justicedao/ipfs_state_laws huggingface dataset:
101-020-0038 Correcting Processing Errors (1) Administrative processing errors occur when benefit plan elections are processed incorrectly in the payroll and benefit system by the agency, PEBB, or third party administrative staff, or PEBB carrier. Administrative error also includes when a newly eligible employee does not receive correct enrollment information or materials within 30 days of the eligibility date. (a) PEBB must review all processing errors on PEBB optional plans (non-health carriers). (A) Approval letters for a plan that requires underwriting are not official documents for enrollments unless the enrollment is entered into the PEBB system. (B) If the enrollment is not entered into the system due to an administrative error, the member may pay all retro premiums back to the first of the month following carrier approval or re-apply for the coverage during an upcoming open enrollment period or within 30 days of a qualifying midyear event (Medical evidence may be required). (C) PEBB will not be held responsible for processing errors made outside of PEBB. The eligible employee is responsible for identifying enrollment errors and maintaining a valid and accurate enrollment. (b) PEBB authorizes the agency to correct processing errors identified within 30 days of the eligibility date or the midyear plan change date. Corrections are retroactive to the first of the month following the date the agency received the original paper form or electronic equivalent. The agency must reconcile all premium discrepancies. (c) PEBB must review all processing error correction requests identified after 30 days of the eligibility date or the midyear plan change date. If approved, corrections are retroactive to the first of the month following the date the paper form or electronic equivalent was first received by the agency. The agency must reconcile all premium discrepancies. (d) PEBB authorizes the agency to correct open enrollment processing errors. The agency must receive requests for correction after the open enrollment end date but no later than the last day of February of the new plan year. (e) PEBB must review all open enrollment correction requests received after the last day of February of the new plan year. (f) When a newly eligible employee fails to receive enrollment information within 30 days of the eligibility date or receives incorrect information, benefit plan elections will be effective retroactive to the first of the month following the eligibility date. Verification must be received by PEBB to consider the request. Statutory/Other Authority: ORS 243.061 - 302 Statutes/Other Implemented: ORS 243.061 - 302 History: PEBB 6-2018, adopt filed 08/15/2018, effective 08/15/2018
101-020-0040 Late Enrollment (1) Late enrollment occurs when an eligible employee fails to enroll themselves, eligible family members, domestic partner, or a domestic partner’s child in benefit plans within the required time period. (2) An enrolled employee requesting late enrollment for a family member, domestic partner, or domestic partner’s dependent child must provide supporting documentation that shows an inability to enroll the individual when first eligible because of circumstances beyond the employee’s control. (3) A newly eligible employee approved for late enrollment receives only employee basic life insurance coverage and may only elect medical and dental coverage for themselves, spouse, domestic partner, or dependent children. If late enrollment is approved, benefit coverage is effective the first of the month following receipt of the completed enrollment forms. (4) Following receipt of the completed forms, late enrollment of an employees’s biological newborn dependent child will be retroactive to the first of the month following the date of birth if completed forms are received during the first twelve months of life. Statutory/Other Authority: ORS 243.061 - 302 Statutes/Other Implemented: ORS 243.061-302, 659A.060-069, 743.600-602 & 743.707 History: PEBB 6-2018, amend filed 08/15/2018, effective 08/15/2018 PEBB 3-2009, f. 9-29-09 cert. ef. 10-1-09 PEBB 2-2008, f. & cert. ef. 8-1-08 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07 PEBB 1-2006, f. & cert. ef. 11-28-06 PEBB 3-2005, f. 8-31-05, cert. ef. 9-1-05 PEBB 3-2004, f. & cert. ef. 10-7-04 PEBB 1-2004, f. & cert. ef. 7-2-04 PEBB 1-2003, f. & cert. ef 12-4-03 PEBB 1-2002, f. 7-30-02, cert. ef. 8-1-02 PEBB 1-2001, f. & cert. ef. 9-6-01 PEBB 1-2000, f. 11-15-00, cert. ef. 1-1-01 PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00
101-020-0047 Transfer (1) When an eligible employee transfers from one PEBB participating organization to another, the organization losing the employee must pay the benefit amount for the month following the transfer, regardless of hours worked at that organization. Exception: An eligible employee transfers mid-month from part-time to full time and submits enrollment forms to the gaining organization prior to the end of the month. In this case, the gaining organization pays the full benefit amount for the month following the transfer. (2) All PEBB benefit plan elections transfer from the PEBB organization losing the employee to the organization gaining the employee without a lapse in insurance coverage. (3) Benefit plan changes or elections are not permitted solely due to a transfer. Statutory/Other Authority: ORS 243.061-302 Statutes/Other Implemented: ORS 243.061-302 History: Renumbered from 101-040-0020, PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07 PEBB 3-2005, f. 8-31-05, cert. ef. 9-1-05 PEBB 3-2004, f. & cert. ef. 10-7-04 PEBB 1-2004, f. & cert. ef. 7-2-04 PEBB 1-2001, f. & cert. ef. 9-6-01 PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00
101-020-0050 Midyear Benefit Plan Changes (1) Eligible employee plan elections are irrevocable for the plan year. There are limited exceptions to the irrevocability rule if certain conditions or events are met. These events fall into three broad groups: (a) Qualified Status Changes (QSC), which include: (A) Changes in the eligible employee's legal marital status, such as marriage or divorce; (B) Changes in the eligible employee's number of dependents, such as birth or adoption of a child; (C) Changes in the employment status of the eligible employee or family member, such as the start or end of employment, or a change from part-time to full time; (D) Changes in the eligibility of a dependent, such as attaining a certain age; (E) Changes in the residence of the eligible employee , or; (F) Changes in the eligible employee's domestic partnership. (b) Cost or coverage changes. For example: (A) An increase in out-of-pocket premium cost imposed by the employer; (B) A reduction or a loss in the spouse's or domestic partner's group plan benefits, or; (C) A reduction or a loss of plan coverage. (c) Other laws or court orders. For example: National Medical Support Notice, Medicare, or HIPAA related special enrollments. (2) The eligible employee may request only those midyear plan change elections that are consistent with the event. Example: In the middle of the plan year, John moves from his current medical plan’s service area and can no longer access the plan’s closed panel of providers. However, all of John’s other coverages (dental, life, etc.) remain active for his new address. John may request to change his medical plan, because it is consistent with the event due to a move from his current medical plan’s service area. John may not request to change or add any other elections at this time because that would not be consistent with the allowable midyear event occurrence. (3) Eligible employees experiencing a qualified midyear event, and who request a change of enrollment elections must complete and submit to their agency the correct update forms and all required documentation within 30 days of the event. Agencies receiving employee midyear change requests can make only those changes that are consistent with the event. All election changes are effective the later of the first of the month after receiving all required update forms and documents or the event date. Agencies will not process enrollment request changes when enrollment and change request information is incomplete or missing required documentation. (4) The tag-a-long rule applies when the eligible employee experiences a QSC addition of a new family member, domestic partner, or domestic partner’s child. The rule allows the employee to add another eligible family member, domestic partner, or domestic partner’s child who was previously eligible for PEBB plan coverage but never added to coverage, to be added to coverage. Statutory/Other Authority: ORS 243.061 - 302 Statutes/Other Implemented: ORS 243.061 - 302, 659A.060 - 069, 743.600 - 602 & 743.707 History: PEBB 2-2017, f. & cert. ef. 8-17-17 PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07
101-020-0052 Surcharges (1) For the purposes of this rule, the following definitions apply: (a) Double Coverage means a subscriber/employee that is also an eligible dependent and is enrolled in two PEBB/PEBB or PEBB/OEBB medical plans. (b) OEBB means the Oregon Educators Benefit Board in Oregon. (c) Subscriber/employee means the individual who subscribes to their employer’s health plan. For the purposes of this rule, a subscriber excludes a COBRA participant, part-time employee, retiree or self-pay member. (d) Dependent means and includes a dependent child as defined by OAR 101-015-0011, Spouse as defined by OAR 101-015-0005, and Domestic Partner as defined by OAR 101-015-0011. (e) Surcharge means an extra fee deducted from the employee’s monthly pay. (2) Tobacco Use Surcharge: (a) Employees and spouses/Domestic Partners who are enrolled in a PEBB medical plan and use tobacco products may pay a monthly surcharge. The surcharge is deducted from the employee’s monthly paycheck. The monthly surcharges are determined by the PEBB Board. (b) Employees who opt-out of a PEBB medical plan are not subject to this surcharge. (c) Tobacco usage status can be updated prospectively at any time during the plan year by completing and submitting a Midyear change form. (3) Spouse/Domestic Partner Other Group Coverage Surcharge: (a) Employees will pay a monthly surcharge if the spouse/Domestic Partner is covered on the employee’s PEBB plan and chooses to not enroll in their own employer’s medical coverage (non-PEBB coverage). The monthly surcharges are determined by the PEBB Board. (b) Employees who have a spouse/Domestic partner who opts out of PEBB coverage are not subject to this surcharge. (c) Employees may submit a Midyear change form if this changes anytime during the plan year. The change request form must be submitted to their employer’s payroll or university benefits office within 30 days of the change. Changes take effect prospectively upon receipt of the appropriate form. (4) Double Coverage: (a) Effective January 1, 2021, any active full-time employees who cover an eligible dependent that is also enrolled as a subscriber for either a PEBB or an OEBB-sponsored medical plan will be assessed a monthly surcharge. (b) The amount of the surcharge is determined annually by the PEBB Board. (c) The monthly surcharge will only be charged to the subscriber. (d) The subscriber will only pay one double coverage surcharge no matter how many dependents are double covered. (e) The Double Coverage surcharge does not apply to Opt Out, Retirees, COBRA participants, self-pay participants or part-time employees. Statutory/Other Authority: ORS 243.061 - 243.302 Statutes/Other Implemented: ORS 243.125(1), ORS 243.125(3) History: PEBB 7-2020, adopt filed 12/22/2020, effective 12/22/2020
101-030-0007 Portability of Medical Insurance Coverage Some PEBB sponsored group medical insurance plans allow portability. An eligible individual enrolled in one of these medical plans may continue insurance coverage under the plan’s portability provisions before, during, or at the end of the period that medical insurance coverage is provided under COBRA, if: (1) They were continuously covered for 180 days or more under one or more PEBB sponsored group medical insurance plans and they lost eligibility for group medical insurance coverage; (2) They are not covered by another group medical insurance plan, Medicare, or TriCare; (3) They enroll in a continued medical insurance plan under the portability provisions within 63 days after termination of the group medical insurance coverage; and (4) They comply with all requirements of the applicable insurance carrier for continuation of medical insurance coverage under the carrier’s portability plan provisions. Statutory/Other Authority: ORS 243.061-302 Statutes/Other Implemented: ORS 243.061-302 History: Renumbered from 101-030-0035, PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07 PEBB 1-2004, f. & cert. ef. 7-2-04 PEBB 1-2001, f. & cert. ef. 9-6-01 PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00
101-030-0010 Continuation of Group Health Benefit Coverage for Injured Workers (CBIW) (1) The state is required by ORS 659A.060-069 to continue to pay the benefit amount for PEBB health benefit coverage in effect at the time an eligible employee has a work-related injury or illness. The benefit amount may continue for up to 12 consecutive months or until one of the events listed in ORS 659A.063 occurs, whichever occurs first. Health benefit coverage for this purpose includes the medical, dental, vision, and prescription drug coverage of the employee, family members, and domestic partner. (2) An eligible employee may continue coverage for life, accidental death and dismemberment and Long Term Care insurance plans for up to 12 months if they self-pay the premiums to the agency. (3) Refer to OAR 101-020-0002(7)(d) for employee premium payment requirements. (4) When an employee returns to work within 12 months, they will have their previous enrollment for medical, dental, life, and disability insurance reinstated the first of the month following their return to work. The employee may make midyear plan changes within 30 days of the date they return to work. (5) An employee returning to work will not be reinstated in any pretax Flexible Spending Accounts, or PEBB Commuter Accounts. They may reenroll within 30 days of the date they return to work. (6) A previously benefit eligible employee returning to paid regular status immediately following CBIW is not required to work at least half-time in the month they return to be eligible for benefits the following month. (7) A COBRA qualifying event occurs at the end of the CBIW continuation period, or when the current benefit eligible stability period ends the allowable benefit period, if the employee has not returned to paid regular status. Statutory/Other Authority: ORS 243.061 - 302 & 659A.060 - 069 Statutes/Other Implemented: ORS 243.061 - 302 & 659A.060 - 069 History: PEBB 2-2017, f. & cert. ef. 8-17-17 PEBB 1-2015, f. & cert. ef. 5-12-15 PEBB 3-2014(Temp), f. & cert. ef. 11-12-14 thru 5-10-15 PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07 PEBB 3-2004, f. & cert. ef. 10-7-04 PEBB 1-2004, f. & cert. ef. 7-2-04 PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00
101-030-0020 Continuation of Group Medical and Dental Insurance Coverage for Employees Covered under the Oregon Family Leave Act (OFLA) — ORS 659A.150-186 (1) A permanent, temporary or impermanent benefit eligible employee who qualifies for OFLA leave will continue benefits as outlined in OAR 101-020-0005 according to the their benefit eligible current stability status at the time the leave starts. (2) When benefits continue during OFLA because of the employee’s current benefit eligible stability status, refer to OAR 101-20-0002(7)(d) for employee premium payment requirements. (3) If active employee’s PEBB insurance coverage ends, the employee will receive a COBRA election notice. See OAR 101-030-0005. (4) See OAR 101-020-0045 Returning to Work. Statutory/Other Authority: ORS 243.061-302 & 659A.150-186 Statutes/Other Implemented: ORS 243.061-302 & 659A.150-186 History: PEBB 1-2015, f. & cert. ef. 5-12-15 PEBB 3-2014(Temp), f. & cert. ef. 11-12-14 thru 5-10-15 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07 PEBB 3-2004, f. & cert. ef. 10-7-04 PEBB 1-2004, f. & cert. ef. 7-2-04 PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00
101-030-0022 Continuation of Benefit Coverage for Employees on Active Military Leave (1) The state will continue to pay the benefit amount for core benefit coverage in effect at the time an eligible employee begins active military duty. This benefit coverage will continue for the duration of the active military leave, up to 24 consecutive months. The agency may end this coverage before or during the 24 months of active duty only if the member submits a signed written request to end the coverage. (2) An eligible employee may continue the following optional plans during active military duty up to 12 months by self-paying premiums or contributions to the agency: (a) Optional Life Insurances, (b) Accidental Death and Dismemberment Insurance, (c) Long Term Care (LTC), and, (d) Health Flexible Spending Account (FSA). (3) An eligible employee on active military leave during open enrollment may make open enrollment benefit elections. The employee may allow another individual to make plan elections in the employee’s absence by providing documentation of a power of attorney to the agency. Enrollment in a Health FSA must occur during open enrollment in order to participate in the new plan year. (4) An eligible employee who returns to work within 24 months will have available previous optional plan enrollments reinstated retroactive to the first day of the month the employee returns. A returning employee is not required to work at least half-time in the month they return to be eligible for benefits the following month. (a) The employee must self-pay premiums for optional insurance plan reinstatements for the month in which they return. (b) An employee returning to work will not be reinstated in Long Term Care, Commuter Accounts or any FSA, unless contributions to their Health FSA and Long Term Care while on military leave continued. (c) The employee may make midyear plan changes within 30 days of the date they return to work. (5) A COBRA qualifying event occurs when an eligible employee: (a) Is no longer in active duty status or paid regular status, and does not return to work following the allowed decompression time; (b) Remains in active duty status after 24 months of active duty, or; (c) Terminates employment. Statutory/Other Authority: ORS 243.061 - 302 Statutes/Other Implemented: ORS 243.061-302 & 408.240 History: PEBB 2-2017, f. & cert. ef. 8-17-17 PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11 PEBB 3-2009, f. 9-29-09 cert. ef. 10-1-09 PEBB 2-2008, f. & cert. ef. 8-1-08 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07 PEBB 3-2005, f. 8-31-05, cert. ef. 9-1-05 PEBB 3-2004, f. & cert. ef. 10-7-04 PEBB 1-2004, f. & cert. ef. 7-2-04 PEBB 1-2003, f. & cert. ef 12-4-03
101-030-0026 Employer Designated Furlough Leaves The State of Oregon as the employer may designate furlough leave without pay. Furlough leave does not affect an employee’s eligibility or current enrollment in medical, dental, and employee basic life insurance. Statutory/Other Authority: ORS 243.061 - 302 Statutes/Other Implemented: ORS 243.061-302 & 292.05 History: PEBB 2-2009, f. 7-29-09, cert. ef. 8-1-09 PEBB 1-2009(Temp), f. & cert. ef. 2-24-09 thru 8-22-09
101-030-0027 Non-medical Leave Without Pay (LWOP) — Continuation of Optional Insurance Plans An eligible employee who is in a non-medical LWOP status may continue coverage for optional life insurances, accidental death and dismemberment insurance plans and Long Term Care (LTC) for up to 12 months if they self-pay the premium to the agency. The employee is not eligible to continue short term or long term disability insurance plans while on LWOP. Statutory/Other Authority: ORS 243.061 - 302 Statutes/Other Implemented: ORS 243.061 - 302 History: PEBB 2-2017, f. & cert. ef. 8-17-17 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07
101-030-0070 Life, Disability, and Accidental Death and Dismemberment Insurance — Continuation of Coverage (1) When an eligible employee separates from state service optional life insurance coverage may continue through the plan, not PEBB, as follows: (a) Portability. An eligible employee terminating employment, other than for disability or retirement, may continue the employee’s optional employee, spouse, and domestic partner life insurance coverage at the group rate, plus billing fees. The policy remains a term life insurance policy. The employee must apply directly to the plan within 30 days of the date coverage ends. Portability is not available for employee basic life or dependent life coverage. A survivor of a covered eligible employee may continue optional life insurance through the plan upon the death of the employee. (b) Conversion Rights. An eligible employee terminating employment for any reason, including disability or retirement, or experiencing a reduction in hours to less than 80 paid regular hours in the month, may be eligible to convert the employee’s term life insurance coverage. Not all policy types are available for conversion. The employee must apply directly to the plan within 30 days of the date insurance coverage ends. A survivor of a covered eligible employee may convert life insurance coverage through the plan upon the death of the employee. (c) Retiree Life Insurance Option. An eligible employee who retires may purchase the Retiree Life Insurance Option without submitting evidence of insurability. The employee must apply directly to the insurance plan within 30 days of the date insurance coverage ends. (d) Transfer of Premium Payment for Optional Employee Life Insurance. When two active eligible employees are married or in a domestic partnership and both are state employees, one employee can transfer their optional life insurance coverage to the other employee's life insurance coverage or to themselves upon: (A) Terminating employment for any reason; (B) Beginning an active military leave; (C) Divorce; (D) Termination of their domestic partnership, or; (E) Retirement. The remaining employed eligible employee must submit the completed and signed transfer form to their agency within 30 days of the date of the events listed in (1)(d) of this rule. (2) There are no portability, conversion, or rollover continuation options for short term or long term disability or accidental death and dismemberment insurance coverage. Statutory/Other Authority: ORS 243.061 – 302 Statutes/Other Implemented: ORS 243.061 – 302 History: PEBB 1-2013, f. & cert. ef. 9-24-13 Renumbered from 101-020-0070, PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07