Loading
The Oregon Administrative Rules contain OARs filed through July 15, 2014
 
QUESTIONS ABOUT THE CONTENT OR MEANING OF THIS AGENCY'S RULES?
CLICK HERE TO ACCESS RULES COORDINATOR CONTACT INFORMATION
 

OREGON HEALTH AUTHORITY,
PUBLIC EMPLOYEES' BENEFIT BOARD

 

DIVISION 70

LOCAL GOVERNMENT PARTICIPATION

101-070-0001

Definitions

“Local Government” has the meaning given to it in House Bill 2279 (2013).

Stat. Auth: ORS 243.061-302, 659A.060-069, 743.600-602 & 743.707
Stats. Implemented: ORS 243.061-302 & OL 2007 Ch. 99
Hist.: PEBB 3-2013(Temp), f. & cert. ef. 12-17-13 thru 6-15-14; PEBB 1-2014, f. & cert. ef. 5-1-14

101-070-0005

Participation Requirements

(1) Notice of Intent to Participate

(a) Local Governments choosing voluntarily to participate in PEBB must complete and submit to PEBB a written Notice of Intent to Participate. The following notification timeline applies if the Local Government employs:

(A) 50 or fewer participating, eligible employees - 90 days prior to the PEBB Open Enrollment start date (usually October 1), or;

(B) More than 50 participating, eligible employees but fewer than 500 participating, eligible employees — 120 days prior to the PEBB Open Enrollment start date, or;

(C) More than 500 participating, eligible employees — 180 days prior to the PEBB Open Enrollment start date.

(b) Local Governments employing more than 500 participating, eligible employees that submit a Notice of Intent to Participate may allow individual employee groups entry into PEBB plans upon expiration of collective bargaining agreements that govern employee health and welfare benefits for the individual employee groups.

(2) Financial Participation

(a) Local Governments must provide PEBB with the most recent two years of medical premiu — equivalent rates for self-insured groups and the most recent two years of medical premium rates for fully insured groups either before submitting a Notice of Intent to Participate or accompanied with the Notice of Intent to Participate. Demographic data and logistical data may be requested as well.

(A) If an actuarial plan comparison completed by PEBB’s Consultant demonstrates these rates are less than 10% over PEBB’s costs during the same two year period, the Local Government may enter participation at current PEBB rates.

(B) If an actuarial plan comparison demonstrates these rates are equal to or over 10% of PEBB’s costs during the same two year period, PEBB may add a rate surcharge for up to three years.

(i) Upon entry into PEBB participation, Local Governments with more than 500 self-insured employees must either:

(I) Deposit a sufficient monetary reserve by February 1 of the first plan year to finance the stabilization account of the PEBB revolving fund to the PEBB risk-adjusted level as determined by the PEBB Consultant ; or

(II) Agree to pay an additional surcharge to premiums to establish a reserve fund for the Local Government over a period of time as determined by PEBB’s Consultant.

(ii) When a Local Government with more than 500 self-insured employees terminates participation in PEBB, it may take its initial contribution paid into the stabilization account of the PEBB revolving fund as determined by PEBB’s Consultant.

(iii) When a Local Government provides a cash incentive to a member for opting-out of health coverage and the value of the incentive is 50% or more than the PEBB premium rate for an employee-only tier, PEBB may assess a surcharge to the Local Government.

(iv) Monthly Remittance. For the purpose of subsections (6) through (11), the terms below have the following meanings:

(I) "ACH credit" means a payment initiated by a participating Local Government that is cleared through the Automated Clearing House (ACH) network for deposit to the PEBB treasury account;

(II) "ACH debit" means a payment initiated by PEBB and cleared through the ACH network to debit a participating Local Government’s financial account and credit the PEBB treasury account;

(III) “Local Government Payment” means the monthly Local Government Payment to PEBB that includes the contributions of both Local Government as the employer, and its employees as required to pay the monthly premiums in full for selected PEBB benefit plans;

(IV) “Local Government Payment Invoice" means a monthly itemized statement provided by PEBB that includes the enrollment elections of the employees and dependents of a Local Government and the PEBB premium rate associated with the benefit coverage enrollment month.

(V) “Pay-As-Billed” means billing a Local Government based upon its monthly enrollment file in the PEBB.benefits system.

(VI) “Overpayment” means the amount of a Local Government’s monthly payment to PEBB that exceeds the amount due.

(VII) “Underpayment” means a payment submitted by a Local Government that is less than the invoiced amount.

(VIII) “Electronic Funds Transfer” refers to a payment through ACH credit or ACH debit.

(IX) “Cover Oregon” refers to the Oregon Health Insurance Exchange public corporation.

(X) “Due date” means the third business day into the current month of coverage.

(v) Local Governments will receive a monthly invoice from PEBB by the first business day of the month of coverage that details the payments due for that month of coverage.

(vi) Local Governments are required to submit payment to PEBB through Electronic Funds Transfer no later than the due date.

(vii) PEBB reserves the right to issue surcharges or take other appropriate measures to Local Governments that submit monthly payments after the due date.

(viii) Local Governments must select an electronic funds transfer method by submitting an Electronic Funds Transfer authorization form to PEBB 45 days prior to participation in a PEBB plan year.

(ix) Local Governments seeking a refund of an overpayment must notify PEBB within 45 calendar days from the date the overpayment occurred;

(I) PEBB will request a refund from a carrier in accordance with the law. The carrier will refund the premium to PEBB back to the date of the termination or the date allowed by law for recoupment.

(II) PEBB will generally reimburse a Local Government overpayment by making an adjustment to the next monthly invoice.

(3) General Participation Requirements

(a) Local Governments who choose to participate in PEBB must comply with PEBB eligibility, enrollment, and continuation of insurance rules as defined in OAR Division 101-10, 101-015 and 101-030, regardless of whether the Local Government is administering a Section 125 Cafeteria Plan.

(b) Local Governments must agree to and sign an inter-governmental agreement with PEBB along with the Notice of Intent to Participate that includes provisions of their participation in PEBB, including, but not limited to, the following participation requirements. Local Governments must:

(A) Retain full authority to define employee-employer premium cost share arrangements compliant with Affordable Care Act (ACA) regulations.

(B) Participate in all benefit coverage types approved and provided by PEBB. All PEBB plans must be available to all benefit eligible employees.

(C) Use the PEBB tiered-rate structure for all benefit coverage types.

(D) Participate in all PEBB health and wellness and programs offered by PEBB.

(E) Comply with the PEBB benefit plan-year cycle, Open Enrollment period, and plan renewal timeline.

(F) Submit all premium payments to PEBB on a monthly basis. Premium submission to PEBB is completed through Electronic Funds Transfer, no later than the due date as indicated by PEBB.

(G) Not transfer to any PEBB plan any deductibles or annual out-of-pocket maximums met with a prior carrier.

(H) Agree that PEBB.benefits is the authority for managing and reporting all billing, eligibility and enrollment information communicated to the insurance plan carriers by PEBB and Local Governments will update employment changes in PEBB.benefits as they occur.

(c) Local governments may allow currently enrolled Early Retirees to participate in PEBB retiree plans only if the retirees participated in the Local Government’s retiree medical plan for at least two years prior to January 1, 2014. The PEBB Retiree Rules as defined in OAR Division 101-50-0005 et. seq. apply to all Early Retirees.

(d) Local Governments may request transfer of term life insurance coverage through the Local Government group life policy to the PEBB term life insurance policy. PEBB will transfer the life insurance amount in force on the last day the prior group coverage was in effect if requested and documented by the Local Government rounded to the nearest multiple of $10,000. Premium rates for the coverage will be at the current PEBB life insurance rate tier structure.

(e) Local Governments that elect to participate in benefit plans provided by PEBB may elect to terminate participation in PEBB, subject to the following rules:

(I) Termination of participation will be allowed on a one-time basis only; however, Local Governments electing to terminate PEBB plan coverage and electing to participate in Cover Oregon, can elect to return to participate in plans provided by the PEBB. Upon returning to PEBB, a Local Government must again satisfy all Notice of Intent to Participate and other participation requirements.

(II) PEBB may terminate participation of a Local Government within three months of entering PEBB if the Local Government fails to perform any action required by Oregon Revised Statutes (ORS) 243.105 to 243.285 and 292.051 or by PEBB rule.

(f) Local Governments may purchase employee benefits not offered by PEBB or Cover Oregon.

Stat. Auth: ORS 243.061-302, 659A.060-069, 743.600-602 & 743.707
Stats. Implemented: ORS 243.061-302 & OL 2007 Ch. 99
Hist.: PEBB 3-2013(Temp), f. & cert. ef. 12-17-13 thru 6-15-14: PEBB 1-2014, f. & cert. ef. 5-1-14

The official copy of an Oregon Administrative Rule is contained in the Administrative Order filed at the Archives Division, 800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the published version are satisfied in favor of the Administrative Order. The Oregon Administrative Rules and the Oregon Bulletin are copyrighted by the Oregon Secretary of State. Terms and Conditions of Use

Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

© 2013 State of Oregon All Rights Reserved​