Office of Human Resources

If you or your spouse did not complete the HEM requirements, the HEM monthly surcharge will be deducted from your October, November and December paychecks.  The monthly surcharge amount will be:

• $17.50 if either you or your enrolled spouse/partner did not complete the two online e-lessons
• $35.00 if both you and your enrolled spouse/partner did not complete the two online e-lessons

IF YOU ARE CHARGED THE SURCHARGE IN ERROR you will need to complete the appeal process to have PEBB remove the surcharge.  If you need assistance in identifying if PEBB identified you or your enrolled spouse/partner as not completing the e-lessons you can contact PEBB at 503.373.1654 or email Employee Benefits at employee.benefits@oregonstate.edu.

APPEAL PROCESS

Complete the Appeal form and attach a copy of the e-lesson certificate/confirmation from your plan’s website showing you and/or your enrolled spouse/partner completed the requirement as scheduled.

E-lesson Certificates/Confirmation:

• Providence members log in to your myProvidence account (https://myprovidence.healthtrioconnect.com/app/index.page). Click on the “Self-Help” quick link under “My Health” located on the left hand side of the page. Print the certificates of the e-lessons you completed.
• Kaiser members sign on at https://healthy.kaiserpermanente.org/health/care/signon, navigate to your Kaiser Healthy Lifestyle Program page.  Take a screen shot and print this page.

Return form and confirmation to PEBB at:

• Fax - 503-373-1654
• Mail - PEBB, 1225 Ferry St SE, Ste B, Salem, OR 97301
• Email: inquiries.pebb@state.or.us.

Additional information can be found on the PEBB website

If you have any questions, please contact Employee Benefits by email at employee.benefits@oregonstate.edu or by phone at 541.737.2805.