverage is approved. The amount you pay is based on your coverage amount, age, and tobacco status.

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  Coverage amount:

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  Your smoker status:

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  Your current age:

  Optional Spouse/Domestic Partner Life:

  Optional spouse/domestic partner life insurance provides a lump-sum payment if your spouse/domestic partner were to pass away. You may purchase optional spouse/domestic partner life insurance in increments, up to {{session.misc.ddMax.spOptLifeAmounts.label}}. Your spouse/domestic partner may need to provide EOI (or proof of good health) before coverage is approved. The amount you pay is based on your spouse’s/domestic partner’s coverage amount, age, and tobacco status.

  {{input.optional.spOptLifeAmounts.label}}

  Coverage amount:

  {{input.optional.spOptLifeSmoker.label}}

  Your spouse/domestic partner's smoker status:

  {{input.optional.spOptLifeAge.label}}

  Your spouse/domestic partner's current age:

  Optional Child Life:

  Optional child life insurance provides a lump-sum payment if your dependent child were to pass away. You may purchase optional child life insurance equal to {{session.misc.ddMax.depLife}}.

  Optional Accidental Death and Dismemberment:

  Optional Accidental Death and Dismemberment (AD&D) insurance provides a lump-sum payment if an accident takes your life or causes serious harm. You can purchase coverage for yourself and your family. You may purchase optional AD&D insurance in increments, up to {{session.misc.ddMax.add.label}}. The amount you pay is based on your coverage amount.

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  Coverage amount:

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  Who will be covered:

  Short-Term Disability:

  Short-Term Disability (STD) replaces a portion of your paycheck if you can’t work because of an illness, injury, or pregnancy. You may choose to purchase STD coverage to increase the money you receive when you are unable to work. The STD plan’s benefit amount will be the difference between what you receive from Paid Leave Oregon and the maximum benefit amount of your STD plan. The amount you pay is based on your current salary amount. (You can adjust your salary amount on the first tab, 1. Basic Info.)

  If you don't enter your monthly salary (on tab 1), you will not be able to choose STD coverage and see estimated deduction costs in the summary below.

  Long-Term Disability:

  Long-Term Disability (LTD) replaces a portion of your paycheck if you can’t work for a long period because of an illness and injury. You may purchase LTD coverage to receive some income while you’re unable to work for longer periods. The amount you pay is based on your current salary amount. (You can adjust your salary amount on the first tab, 1. Basic Info.)

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  Coverage amount:

  If you don't enter your monthly salary (on tab 1), you will not be able to choose LTD coverage and see estimated deduction costs in the summary below.

  Employee Long-Term Care

  Long-Term Care (LTC) Insurance helps pay for the care you may need if you can’t independently perform the basic activities of daily living. You may purchase coverage for yourself and your eligible dependents. The amount you pay is based on the coverage level you choose and current age.

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  Coverage amount:

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  Coverage duration:

  {{input.optional.eeLTCAge}} years old

  Your current age:

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  Plan option:

  Spouse/Domestic Partner Long-Term Care

  Long-Term Care (LTC) Insurance helps pay for the care you may need if you can’t independently perform the basic activities of daily living. You may purchase coverage for yourself and your eligible dependents. The amount you pay is based on the coverage level you choose and current age.

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  Coverage amount:

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  Coverage duration:

  {{input.optional.spLTCAge}} years old

  Your spouse/domestic partner's current age:

  {{input.optional.spLTCPlan.label}}

  Plan option:

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• 4. Spending/Commuter Accounts

  Select the flexible spending accounts and commuter accounts you want to participate in. Learn more about PEBB’s spending and commuter accounts on their website.

  Health Care FSA:

  The Health Care Flexible Spending Account (FSA) is a tax-free account that allows you to pay for essential health care expenses that are not covered, or are partially covered, by your medical, dental, and vision insurance plans. You can contribute up to {{session.misc.ddMax.hlthFSAamt}} per year. (State employees should choose 12 months as their coverage duration.)

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  Coverage duration:

  Dependent Care FSA:

  The Dependent Care Flexible Spending Account (FSA) creates a tax break for child or elder care expenses that enable you to work. You can contribute up to {{session.misc.ddMax.depFSAamt}} per year. (State employees should choose 12 months as their coverage duration.)

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  Coverage duration:

  Transportation Account:

  The commuter account is a tax-free account that allows you to pay for commuting expenses to and from work. You can contribute up to {{session.misc.ddMax.transportation}} per month. Learn more about this type of account on PEBB’s website.

  Parking Account:

  The parking account is a tax-free account that allows you to pay for parking expenses while you work. You can contribute up to {{session.misc.ddMax.parking}} per month. Learn more about this type of account on PEBB’s website.

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• 5. Surcharges/HEM

  Enter information about your and/or your spouse/domestic partner’s participation in HEM, tobacco usage, and other available coverage. This information is used to determine which surcharges, if any, apply to you and your enrolled dependents.

  Health Engagement Model (HEM):

  When you participate in HEM, PEBB pays you a taxable incentive of $17.50/month. You can also keep your medical plan deductible low. Click here for more details about HEM.

  {{input.surcharge.hem.label}}

  Participation:

  Employee Tobacco:

  Employees who are enrolled in a PEBB medical plan and use tobacco products pay a monthly surcharge. This fee is $25/month for employees.

  {{input.surcharge.eeTobacco.label}}

  Your smoker status:

  Spouse Tobacco:

  A monthly surcharge applies for spouses/domestic partners who are enrolled in a PEBB medical plan and use tobacco products. This fee is $25/month for your spouse/domestic partner.

  {{input.surcharge.spTobacco.label}}

  Your spouse/domestic partner's smoker status:

  Spouse/Domestic Partner Other Employer Group Coverage:

  You will pay $50/month if your spouse/domestic partner is eligible for benefits coverage through their own employer (not PEBB), but is covered under your PEBB coverage instead.

  {{input.surcharge.spOther.label}}

  Do you have a spouse/domestic partner who is covered under your PEBB plans, but is eligible for benefits coverage through their own employer (i.e., not through PEBB)?

  Double Coverage:

  You will pay a monthly $5 surcharge if you are an active fulltime employee, and:

  • Someone in your family is covered as a member under their own PEBB or Oregon Educators Benefit Board (OEBB) plan.
  • That person is also covered as a dependent (spouse/domestic partner or child) on your PEBB plan.

  {{input.surcharge.dblCov.label}}

  Do you have a family member (spouse, partner, or dependent child) who is enrolled as a member under their own PEBB or OEBB plan?

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• 6. Estimated Deductions

  Review your total estimated premium deductions below. Estimated monthly costs are shown based on the plans in which you might enroll. Premium deductions are estimates only.

  • To save a copy of this estimate, click the Print button in the top right corner. Print a hardcopy or save a PDF.
  • To enroll in benefits, go to PEBBenroll.com. (You can’t enroll for benefits through this premium estimator tool.)
  • For questions about PEBB’s benefit plans, go to PEBBinfo.com.

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