PEBB Providence Choice expands service area

As of Jan. 1, PEBB has expanded its PEBB Providence Choice Plan, a medical home model, to additional counties in Oregon. Originally offered only to a limited area, the plan area now includes Multnomah, Clackamas, Washington, Clark, Marion, Polk, Lane, Linn, Benton, Deschutes, Curry, Coos, Deschutes and Jackson counties. PEBB members living in these counties choose either the PEBB Statewide Plan or PEBB Providence Choice Plan.

Initially, a limited number of clinics are acting as medical homes; however, the number of medical homes may expand throughout the next few years. If you are interested in participating in Providence’s medical home model, please contact your Provider Relations representative.

Following are highlights from each of the plans:

PEBB Statewide Plan

  • This plan uses the EPO Panel/Open Option.
  • The member ID card indicates “PEBB Statewide Plan.”
  • Care and services are not managed by a primary care provider, and referrals are not required.
  • This plan has higher member out-of-pocket benefits (e.g., the percentage of coinsurance for office visits).

PEBB Providence Choice Plan

  • This plan uses the medical home model and requires a member to choose a medical home.
  • All participating EPO providers with a signed 2011 amendment are considered participating on Providence Choice Plan but not all providers are a medical home.
  • The member ID card indicates “PEBB Providence Choice Plan” and includes the term “medical home.”
  • A member has lower out-of-pocket benefits (e.g., a $5 copayment for office visit) when care is managed by his or her medical home either with direct care by a medical home provider or upon referral from a medical home to a participating EPO provider outside the medical home.
  • A member may access care outside the medical home without a referral. A member’s benefit reverts to a higher out-of-pocket cost when service is accessed without a referral.