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Oregon Bulletin

August 1, 2013

Oregon Health Authority, Oregon Educators Benefit Board, Chapter 111

Rule Caption: Amendments to this rule align rule language with current OEBB processes

Adm. Order No.: OEBB 5-2013

Filed with Sec. of State: 7-12-2013

Certified to be Effective: 7-12-13

Notice Publication Date: 6-1-2013

Rules Amended: 111-065-0010, 111-065-0015, 111-065-0025, 111-065-0030

Rules Repealed: 111-065-0010(T), 111-065-0015(T), 111-065-0025(T), 111-065-0030(T)

Subject: Amendments to OAR 111-065-0010, 111-065-0015, 111-065-0025 and 111-065-0030 align rule language with current OEBB processes related to payment information for early retirees who self-pay their insurance premiums directly to OEBB.

Rules Coordinator: April Kelly—(503) 378-6588

111-065-0010

OEBB Early Retiree Invoicing

(1) OEBB will enroll the Early Retiree after OEBB has received the enrollment form and one of the following is completed:

(a) The required ACH Authorization for a recurring Direct Debit Payment is received from the early retiree to initiate the setup of automated payments via ACH; or

(b) An Exception Request Form is received from the early retiree and reviewed and approved by OEBB.

(2) OEBB will send payment invoices to early retirees that will provide notification of the amount and payment due date or the date the automatic checking deduction will occur. OEBB will send invoices on or around the 15th of the month with payment due on the 2nd business day of the following month.

(3) Advance payments may be made only within the same Plan Year. However, any remaining balances will be carried into the next Plan Year.

Stats. Auth.: 243.860 - 243.886

Stats. Implemented: ORS 243.864(1)(a)

Hist.: OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12; OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. & cert. ef. 7-12-13

111-065-0015

Early Retiree Payment Methods and Due Dates

(1) Premium payments will be made through Direct Debit via ACH on the 2nd business day of the month unless otherwise prior authorized by designated OEBB staff.

(2) As necessary, or upon written request of a participating Early Retiree, OEBB staff will review and determine if an alternative withdrawal date is warranted to avoid future payments being returned for Non-sufficient Funds (NSF) on a recurring basis.

(3) OEBB will accept payment from early retirees by methods other than Direct Debit when specific exceptions apply:

(a) The individual does not have an account with a financial institution within the United States;

(b) The individual’s special circumstances, which OEBB will review on a case by case basis.

(4) A request for exception must be made in writing and include the reason why or special circumstance that would not allow the member to submit payment via Direct Debit.

(5) OEBB will review the request for exception, determine whether to allow or deny the exception, and notify the requesting party of its decision within 21 days of receipt of the request.

(6) Notwithstanding OAR 111-065-0010, all premium payments must be received on or before the 2nd business day of the month for the current month’s health care coverage. All payments will be subject to this due date.

(7) If the Early Retiree has a checking account, but submits a written letter declining to use the Direct Debit payment method, a $35.00 processing fee shall be applied to the Early Retiree’s monthly premium.

Stats. Auth.: 243.860 - 243.886

Stats. Implemented: ORS 243.864(1)(a)

Hist.: OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12; OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. & cert. ef. 7-12-13

111-065-0025

Early Retiree Underpayments

(1) Premiums must be paid in full on or before the 2nd business day of the month, unless otherwise pre-approved by OEBB under OAR 111-065-0015(2).

(2)(a) Early retirees will be notified if their coverage was terminated due to the premium not being paid in full on the specified due date, including payments returned by the bank for Non-Sufficient Funds (NSF), closed bank accounts, and frozen accounts.

(b) A check or ACH transaction that is returned for NSF, closed bank account, or frozen account is considered non-payment of premiums.

Stats. Auth.: 243.860 - 243.886

Stats. Implemented: ORS 243.864(1)(a)

Hist.: OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12; OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. & cert. ef. 7-12-13

111-065-0030

Termination

(1) OEBB shall not be responsible for any unpaid portion of premiums for coverage and will terminate the early retiree and dependent coverage for non-payment or underpayment of premiums due.

(2) OEBB coverage will be terminated under the following circumstances:

(a) Premiums are not paid in full by the due date. If the payment is not received in full on the 2nd business day of the month unless otherwise preapproved by OEBB under OAR 111-065-0015(2), the early retiree’s coverage will be terminated on the last day of the month in which a full premium payment was received; or

(b) As referenced in 111-050-0015.

Stats. Auth.: 243.860 - 243.886

Stats. Implemented: ORS 243.864(1)(a)

Hist.: OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12; OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. & cert. ef. 7-12-13


Rule Caption: Amendments made to this rule to update and clarify definitions used by OEBB

Adm. Order No.: OEBB 6-2013

Filed with Sec. of State: 7-12-2013

Certified to be Effective: 7-12-13

Notice Publication Date: 6-1-2013

Rules Amended: 111-010-0015

Subject: Amendments made to this rule are to update and clarify definitions used by OEBB.

Rules Coordinator: April Kelly—(503) 378-6588

111-010-0015

Definitions

Unless the context indicates otherwise, as used in OEBB administrative rules, the following definitions will apply:

(1) “Actuarial value” means the expected financial value for the average member of a particular benefit plan.

(2) “Adverse Benefit Determination” means a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part), for a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on but not limited to:

(a) A determination of a member’s eligibility to participate in the plan;

(b) A determination that the benefit is not a covered benefit; or

(c) A rescission of coverage, whether or not, in connection with rescission, there is an adverse effect on any particular benefit.

(3) “Affidavit of Domestic Partnership” means a document that attests the eligible employee and one other eligible individual meet the criteria in section (15)(b).

(4) “Benefit plan” includes, but is not limited to, insurance or other benefits including:

(a) Medical (including non-integrated health reimbursement arrangements (HRAs));

(b) Dental;

(c) Vision;

(d) Life, disability and accidental death;

(e) Long term care;

(f) Employee Assistance Program Plans;

(g) Supplemental medical, dental and vision coverages (including Integrated General Purpose and Integrated Post-Deductible health reimbursement arrangements (HRAs); and Limited Purpose, Post-Separation/Retiree, and Premium Only health reimbursement arrangements (HRAs));

(h) Any other remedial care recognized by state law, and related services and supplies;

(i) Comparable benefits for employees who rely on spiritual means of healing; and

(j) Self-insurance programs managed by the Board.

(5) “Benefits” means goods and services provided under Benefit Plans.

(6) “Board” means the ten-member board established in the Department of Administrative Services as the Oregon Educators Benefit Board under chapter 00007, Oregon Laws 2007.

(7) “Child” means and includes the following:

(a) An eligible employee’s, spouse’s, or domestic partner’s biological son or daughter; adopted child; child placed for adoption; or legally placed child, who is 25 or younger on the first day of the month. An eligible employee must provide the required custody or legal documents to their Educational Entity showing proof of adoption, legal guardianship or other court order if enrolling a child for whom the employee, spouse, or domestic partner is not the biological parent. Grandchildren are only eligible when the eligible employee is the legal guardian or adoptive parent of the grandchild.

(b) A person who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. There is no age limit for a dependent child who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. When the dependent child is 26 years of age or older all the following requirements must be met:

(A) The disability must have existed before attaining age 26.

(B) The employee must provide evidence to the Educational Entity or OEBB that (1) the person had health plan coverage, group or individual, prior to attaining age 26, and (2) health plan coverage continued without a gap until the OEBB health plan effective date.

(C) The person’s attending physician must submit documentation of the disability to the eligible employee’s OEBB health insurance plan for review and approval. If the person receives health plan approval, the health plan may review the person’s health status at any time to determine continued OEBB coverage eligibility.

(D) The person must not have terminated from OEBB health plan coverage after attaining the age of 26.

(c) Eligibility for coverage under this rule includes people who may not be dependents under federal or state tax law and may require an Educational Entity to adjust an Eligible Employee’s income based on the imputed value of the benefit.

(8) “Comparable cost (Medical, Dental and Vision)” means that the total cost to a district for enrollment in OEBB plans comparable in design to the district’s plan(s) do not exceed the total cost to a district for enrollment in the district’s plan(s) using the rate(s) in effect or proposed for the benefit plan year.

(9) “Comparable cost (Basic and Optional Life Insurance, Accidental Death & Dismemberment, and Short and Long Term Disability)” means that the premium rates of an OEBB plan design option do not exceed the average, aggregate premium rates of a district’s pre-OEBB plan design in effect the year prior to implementation.

(10) “Comparable plan design (Medical, Dental and Vision)” means that the actuarial values of two plan designs are within 2.5 percent higher or lower of each other.

(11) “Comparable plan design (Basic and Optional Life Insurance and Accidental Death & Dismemberment)” means that 90 percent of district employees can obtain a maximum benefit through an OEBB plan design that is within $2,500 of the maximum benefit obtained through a pre-OEBB plan design in effect the year prior to implementation.

(12) “Comparable plan design (Short and Long Term Disability)” means 90 percent of the district employees can obtain the same elimination period, percentage of covered compensation, definition of covered compensation, coverage period duration, and maximum payment per benefit period through an OEBB plan design as through a pre-OEBB plan design in effect the year prior to implementation.

(13) “Dependent” means and includes the eligible employee’s spouse or domestic partner, or child as defined by OAR 111-010-0010(7), unless otherwise defined in another OEBB rule.

(14) “Documented district policies” means Educational Entities’ policies and practices that apply to an employee group and are submitted to the Oregon Educators Benefit Board during the plan selection process. Educational Entities’ policies and practices must be identified and submitted with the applicable employee group plan selections.

(15) “Eligible Domestic partner,” unless otherwise defined by a collective bargaining agreement or documented district policy in effect on January 31, 2008, means and includes the following:

(a) An unmarried individual of the same sex who has entered into a “Declaration of Domestic Partnership” with the eligible employee that is recognized under Oregon law; or

(b) An unmarried individual of the same or opposite sex who has entered into a partnership that meets the following criteria:

(A) Both are at least 18 years of age;

(B) Are responsible for each other’s welfare and are each other’s sole domestic partners;

(C) Are not married to anyone and have not had a spouse or another domestic partner within the prior six months. If previously married, the six-month period starts on the final date of divorce;

(D) Share a close personal relationship and are not related by blood closer than would bar marriage in the State of Oregon;

(E) Have jointly shared the same regular and permanent residence for at least six months immediately preceding the date the Affidavit of Domestic Partnership is signed and submitted to the Educational Entity; and

(F) Are jointly financially responsible for basic living expenses defined as the cost of food, shelter and any other expenses of maintaining a household. Financial information must be provided if requested.

(G) The eligible employee and domestic partner must jointly complete and submit to the Educational Entity an Affidavit of Domestic Partnership form, within five business days of the electronic enrollment date or the date the Educational Entity received the enrollment/change form. If the affidavit is not received, coverage will terminate for the domestic partner retroactive to the effective date.

(c) The Eligible Employee must notify the Educational Entity within 31 days of meeting all criteria as defined in 111-010-0015 (15)(b) or obtaining the “Declaration of Domestic Partnership” which is recognized under Oregon law.

(d) Educational Entities’ must calculate and apply applicable imputed value tax for domestic partners covered under OEBB benefit plans.

(16) “Educational Entity” means public school districts (K–12), education service districts (ESDs), community colleges and public charter schools participating in OEBB.

(17) “Eligible employee” means and includes an employee of an Educational Entity who is actively working or on paid or unpaid leave that is recognized by federal or state law, and:

(a) Is employed in a half time or greater position or is in a job-sharing position; or

(b) Meets the definition of an eligible employee under a separate OEBB rule or under a collective bargaining agreement or documented district policy in effect on January 31, 2008; or

(c) Is an employee of a community college who is covered under a collectively bargained contract and has worked a class load of between 25 percent and 49 percent for a minimum period of two years and is expected to continue to work a class load of at least 25 percent. Coverage is limited to medical to include Kaiser Medical Plan 2 (where available), Moda Health Plan E, Moda Health Plan G, or Moda Health Plan H. Moda Health Plan H can only be elected if the eligible employee is eligible for and actively contributing to a Health Savings Account (HSA). The tiered rate structure will apply to all medical plans.

(18) “ Eligible Early Retiree” means and includes a previously Eligible Employee who is:

(a) Not Medicare-eligible; or

(b) Under 65 years old; and

(A) Receiving a service or disability retirement allowance or pension under the Public Employees Retirement System (PERS) or under any other retirement or disability benefit plan or system offered by an OEBB participating organization for its employees;

(B) Eligible to receive a service retirement allowance under PERS and has reached earliest retirement age under ORS Chapter 238;

(C) Eligible to receive a pension under ORS 238A.100 to 238A.245 and has reached earliest retirement age as described in ORS 238A.165; or

(D) Eligible to receive a service retirement allowance or pension under another retirement benefit plan or system offered by an OEBB participating organization and has reached earliest retirement age under the plan or system.

(19) “Employee Group” means employees and early retirees of a similar employment type, for example administrative, represented classified, non-represented classified, confidential, represented licensed, or non-represented licensed, within an Educational Entity. If one or more collective bargaining unit exists within an employee group, each unit will be considered a separate employee group.

(20) “Flexible benefit plan” includes plans that allow contributions on a tax-favored basis including health savings accounts.

(21) “Health Reimbursement Arrangement (HRA)” means an account established and funded solely by the employer that can be used to pay for qualified health care expenses for eligible employees and their spouses and federal tax dependents, up to a maximum dollar amount for a coverage period, and any unused portion of the maximum dollar amount at the end of a coverage period is carried forward to increase the maximum reimbursement amount in subsequent coverage periods. This definition should be interpreted to comply with the guidelines established by the IRS for treatment of HRAs on a tax-favored basis in IRS Publication 969 and IRS Notice 2002-45. HRA includes, but is not limited to, the following:

(a) “Integrated General Purpose HRA” is an HRA that allows participants to be reimbursed for all IRS qualified expenses and is available only to eligible employees who are enrolled in an OEBB medical plan as the primary subscriber.

(b) “Integrated Post-Deductible HRA” is an HRA that allows participants to be reimbursed for expenses up to a certain amount, but only after the participants have met the annual deductible on an OEBB medical plan in which the employee participant is enrolled as the primary subscriber.

(c) “Limited Purpose HRA” is an HRA that allows participants to be reimbursed for only standard dental, vision, and orthodontia expenses and does not require the employee participant to be enrolled in an OEBB medical plan as the primary subscriber, or as a dependent.

(d) “Non-integrated HRA” is an HRA that allows participants to be reimbursed for all IRS qualified expenses when the employee participant is not enrolled in an OEBB medical plan as the primary subscriber.

(e) “Post-Separation/Retiree HRA” is an HRA that allows participants to be reimbursed for qualified expenses only after the employee separates/retires and does not require the employee participant to be enrolled in an OEBB medical plan as the primary subscriber, or as a dependent.

(f) “Premium Only HRA” is an HRA that allows participants to be reimbursed only for insurance premiums paid on an after tax basis, where the employee participant has no ability to pay the premium on a pre-tax basis and the HRA does not require the employee participant to be enrolled in an OEBB medical plan as the primary subscriber, or as a dependent.

(22) “Health Savings Account (HSA)” means a tax-exempt trust or custodial account that is set up with a qualified HSA trustee to pay or reimburse certain incurred medical expenses, as defined in 26 U.S.C. ¦ 223(d) and IRS Publication 969.

(23) “High Deductible Health Plan (HDHP)” means a health plan that meets the criteria for a “high deductible health plan” as outlined in 26 U.S.C. ¦ 223(c)(2). Enrollment in an HDHP is one of the requirements that must be met in order to qualify to contribute to a health savings account (HSA).

(24) “Members” means and includes the following:

(a) “Eligible employee” as defined by OAR 111-010-0015(17).

(b) “Child” as defined by OAR 111-010-0015(7).

(c) “Domestic Partner” as defined by OAR 111-010-0015(15).

(d) “Spouse” as defined by OAR 111-010-0015(30).

(25) “Non-subject District” means a community college not yet participating in benefit plans provided by the Oregon Educators Benefit Board, or a charter school whose employees are not considered employees of a school district.

(26) “Oregon Educators Benefit Board or OEBB” means the program created under chapter 00007, Oregon Laws 2007.

(27) “OEBB participating organization” means a Subject District, Non-subject District, or Provisional Non-subject District that participates in benefit plans provided by the Oregon Educators Benefit Board (OEBB).

(28) “Provisional Non-subject District” means a common school district, a union high school district, or an education service district that:

(a) Was self-insured on December 31, 2006;

(b) Had an independent health insurance trust established and functioning on December 31, 2006; or

(c) Can provide comparable plan designs at a comparable cost as defined by sections (8) and (10) of this Rule.

(29) “Qualified Status Change (QSC)” means a change in family or work status that allows limited mid-year changes to benefit plans consistent with the individual event.

(30) “Spouse” means a person of the opposite sex who is a husband or wife. Except as provided in Oregon Constitution Article XV, Section 5a, a relationship recognized as a marriage in another state will be recognized in Oregon even though such a relationship would not be a marriage if the same facts had been relied upon to create a marriage in Oregon. The definition of spouse does not include a former spouse and a former spouse does not qualify as a dependent.

(31) “Subject District” means a common school district, a union high school district, or an education service district that:

(a) Did not self-insure on January 1, 2007;

(b) Did not have a health trust in effect on January 1, 2007; or

(c) Does not provide comparable plan designs at a comparable cost as defined by sections (8) and (10) of this rule.

Stat. Auth.: ORS 243.860 – 243.886

Stats. Implemented: ORS 243.864(1)(a)

Hist.: OEBB 2-2007(Temp), f. & cert. ef. 9-21-07 thru 3-18-08; OEBB 2-2008, f. & cert. ef. 1-4-08; OEBB 10-2008(Temp), f. & cert. ef. 8-13-08 thru 2-6-09; OEBB 1-2009, f. & cert. ef. 1-30-09; OEBB 5-2009(Temp), f. & cert. ef. 3-10-09 thru 9-4-09; OEBB 8-2009, f. & cert. ef. 5-1-09; OEBB 12-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10; OEBB 19-2009, f. & cert. ef. 12-17-09; OEBB 7-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11; OEBB 11-2010(Temp), f. 9-30-10, cert. ef. 10-1-10 thru 1-29-11; OEBB 1-2011, f. & cert. ef. 2-11-11; OEBB 6-2011(Temp), f. & cert. ef. 2-15-11 thru 8-13-11; OEBB 14-2011, f. & cert. ef. 8-2-11; OEBB 15-2011(Temp), f. & cert. ef. 8-2-11 thru 1-28-12; OEBB 16-2011(Temp), f. 9-30-11, cert. ef. 10-1-11 thru 1-28-12; OEBB 20-2011, f. 10-13-11, cert. ef. 10-14-11; OEBB 22-2011, f. & cert. ef. 12-14-11; OEBB 13-2012, f. & cert. ef. 12-19-12; OEBB 6-2013, f. & cert. ef. 7-12-13


Rule Caption: Amendments to this rule update plans available, open enrollment period and premium payments

Adm. Order No.: OEBB 7-2013(Temp)

Filed with Sec. of State: 7-12-2013

Certified to be Effective: 7-12-13 thru 1-7-14

Notice Publication Date:

Rules Amended: 111-070-0005, 111-070-0015, 111-070-0050

Subject: Amendments to 111-070-0005 update plans available to this group. Amendments to 111-070-0015 extend the open enrollment timeframe and amendments to 111-070-0050 add a processing fee if the member declines the use of the electronic funds transfer and has a checking account.

Rules Coordinator: April Kelly—(503) 378-6588

111-070-0005

Plan Selections

HB 2557 eligible members will use the tiered rate structure and may elect to enroll in Moda Health Plan E, Moda Health Plan G, or Moda Health Plan H. Moda Health Plan H can only be elected if the HB 2557 member qualifies for and contributes to Health Savings Account (HSA).

Stat. Auth.: ORS 243.860 - 243.886

Stats. Implemented 243.864(1)(a)

Hist.: OEBB 4-2010, f. & cert. ef. 3-15-10; OEBB 7-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

111-070-0015

Enrollment

(1) OEBB will directly provide HB 2557 eligible members notice of their eligibility, the open enrollment schedule and instructions for completing the required enrollment information prior to the beginning of the open enrollment period.

(2) HB 2557 eligible members and eligible dependents may enroll in a medical plan as specified in 111-070-0005 when one of the following occurs:

(a) During the annual open enrollment period (August 15 through September 25);

(A) Required enrollment information may be submitted by the member to the OEBB office prior to the beginning of the open enrollment period;

(B) All required enrollment information must be received from the member by OEBB by close of business on September 25;

(C) Required enrollment information not received from the member on or before the end of the open enrollment period will be considered a declination of coverage for the Plan Year;

(D) Coverage selected will be effective at the beginning of the new Plan Year (October 1) for HB 2557 eligible member and dependent(s) who have submitted the required enrollment information by the submission deadline; or

(b) Following confirmation that an individual not initially identified as eligible for benefits is eligible for benefits:

(A) All required enrollment information must be received from the member by OEBB by close of business on the date specified in the written eligibility notice sent to the HB 2557 eligible member. Failure to meet the due date will be considered a declination of coverage for the Plan Year;

(B) Coverage selected will be effective the first day of the month following eligibility confirmation and receipt of the required enrollment information.

Stat. Auth.: ORS 243.860 - 243.886

Stats. Implemented 243.864(1)(a)

Hist.: OEBB 4-2010, f. & cert. ef. 3-15-10; OEBB 7-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

111-070-0050

Premium Payment

(1) HB 2557 Eligible Member Payment Methods and Due Dates:

(a) HB 2557 eligible members will submit payment to OEBB for benefits by electronic funds transfer (EFT).

(b) OEBB may grant an exception from the requirement in section (1) to pay by EFT if the HB 2557 eligible member demonstrates their financial institution cannot accommodate an EFT transfer, or the member does not maintain an account at a financial institution.

(c) Notwithstanding section (2), the electronic transfer of funds will occur on the 25th day of the month prior to the next month’s health care coverage. All payments will be subject to this due date.

(2) If the HB 2557 member has a checking account, but submits a written letter declining to use the electronic funds transfer payment method, a $35.00 processing fee shall be applied to the HB 2557 member’s monthly premium.

(3) HB 2557 Eligible Member Invoicing:

(a) OEBB will enroll a new HB 2557 eligible member after one of the following is completed:

(A) The required ACH payment agreement for electronic transfer of funds is received from the member, processed and set-up with their financial institution; or

(B) The Exception Request Form is received from the member, reviewed and approved;

(b) OEBB will mail payment reminders to HB 2557 eligible members to provide notification of the amount and date the automatic checking deduction will occur.

(c)(A) If the payment is not received in full by the 25th calendar day of the month, the member’s coverage will be terminated on the last day of the month in which a full premium payment was received. All premium payments must be paid in full before payment to the carrier will be made.

(B) OEBB shall not be responsible for any unpaid portion of premiums for coverage and will terminate the HB 2557 eligible member and dependent coverage for non-payment or underpayment of premiums due.

(4) HB 2557 Eligible Member Overpayments:

(a) OEBB will mail notification of overpayments to the HB 2557 eligible member. This written notice shall inform the member of the amount overpaid and a description of the overpayment.

(b)(A) OEBB will automatically apply any overpayments to the next month’s premium due. The member may complete a Request for Reimbursement form if a refund of an overpayment is desired. However, the member may be responsible for processing fees associated with refunds less than $100.

(B) Remaining balances on coverage that has ended will be refunded in full.

(5) HB 2557 Eligible Member Underpayments:

(a) Premiums that are not paid in full by the 25th calendar day of the month prior to the coverage effective month will result in the eligible member’s and dependent’s coverage being terminated at the end of the last month for which premiums were paid in full.

(b)(A) HB 2557 eligible members will be notified if their coverage was terminated due to the premium not being paid in full, including payments returned by the bank for Non-Sufficient Funds (NSF).

(B) A check or ACH transaction that is returned for NSF is considered non-payment of premiums.

(c) Coverage terminated due to non-payment or underpayment cannot be reinstated until a following Plan Year in which a person is deemed a HB 2557 eligible member.

Stat. Auth.: ORS 243.860 - 243.886

Stats. Implemented 243.864(1)(a)

Hist.: OEBB 4-2010, f. & cert. ef. 3-15-10; OEBB 7-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14


Rule Caption: Removing development of benefit plans from rule and updating new plans and plan requirements

Adm. Order No.: OEBB 8-2013(Temp)

Filed with Sec. of State: 7-12-2013

Certified to be Effective: 7-12-13 thru 1-7-14

Notice Publication Date:

Rules Amended: 111-030-0010, 111-030-0046

Rules Suspended: 111-030-0001, 111-030-0005, 111-030-0020, 111-030-0025

Subject: Removing development of benefit plans from rule, as this language applied to the OEBB benefit program when the program was in development. Benefit plan selection no longer applies since the Board made the decision to no longer restrict plans. Amendments made to plan selection criteria and the Health Savings Account section update new plans and plan requirements

Rules Coordinator: April Kelly—(503) 378-6588

111-030-0001

Development of OEBB Medical, Pharmaceutical, Dental and Vision Plan Designs

(1) As used in this section, “comparable plan design” means the actuarial value of the OEBB plan design is within 2.5 percent (higher or lower) than a current district plan.

(2) OEBB will develop plan designs for medical, pharmaceutical, dental and vision benefit plans that are comparable to the plan designs provided by Subject Districts prior to entering the OEBB.

(3) OEBB will develop comparable plan designs by:

(a) Collecting the medical, pharmaceutical, dental and vision plan designs provided by Subject Districts that will be entering OEBB on October 1, 2008, October 1, 2009, and October 1, 2010.

(4) Following initial implementation of the OEBB benefit plans on October 1, 2008, OEBB will re-evaluate its plan designs for the October 1, 2009, and October 1, 2010, plan year start dates to determine if the Subject District plan design was included in the comparability assessment performed for plan design development in 2008.

(a) If the Subject District plan design was considered during the initial plan design process no further analysis will be conducted.

(b) If the plan design was not considered during the initial plan design process OEBB will:

(A) Calculate the actuarial value for the Subject District plan design using an industry-standard actuarial model; and

(B) Identify whether a current OEBB plan design has an actuarial value 2.5 percent higher or lower than the Subject District plan design.

(5)(a) If none of the OEBB plan designs has an actuarial value within 2.5 percent higher or lower than the Subject District plan and the Subject District has 100 or more enrollees, OEBB will develop and implement a plan design with an actuarial value of 2.5 percent higher or lower than the Subject District’s plan unless;

(b) There is an OEBB plan that has an actuarial value that is more than 2.5 percent higher than the Subject District’s plan and it is determined that OEBB can still meet the comparable cost requirement.

Stat. Auth: ORS 243.860 - 243.886

Stats. Implemented: ORS 243.864

Hist.: OEBB 8-2008, f. 6-25-08, cert. ef. 6-26-08; OEBB 13-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10; OEBB 20-2009, f. & cert. ef. 12-17-09; Suspended by OEBB 8-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

111-030-0005

Benefit Plans Selection through OEBB

(1) As used in this section, “benefit plans” includes medical, dental, pharmaceutical, dental, basic life and accidental death and dismemberment, optional life and AD&D, short and long term disability, long term care and employee assistance program.

(2) OEBB will offer a range of benefit plans that provide the flexibility to choose between a number of high quality plan options.

(3) The process for the 2012-13 Plan Year benefit plans selection includes:

(a) OEBB releases preliminary designs and costs for all benefit plan options to Educational Entities no later than 45 days prior to final selection date. The total number offered may vary each year.

(b) OEBB will pre-populate the MyOEBB Educational Entity Plan Management section with all medical, dental and vision plans available in the Educational Entity’s service area.

(c) Educational Entities may choose to, or allow each Employee Group to choose to, de-select benefit plan options to be offered to each Employee Group unless otherwise specified in an OEBB administrative rule.

(d) Final benefit plan selections for each Employee Group must be submitted through the MyOEBB Educational Entity plan management section or an approved electronic format to OEBB no later than June 15 each year for the following plan year. Plan selections must be authorized by an official with the Educational Entity.

Stat. Auth: ORS 243.860–243.886

Stats. Implemented: ORS 243.864(1)(a)

Hist.: OEBB 8-2008, f. 6-25-08, cert. ef. 6-26-08; OEBB 13-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10; OEBB 20-2009, f. & cert. ef. 12-17-09; OEBB 8-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11; OEBB 2-2011, f. & cert. ef. 2-11-11; OEBB 3-2012(Temp), f. & cert .ef. 4-20-12 thru 10-16-12; OEBB 8-2012, f. & cert. ef. 10-9-12; Suspended by OEBB 8-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

111-030-0010

Medical, Pharmaceutical, Dental and Vision Plan Selection Criteria

Educational Entities may choose or allow all medical, dental and vision plans available in the service area to be available to some or all Entity Employee Groups with the following exceptions:

(1) The HMO vision plan offered through Kaiser Permanente is only available if the HMO medical plan offered through Kaiser Permanente is available.

(2) Moda Health Plan H can only be offered to employee groups who have the option to participate in a Health Savings Account (HSA) effective October 1, 2013.

Stat. Auth.: ORS 243.860–243.886

Stats. Implemented: ORS 243.864(1)(a))

Hist.: OEBB 8-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11; OEBB 2-2011, f. & cert. ef. 2-11-11; OEBB 3-2012(Temp), f. & cert .ef. 4-20-12 thru 10-16-12; OEBB 8-2012, f. & cert. ef. 10-9-12; OEBB 8-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

111-030-0020

Development of OEBB Basic Life and Accidental Death and Dismemberment and Optional Life and Accidental Death and Dismemberment Plan Designs

(1) As used in this section, “comparable plan design” means that 90 percent of district employees can obtain a maximum benefit through an OEBB plan design that is within $2,500 of the maximum benefit obtained through a pre-OEBB plan design in effect the year prior to implementation.

(2) OEBB will develop plan designs for basic life and AD&D and optional life and AD&D benefit plans that are comparable to the plan designs provided by Subject Districts prior to entering the OEBB.

(3) OEBB will develop comparable plans by: Collecting plan designs for basic life and AD&D and optional life and AD&D plans provided by Subject Districts that enter OEBB on October 1, 2009, and October 1, 2010.

(4) Following initial implementation of the basic life and AD&D and optional life and AD&D benefit plans, OEBB will re-evaluate its plan designs for the October 1, 2010, plan year start date to determine if the Subject District plan design was included in the comparability assessment performed for plan design development.

(a) If the Subject District plan design was considered during the initial plan design process no further analysis will be conducted.

(b) If the plan design was not considered during the initial plan design process OEBB will:

(c) Identify whether a current OEBB plan design is within $2,500 higher or lower than the pre-OEBB life insurance or AD&D benefit level.

(5) If none of the OEBB plan designs is within $2,500 higher or lower than the pre-OEBB life insurance or AD&D benefit level and the Subject District has 100 or more enrollees, OEBB will develop and implement a plan design within $2,500 higher or lower than the pre-OEBB life insurance or AD&D benefit level unless;

(6) There is an OEBB plan that provides a benefit level more than $2,500 higher than the district’s option and it is determined that OEBB can still meet the comparable cost requirement.

Stat. Auth.: ORS 243.860 - 243.886

Stats. Implemented: ORS 243.864(1)(a) & 243.868(1)

Hist.: OEBB 13-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10; OEBB 20-2009, f. & cert. ef. 12-17-09; Suspended by OEBB 8-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

111-030-0025

Development of OEBB Short and Long Term Disability Plan Designs

(1) As used in the section, “comparable plan design” means 90 percent of the district employees can obtain the same elimination period, percentage of covered compensation, definition of covered compensation, coverage period duration, and maximum payment per benefit period through an OEBB plan design as through a pre-OEBB plan design in effect the year prior to implementation.

(2) OEBB will develop comparable plan designs by collecting plan designs for short and long term disability plans provided by Subject Districts that enter OEBB on October 1, 2009, and October 1, 2010.

(3) Following initial implementation of the short and long term disability benefit plans, OEBB will re-evaluate its plan designs for the October 1, 2010 plan year start date to determine if the Subject District plan design was included in the comparability assessment performed for plan design development.

(a) If the Subject District plan design was considered during the initial plan design process no further analysis will be conducted.

(b)(A) If the plan design was not considered during the initial plan design process OEBB will:

(B) Identify if a current OEBB plan design offers a level of benefits, elimination period, percentage of covered compensation, coverage period duration, and maximum payment per benefit period available through the group contract.

(4)(a) If none of the OEBB plan designs offers a level of benefits, elimination period, percentage of covered compensation, coverage period duration, and maximum payment per benefit period available through the group contract, OEBB will develop and implement a plan option that offers the level of benefits available through the Subject District unless;

(b) There is an OEBB benefit option that provides a benefit level or elimination period more generous than the district’s option and it is determined that OEBB can still meet the comparable cost requirement.

Stat. Auth.: ORS 243.860 - 243.886

Stats. Implemented: ORS 243.864(1)(a) & 243.868(1)

Hist.: OEBB 13-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10; OEBB 20-2009, f. & cert. ef. 12-17-09; Suspended by OEBB 8-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

111-030-0046

Development of Health Savings Accounts (HSA)

(1) Effective October 1, 2011, OEBB will offer the use of an employer sponsored vendor for Health Savings Accounts (HSA). For purposes of this rule, an HSA vendor will be considered employer sponsored if the Educational Entity offers:

(a) Employer contributions to the HSA; or

(b) Pre-tax or direct deposit of employee contributions to the HSA.

(2) If an Educational Entity chooses to offer an employer sponsored HSA, the Educational Entity may offer this plan through the OEBB-contracted HSA.

(3) Educational Entities may select or allow the HSA option to be available to eligible employees who enroll in OEBB’s high-deductible health plan (HDHP) option (currently Moda Health Plan H).

(4) Eligible employees who are eligible to enroll in an HSA, and choose the employer sponsored HSA vendor, may do so directly through the HSA vendor or their Educational Entity.

(5) Eligible employees must meet requirements established by the Internal Revenue Service (IRS) to qualify for enrollment in an HSA. Once enrolled in an HSA, members are responsible to adhere to tax requirements of the IRS.

(6) Because IRS requirements for an individual to qualify for enrollment in an HSA include concurrent enrollment in a high-deductible health plan (HDHP), an Educational Entity that offers an employer sponsored HSA must offer its employees the choice of a HDHP option from among OEBB’s medical plans (i.e., prior to the 2013-14 plan year, ODS Health Plan 9; beginning with the 2013-14 plan year, Moda Health Plan H). If an employee is enrolled in an OEBB medical plan other than OEBB’s HDHP, the employee may not enroll in the OEBB HSA.

Stat. Auth.: ORS 243.860 - 243.886

Stats. Implemented: ORS 243.874(5)

Hist.: OEBB 13-20111(Temp), f. & cert. ef. 8-2-11 thru 1-28-12; OEBB 21-2011, f. 10-13-11, cert. ef. 10-14-11; OEBB 8-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14


Rule Caption: Establishes eligibility verification and reviews language under OEBB Operations rule

Adm. Order No.: OEBB 9-2013(Temp)

Filed with Sec. of State: 7-12-2013

Certified to be Effective: 7-12-13 thru 1-7-14

Notice Publication Date:

Rules Adopted: 111-080-0055

Subject: Currently, limited eligibility review language exists in Division 40 and Division 50 under OEBB’s Chapter 111 rules. 111-080-0055 establishes eligibility verification and reviews language in rule under OEBB’s Operations rule which elaborates on the different types of verifications and reviews and the timeline for such reviews.

Rules Coordinator: April Kelly—(503) 378-6588

111-080-0055

Eligibility Verifications and Reviews

(1) OEBB shall plan and conduct eligibility verifications and reviews to monitor compliance with OEBB administrative rules. Reviews shall include, but are not be limited to the following:

(a) Dependent eligibility;

(b) Employee eligibility;

(c) Election change limitations; and

(d) Plan enrollment limitations.

(2)(a) Employee eligibility, election change and plan enrollment reviews may occur on a random basis throughout the year, or if anomalies in data warrant a formal review.

(b) The Eligible Employee and educational entity are responsible to submit documentation upon request.

(3) Dependent eligibility verifications shall be completed at least once every three years per participating educational entity.

(a) OEBB shall develop a review plan that will include an onsite verification of dependent eligibility documentation for benefit-eligible employees of each participating educational entity once every three years.

(b) Educational entities may have a formal dependent eligibility verification and review completed by a third party vendor on or after October 1, 2013. The use of a third party vendor for a dependent eligibility verification and review may meet the once every three years requirement provided the vendor meets the standards and criteria set in the OEBB verification and review plan and agrees to report all findings to OEBB via a secure electronic file. All requests to substitute a third party vendor for this purpose must be pre-approved by OEBB.

(c) The member is responsible to submit documentation upon request. In the event the member does not provide the required documentation to sufficiently prove the dependent meets eligibility requirements, or the documentation provided is insufficient, the dependent’s coverage will be terminated. Retroactive terminations may occur if the documentation provided shows the dependent was not eligible for coverage and the member misrepresented the dependent as being an eligible dependent as defined by OAR 111-080-0045.

Stat. Auth.: ORS 243.860 - 243.886

Stats. Implemented: ORS 243.864(1)(a)

Hist.: OEBB 9-2013(Temp), f. & cert. ef. 7-12-13 thru 1-7-14

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2012.

2.) Copyright 2013 Oregon Secretary of State: Terms and Conditions of Use

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