(Dental Service Plans are not shown.) Participating Providers. Aetna - Commercial Aetna - PEBTF Aetna - Medicare Advantage Aetna Institutes of Excellence - ...Pennsylvania Employees Benefit Trust Fund (PEBTF)—The PEBTF administers health care benefits for approximately 76,000 eligible commonwealth employees and their dependents. It is governed by a Board of Trustees comprised of both commonwealth and union representatives. State Employees’ Retirement System (SERS)—SERS administers four …Discounts on fitness, wellness, weight loss programs, etc. Members may visit the PEBTF website for links to the plan's wellness benefits. Click on the Get Healthy Discount Programs button to get started. Discounts on fitness, wellness, weight loss programs, etc. Members may visit the PEBTF website for links to the plan's wellness benefits.PEBTF-14 Adult Dependent Coverage Form. PEBTF-36 Active Employer Benefit Verification Form for Active Members. PEBTF-40 Direct Payment Authorization Form. PEBTF-41 Enrollment in PEBTF Prescription Drug Plan Without PEBTF Medical Plan Coverage. PEBTF-44 Attesting to Other Coverage Due to a Plan Change Effective 4/1/2021 …(PEBTF) operates as a non-profit organization. The Organization offers health care assistance such as vision, dental, hearing aid, and other related ...Appointments are available the last Thursday of each month (except on holidays). Please call the PEBTF to schedule. Appointments must be scheduled in advance. Unscheduled walk-ins are not accepted. Secure Dropbox: For your convenience a locked drop-box is located just inside the main doors of the PEBTF offices. You may drop off a check payment ... Summary. In-network deductibles differ between the Choice PPO and the Basic PPO. – Choice PPO – Annual in-network deductible is $400 single/$800 family. – Basic PPO – Annual in-network deductible is $1,500 single/$3,000 family. PPO option covers medical services as set forth in the PEBTF Plan Document. PPO option offers both an in ...PEBTF - Log In. Active Members. Benefit Information. Health Plan Choices by County. Open Enrollment Information. Benefit Comparison. 2024 Formulary. SilverScript Employer PDP sponsored by REHP (SilverScript) 2024 Formulary. (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. This formulary was updated on 08/16/2023. For more recent information or other questions, please contact …PEBTF-6 Disabled Dependent Certification Form. PEBTF-11 Retiree Declaration of Spouse Health Coverage for Retiree Members. PEBTF-14 Adult Dependent Coverage Form. PEBTF-36 Retiree Employer Benefit Verification Form for Retiree Members. PEBTF-40 Direct Payment Authorization Form.COVID-19 test (processed at a pharmacy, doctor’s office or other location) Copay applies. Over the counter COVID-19 test kits. Covered 4 per member per month under your SilverScript prescription drug plan; maximum reimbursement of $12 per test kit if claim form is submitted to CVS Caremark. To purchase an at-home COVID test: Present your ...PEBTF-11 Retiree Declaration of Spouse Health Coverage for Retiree Members. PEBTF-14 Adult Dependent Coverage Form. PEBTF-36 Active Employer Benefit Verification Form for Active Members. PEBTF-36 Retiree Employer Benefit Verification Form for Retiree Members. PEBTF-40 Direct Payment Authorization Form. For more information about Aetna plans, go to PEBTF.AetnaMedicare.com or call Member Services at toll-free at 1-888-272-5651 (TTY: 711). Hours are 8 a.m. to 9 p.m. EST, Monday through Friday. The provider network may change at any time. You will receive notice when necessary. In case of emergency, you should call 911 or the local emergency hotline.PEBTF-11 Retiree Declaration of Spouse Health Coverage for Retiree Members. PEBTF-14 Adult Dependent Coverage Form. PEBTF-36 Active Employer Benefit Verification Form for Active Members. PEBTF-36 Retiree Employer Benefit Verification Form for Retiree Members. PEBTF-40 Direct Payment Authorization Form.The Summary of Benefits & Coverage (SBC) is an easy to understand summary of your benefits and coverage under each plan option – PPO, HMO and Bronze Plan. It is meant as a summary only. For more detailed benefit information, see the PEBTF Summary Plan Description (SPD). Bronze Plan (for employees working an average of 30 hours per week ...Please note: This PEBTF Specialty Pharmacy Drug List is a list of drugs that must be filled through the pharmacy benefit plan, unless noted under the drug class heading. Prospective Patients: Ready to get started? Enroll to get your medications from CVS Specialty.PEBTF - Benefit Comparison. Active Members. Benefit Information. Health Plan Choices by County. Open Enrollment Information. Benefit Comparison.PEBTF-6 Disabled Dependent Certification Form. PEBTF-11 Retiree Declaration of Spouse Health Coverage for Retiree Members. PEBTF-14 Adult Dependent Coverage Form. PEBTF-36 Retiree Employer Benefit Verification Form for Retiree Members. PEBTF-40 Direct Payment Authorization Form.Your physician should be the only one prescribing medications for you. If you should happen to receive a call similar to what was reported above, please contact the PEBTF’s Fraud area via the Contact the PEBTF section of www.pebtf.org or call the PEBTF at 1-800-522-7279.About Us. The Pennsylvania Employees Benefit Trust Fund (PEBTF), established in 1988, administers health care benefits to approximately 68,000 eligible Commonwealth of Pennsylvania employees and their dependents and 65,000 retirees and their dependents, as well as additional employer groups. The PEBTF is governed by a Board of Trustees ... CVS Caremark is a pharmacy benefit manager dedicated to helping each of our members on a path to better health by getting them the prescriptions they need when they need them.New users, enter registration key, PEBTF. Any questions or issues with online registration may be directed to Quest Diagnostics Customer Support by email at [email protected] or by calling 1-844-598-7966, Monday – Friday, 8 a.m. – 8 p.m. EST and Saturday 8:30 a.m. – 3 p.m. EST. ...Visit www.pebtf.org > 2023 Open Enrollment. View the webinar, plan benefits and compare plans in your county of residence. Call 1-800-522-7279 or email [email protected]. The representative can answer questions about your benefits, costs and how to change plans. Call 1-855-855-4238 to help locate network doctors. PEBTF Website Contact ...The PEBTF will not receive any information that would enable us to identify you or your individual results. Who is eligible to complete the wellness screening? For 2022, wellness screenings are available to employees only who are enrolled in PEBTF medical and/or prescription drug benefits.Pennsylvania Employees Benefit Trust Fund (PEBTF)—The PEBTF administers health care benefits for approximately 76,000 eligible commonwealth employees and their dependents. It is governed by a Board of Trustees comprised of both commonwealth and union representatives. PEBTF The CVS Caremark® Performance Drug List - Standard Control for PEBTF is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition.Enter your last name, date of birth and social security number. On the next screen, you will be able to Select your Payment – either pay in full or make a custom payment. Enter the …The Bronze Plan is offered to non-permanent employees working an average of 30 hours a week. It offers both an in-network and an out-of-network benefit. You are responsible for the first $9,450 of in-network covered medical and prescription drug expenses for single coverage or $18,900 for family coverage. This is known as the annual deductible. Mar 1, 2018 ... What are your initial thoughts on the Pennsylvania Employees Benefit Trust Fund (PEBTF)'s decision to cover bariatric surgery for state ...The weight management program is a covered preventive benefit for PEBTF employees and dependents over 18 years old with an Aetna health plan, who qualify through the health quiz. How do I sign up?PEBTF - Log In. Active Members. Benefit Information. Health Plan Choices by County. Open Enrollment Information. Benefit Comparison. Jan 1, 2013 · Medicare Part D Prescription Drug Plan. Three-Tier Copayment Plan - Generic, Preferred Drugs and Non-Preferred Drugs. Retail Prescriptions (up to 30-day supply) - Generic drug: $12; Preferred brand-name drug: $30, plus the cost difference between the brand and the generic, if one exists; Non-preferred brand-name drug: $60, plus the cost ... Access – PA Medicaid (must have medical insurance); Aetna (except PEBTF plans); AmeriHealth; AmeriHealth Administrators; Blue Cross Blue Shield; Cigna ...PENNSYLVANIA EMPLOYEES BENEFIT TRUST FUND MEDICAL PLAN PLAN DOCUMENT as amended and restated effective July 1, 2023Dennis Scanlon speaks with Kate Farley, Executive Director of the Pennsylvania Employees Benefit Trust Fund (PEBTF), to understand the work of the PEBTF and ...pebtf.com has been informing visitors about topics such as Health Insurance for Retirees and Universities. Join thousands of satisfied visitors who ...PEBTF‐2 Rev 01‐2021 EMPLOYEE ENROLLMENT/CHANGE FORM. Important: Changes made on this form will affect your medical, prescription drug, and supplemental benefits. SECTION 1: EMPLOYEE DATA. Social Security # Name (Last Plus Suffix, First, MI) Employee # Street Address Local Municipality (if address change) City/State/Zip County …PEBTF: Basic PPO Coverage for: Individual + Family | Plan Type: PPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be providedPEBTF-6 Disabled Dependent Certification Form. PEBTF-11 Retiree Declaration of Spouse Health Coverage for Retiree Members. PEBTF-14 Adult Dependent Coverage Form. PEBTF-36 Retiree Employer Benefit Verification Form for Retiree Members. PEBTF-40 Direct Payment Authorization Form.May 24, 2021 ... According to our records, you have a spouse enrolled on your Pennsylvania Employees Benefit. Trust Fund (PEBTF) health benefits.As an insurer for 74,000 Pennsylvania public employees and 64,000 retirees (as well as for some dependents), the Pennsylvania Employees.By using or accessing PEBTF.org (the 'Website'), you agree that you will use it for legitimate purposes only, and not for any illegal or unauthorized purpose, including without limitation, in violation of any intellectual property or privacy law. You agree not to attempt to interfere with the Website’s network or security features or to attempt to gain unauthorized access to …Enter your username and password in the Sign In box. You will see your demographic information populate. If you receive the message, Last 4 SSN is required, click on My Account in the upper right, and hit Save. That should take you directly to the Welcome screen where you can click on Get Started to register for a wellness screening.Retail Prescriptions (up to 30-day supply) - Generic drug: $15; Preferred brand-name drug: $40, plus the cost difference between the brand and the generic, if one exists.; Non-preferred brand-name drug: $80, plus the cost difference between the brand and the generic, if one exists. Retail Maintainence at CVS Pharmacy and Mail Order - Generic ... Active Choice PPO Aetna Member Services 1-800-991-9222 PEBTF Active Members 2021 Proprietary We’re just a phone call away Member Services – 1-800-991-9222, 8 a.m. to 6 p.m. Monday through Friday When you need help or information, Aetna Member Services is just a toll-free call away.The PEBTF Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition.Summary. In-network deductibles differ between the Choice PPO and the Basic PPO: - Choice PPO – Annual in-network deductible is $400 single/$800 family. - Basic PPO – Annual in-network deductible is $1,500 single/$3,000 family. PPO option covers medical services as set forth in the PEBTF Plan Document. PPO option offers both an in ... PEBTF - Open Enrollment. Active Members. Benefit Information. Health Plan Choices by County. Open Enrollment Information. Benefit Comparison. NVA Offers Active Members the EyeEssentialSM Plan. Your National Vision Administrators (NVA) vision benefit includes coverage for an annual eye exam. Reimbursement for lenses or contact lenses is provided every year. Reimbursement for frames is provided every two years. There may be times when you would like to purchase another pair of glasses ...Dec 31, 2014 ... Wellness screenings are offered to employees and covered spouses/ domestic partners enrolled in PEBTF medical and/or supplemental benefits. The ...PEBTF-11 Retiree Declaration of Spouse Health Coverage for Retiree Members. PEBTF-14 Adult Dependent Coverage Form. PEBTF-36 Active Employer Benefit Verification Form for Active Members. PEBTF-36 Retiree Employer Benefit Verification Form for Retiree Members. PEBTF-40 Direct Payment Authorization Form.Services or supplies provided by a Hospital or Other Facility Provider, or by a Physician or Other Professional Provider that the Claims Payor - PPO, HMO, or Mental Health and Substance Abuse Plan Provider, or the PEBTF - determines are: (a) appropriate for the symptoms and diagnosis or treatment of the Member's condition, Illness, disease, or ...PEBTF - Benefit Comparison. Active Members. Benefit Information. Health Plan Choices by County. Open Enrollment Information. Benefit Comparison. The PEBTF Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition.These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site.Luzerne County. Basic PPO. Choice PPO. Geisinger Custom HMO Northeastern PA. Bronze Plan. Supplemental Benefits Only. PEBTF - Open Enrollment. Active Members. Benefit Information. Health Plan Choices by County. Open Enrollment Information. Benefit Comparison. The Summary Plan Description (SPD) summarizes the main terms of the benefits provided to Members and their eligible Dependents under the Pennsylvania Employees Benefit Trust Fund Plan. This SPD replaces all previous Summary Plan Descriptions for the Plan. The SPD has been prepared to help you understand the main features of the health benefit ...PEBTF The CVS Caremark® Performance Drug List - Standard Control for PEBTF is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition.Pennsylvania Electronic Benefit Transfer (EBT) Welcome to the PA EBT website! EBT stands for Electronic Benefits Transfer. If you have been approved to receive benefits from one of the programs listed below, you can use this website to view your benefit balance (s). Food Assistance (formerly Food Stamp) - Supplement Nutrition Assistance Program .... Mail Order and CVS Pharmacy – up to a 90 Day Supply. YourThe Bronze Plan is offered by Aetna and is administer Your physician should be the only one prescribing medications for you. If you should happen to receive a call similar to what was reported above, please contact the PEBTF’s Fraud area via the Contact the PEBTF section of www.pebtf.org or call the PEBTF at 1-800-522-7279.Summary. In-network deductibles differ between the Choice PPO and the Basic PPO. – Choice PPO – Annual in-network deductible is $400 single/$800 family. – Basic PPO – Annual in-network deductible is $1,500 single/$3,000 family. PPO option covers medical services as set forth in the PEBTF Plan Document. PPO option offers both an in ... deferred contribution debt to the PEBTF and th * For more information about limitations and exceptions, see the SPD or plan document at www.pebtf.org. Page 4 of 6 Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) Habilitation services Pennsylvania Employees Benefit Trust Fund 150 South 43rd Street, Suit...
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