State PEBB update 6.27.25 – Updates on our Health Care
We have some important information about changes to health coverage for PEBB members and our successful work controlling out of pocket increases. The PEBB board was able to maintain the current plans for 2026 without any increases to deductibles or co-pays, (which would create a hardship for workers and their families).
Because of your actions, our work made a difference for the 2026 plan year. We were able to push back on the out-of-control costs of health care caused by for-profit systems that prioritize making money over providing necessary, affordable health care. We will not let up on reminding management that keeping the 1% premium share for lower cost plans is our priority, and we will continue to fight for that for the 2027 plan year.
As we bargain our contracts, we continue to be very clear with management: our workers deserve and expect quality, affordable health coverage. It’s a benefit important to state workers, and a critical part of their total compensation package.
Workers standing up for what’s right shows our power: more than 1500 members called out Providence, Moda and Kaiser for charging more than necessary for our care.
The changes to your plans are below:
HEM (Health Engagement Model) is Ending
Starting in 2026, the HEM program will no longer be required. That means:
- You will not need to fill out a Health Risk Assessment or complete two “health actions” to get a lower deductible on your medical plan.
- The taxed $17.50 monthly payment current HEM participants receive in their pay will end in 2026.
- Ending HEM is expected to save over $10 million, which will help protect your health benefits.
New Voluntary Program: Garner
The PEBB board has added a new optional program called Garner.
- This program helps Providence and Moda members find top-rated doctors and health providers.
- If you choose these top providers, you could get money back for some of your out-of-pocket costs.
- Garner will reimburse up to $1,000 for individuals and $2,000 for families each year.
- The program is expected to save about $16 million. We hope it helps members find great care while keeping costs down.
90-Day Prescription Requirement
Providence and Moda members who take regular (ongoing) medications will now need to get them in 90-day supplies:
- These can be filled by mail or at local participating pharmacies.
- This change lowers your cost because a 90-day supply co-pay is only 2.5 times the co-pay of a 30-day supply (instead of 3 times).
- This update is expected to save about $2.6 million.
Moda Nurse Line Removed
- Moda is removing their nurse line.
- CirrusMD 24/7 telehealth line already provides the same kind of help.
- Removing the duplicate service will save about $200,000.
Moda Aetna PPO Network Expanded
- Moda’s Aetna PPO network will now be a full national network, not just for travel. This means you can get care anywhere in the U.S. outside of Moda’s regular service area with no extra cost.
Moda has added new and improved behavioral health support:
- A new provider called Gemiini delivers evidence-based therapy.
- Moda Behavioral Health Champions are Moda employees who have been trained to help members find resources and schedule appointments.
- These improvements were made without raising costs, based on feedback from members and the PEBB board.
Delta Dental has added new services, including:
- Sinus lifts and bone grafting for dental implants.
- Conscious sedation for people with intellectual or developmental disabilities.
- These changes come with only a small cost increase.
Kaiser Dental Orthodontics Benefit Improved
- Kaiser Dental increased the orthodontics benefit to a $2,500 lifetime maximum on the full-time plan.
- This change costs an additional $165,000, which is a discounted increase.
GLP-1 Drugs for Weight Loss
The board is still discussing GLP-1 drugs (like Zepbound, and Wegovy) for weight loss. Although these drugs are approved for some conditions, right now, PEBB plans do not cover them for weight loss, except in very rare cases. Drug companies continue to charge very high prices, making it hard to include them in our plans and keep premium costs down. Because of rising health care costs for 2026, the board couldn’t add coverage for these drugs yet. However, the board will review all medical and pharmacy plans for 2027 and will keep working on ways to manage costs—with the goal of possibly adding GLP-1 coverage in the future.
Our Union remains committed to advocating for our health benefits both at the bargaining table and at the PEBB board because you have made it clear that your health care is a priority. It’s critical we keep lifting our voice around this priority as we know quality, affordable coverage will continue to be a long-term struggle.