Benefits 24/7 stabilization update - week of February 10-14

Washington State Health Care Authority sent this bulletin at 02/14/2025 11:15 AM PST

2.14.2025

Dear Benefits Administrators,

Here are updates on HCA’s priorities and progress to stabilize the Benefits 24/7 platform for PEBB and SEBB employees. Our intention is to keep you informed on identified issues, how we’re prioritizing them, and when they’re addressed.

This list does not include all the identified issues, but several that we are prioritizing based on their impact on members’ enrollment. Keep in mind that we’re balancing the work on these issues with additional system issues affecting other PEBB and SEBB members, including retirees.

New priorities

Premium discrepancies: HCA identified additional scenarios affecting some PEBB retiree accounts where the wrong premiums are being charged.

Updates on previously reported priorities

Incorrect UMP Classic Medicare enrollment: Some retiree accounts were incorrectly placed in UMP Classic Medicare with Part D (PDP) coverage. This caused these subscribers to be denied enrollment in other health coverage when their UMP coverage with Moda (UMP’s pharmacy benefits administrator) has not yet been terminated. HCA continues to work with Moda to identify these subscribers and process their accounts before they are terminated from their other coverage.

Employer group enrollments: For three employer groups who were new to PEBB coverage effective January 1, their employee enrollment information was sent to the carriers before carriers’ systems were ready to enroll them. This also affected two employer groups that switched from PEBB medical-only coverage to PEBB full benefits coverage effective January 1. HCA has confirmed with the vision and dental carriers that these employer groups have been enrolled properly and is in the process of following up with medical carriers.

Issues that have been addressed

Carrier file enrollment data: Enrollment data for 836 individuals from the December 24 carrier files did not make it to the PEBB and SEBB insurance carriers. This week, HCA addressed the remaining 149 accounts.

PEBB $0 invoice report: HCA reviewed 129 accounts showing on an internal HCA report of PEBB employees with $0 due for their coverage on the monthly invoice. HCA identified 52 of these accounts had keying errors and corrected these accounts.

Moda enrollment fixes: Retirees enrolled in UnitedHealthcare plans were incorrectly being enrolled by Moda (UMP’s pharmacy benefits administrator) in the Medicare prescription drug portion of UMP Classic Medicare with Part D (PDP). Moda implemented a fix for this issue in their system, and HCA addressed the individuals who were incorrectly enrolled.

If you continue to have challenges on an issue that has been addressed, please submit a new ticket to HCA’s Outreach & Training team.

You can access weekly updates on the Benefits Administrator website via the pink alert box and under Notices and updates. We will expand content on the website later this month.

We appreciate your patience and understanding as we diligently work on resolving these and other issues.

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.