justicedao/ipfs_state_laws huggingface dataset:
101-005-0140 Protest of Contractor Selection, Contract Award (1) Purpose. An adversely affected or aggrieved Proposer must exhaust all avenues of administrative review and relief before seeking judicial review of the Board's Contractor selection or contract award decision. (2) Notice of Intent to Award. Unless otherwise provided in the RFP, the Board shall provide written notice to all Proposers of the Board's intent to award the contract(s). The Board's award(s) shall not be final until the later of the following: (a) Seven (7) days after the date of the notice, unless the RFP provided a different period for protest, or; (b) The Board provides a written response to all timely filed protests that denies the protests and affirms the award. (3) Right to Protest Award. An adversely affected or aggrieved Proposer may submit to the Board a written protest of the Board's intent to award within seven (7) days after issuance of the notice of intent to award the contract, unless a different protest period is provided under the RFP. (a) The Proposer's protest shall be in writing and must specify the grounds upon which the protest is based. (b) A Proposer is adversely affected or aggrieved only if the Proposer would be eligible to be awarded the contract in the event that the protest were successful, and the reason for the protest is that: (A) All higher ranked Proposals are nonresponsive; (B) PEBB has failed to conduct the evaluation of Proposals in accordance with the criteria or processes described in the RFP; (C) PEBB has abused its discretion in rejecting the protestor’s Proposal as nonresponsive; or (D) PEBB’s evaluation of Proposals or PEBB’s subsequent determination of award is otherwise in violation of PEBB’s rules or ORS 243.105 to 243.285. (c) The Board shall not consider a protest submitted after the time period established in this rule or such different period as may be provided in the RFP. (4) Authority to Resolve Protests. The chairperson of the Board, or his or her designee, has the authority to settle or resolve a written protest submitted in accordance with the requirements of this rule. (5) Decision. If a protest is not settled, the chairperson of the Board, or his or her designee, shall promptly issue a written decision on the protest. Judicial review of this decision will be available if provided by statute. (6) Award. The successful Proposer shall promptly execute the contract after the award is final and all contractual terms and conditions have been negotiated and agreed upon. The Board shall execute the contract only after it has obtained all applicable required documents and approvals. Statutory/Other Authority: ORS 243.061 - 243.302 Statutes/Other Implemented: ORS 243.135 & 243.125 History: PEBB 3-2010, f. 9-23-10, cert. ef. 10-1-10 PEBB 2-2005, f. 7-26-05, cert. ef. 7-29-05 PEBB 1-2004, f. & cert. ef. 7-2-04 PEBB 1-2003, f. & cert. ef. 12-4-03
101-015-0005 Eligible Individuals (1) The following individuals are eligible to participate in PEBB-sponsored benefit plans: (a) An eligible employee as defined in OAR 101-010-0005(20). (b) A permanent position seasonal or intermittent employee who meets the following requirements: (A) An individual hired for the first time if expected to work a 90-calendar day continual period and works at least half-time or in a position classified as job share. The eligible employee must enroll within 30 days of the hire or eligibility date; or (B) An individual hired for the first time working at least half-time or in a position classified as job share who was not expected to work a 90-day or more continual period, and works longer than a 90-calednar day continual period. The employee is eligible for enrollment retroactively effective to the first day of the month following the original hire or eligibility date; or (C) A previously ineligible employee returning to work is eligible for benefit plans after 60 calendar days of employment within the current or immediately previous plan year. The 60 calendar days of employment need not be consecutive. (c) An appointed temporary or impermanent employee who (i) as of the date of hire, is expected to work an average of 30 or more hours per week for a 90-day continual period, or (ii) has worked an average of 30 hours or more per week for a full initial measurement period (1,560 hours) and is in a subsequent benefit eligible stability period. (d) A current spouse, domestic partner, or an eligible dependent child listed by the person who is eligible under subsection (1)(a), (b), (c), or (d) of this rule on the required enrollment form or the electronic equivalent. (e) An appointed and elected official. Eligibility for benefit plans begins on the first day of the month following the date the official takes the oath of office. (2) The eligible employee is responsible to maintain a valid PEBB enrollment for all eligible family members receiving coverage. Failure to maintain valid eligibility will result in the removal of coverage. See OAR 101-020-0025. Statutory/Other Authority: ORS 243.061 to ORS 243.302 Statutes/Other Implemented: ORS 243.125(1) History: PEBB 1-2022, amend filed 03/31/2022, effective 03/31/2022 PEBB 1-2015, f. & cert. ef. 5-12-15 PEBB 3-2014(Temp), f. & cert. ef. 11-12-14 thru 5-10-15 Reverted to PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11 PEBB 2-2011(Temp), f. & cert. ef. 8-5-11 thru 1-31-12 Suspended by PEBB 1-2011(Temp), f. & cert. ef. 3-9-11 thru 8-4-11 PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11 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 1-2001, 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
101-015-0026 Domestic Partnership (1) Certificate of Registered Domestic Partnership. When a Registered Domestic Partnership exists and the eligible employee wants to enroll the domestic partner or the domestic partner's eligible children in benefit plans, the employee may electronically enroll or submit enrollment update forms to the agency at the appropriate time as defined by PEBB enrollment rules. (2) PEBB Affidavit of Domestic Partnership. An eligible employee and an individual of the opposite or same sex without a Certificate of Registered Domestic Partnership, who want enrollment in PEBB plans as Domestic Partners must meet all of the following criteria: (a) Are both 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; (d) Share a close personal relationship and are not related by blood closer than would bar marriage in the State of Oregon; (e) Currently share the same regular permanent residence; (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, and; (g) Eligible employees must submit enrollment forms and a notarized affidavit to enroll domestic partners and children. To enroll eligible dependent children of a domestic partnership by affidavit in benefit plans, whether or not the enrollment includes the domestic partner, the employee must submit an Affidavit of Domestic Partnership. (A) For enrollment, the agency must receive the notarized affidavit within five business days following close date of the enrollment period. (B) Employees with qualified mid-year changes may only enroll a domestic partner or partner’s children by submitting the correct enrollment forms and notarized affidavit within the allowable time for the enrollment type. Agencies will not process a domestic partner or a partner’s children’s enrollment until the enrollment documentation submission is complete. (3) An imputed value for the fair market value of the domestic partner and domestic partner's dependent children's insurance premium will be added to the eligible employee's taxable wages. (4) An eligible employee ending a domestic partnership established under the PEBB Affidavit of Domestic Partnership must complete and submit a Termination of Domestic Partnership form and enrollment update forms to the agency within 30 days of the event. Insurance coverage for the domestic partner and domestic partner's dependent children ends the last day of the month in which eligibility is lost. Statutory/Other Authority: ORS 243.061 to ORS 243.302 Statutes/Other Implemented: ORS 243.125(1) History: PEBB 1-2022, amend filed 03/31/2022, effective 03/31/2022 PEBB 4-2018, temporary amend filed 06/25/2018, effective 06/25/2018 through 12/21/2018 PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11 PEBB 5-2010(Temp), f. 9-23-10, cert. ef. 10-1-10 thru 3-29-11
101-015-0030 Eligibility and Policy Term Violations - Definitions For the purposes of OAR 101-015-0035 and OAR 101-015-0040, the following definitions will apply: (1) “Eligibility or Enrollment Violations” means and includes a violation of the PEBB's eligibility or enrollment rules or policies including fraud or material misrepresentation. Misstatements, misrepresentations, omissions or concealments on the part of the PEBB member are not fraudulent unless they are made with intent to knowingly defraud. PEBB has primary responsibly in investigating such violations. If an Eligibility Violation is considered a violation of the insurance carrier’s policy, then the violation may also be considered a Policy Term Violation, and OAR 101-015-0040 would also apply. (a) “Intentional Violation” is a violation that has occurred in which PEBB has electronic or written documentation that the eligible employee took action resulting in a non-eligible member being enrolled in PEBB benefits. (b) “Unintentional Violation” is a violation that has occurred in which the eligible employee was not aware that such violation had occurred and there is no evidence of the eligible employee completing a paper form or logging in and enrolling an ineligible member in PEBB benefits. (2) “Policy Term Violations” means and includes a violation of the insurance carrier’s policy terms. The insurance carrier has primary responsibility in investigating such violations. Statutory/Other Authority: ORS 243.125 & ORS 243.061-302, 659A.060-069, 743.600-602 and 743.707 Statutes/Other Implemented: ORS 243 & ORS 243.061-302, 292.501 and 2007 OL Chap. 99 History: PEBB 5-2018, adopt filed 08/15/2018, effective 08/15/2018 PEBB 3-2018, temporary adopt filed 02/23/2018, effective 02/23/2018 through 08/21/2018
101-015-0035 Eligibility Violations (1) Unintentional Violation: (a) PEBB will remove from coverage an ineligible PEBB member due to eligibility or enrollment violations. Removal from all benefit plans will be retroactive to the date the individual is determined to have no longer been eligible, or the effective date of coverage if eligibility criteria was never met unless in conflict with federal healthcare reform. (b) When an eligibility or enrollment violation has been discovered and investigated, PEBB will notify the member and the Agency Human Resource Department with the outcome. (c) The member may be responsible for any claims paid during the period of time the member was enrolled inappropriately. (2) Intentional Violation: (a) The ineligible member shall be removed from coverage by PEBB. The ineligible member’s coverage will be retroactively terminated to the date the individual is determined to have no longer been eligible, or the effective date of coverage if eligibility criteria was never met. (b) PEBB may terminate the eligible employee along with remaining dependents from all plans excluding basic and mandatory plans selected by the agency. This will be a prospective termination lasting for a period of 12 months. The prospective termination will be effective the first day of the following month that the Intentional Violation was discovered. Statutory/Other Authority: ORS 243.125 & ORS 243.061-302, 659A.060-069, 743.600-602 and 743.707 Statutes/Other Implemented: ORS 243 & ORS 243.061-302, 292.501 and 2007 OL Chap. 99 History: PEBB 5-2018, adopt filed 08/15/2018, effective 08/15/2018 PEBB 3-2018, temporary adopt filed 02/23/2018, effective 02/23/2018 through 08/21/2018
101-015-0040 Policy Term Violations (1) A PEBB-contracted insurance carrier may remove from coverage and/or deny the claims of a PEBB member due to policy term violations. Removal from coverage for policy term violations is at the discretion of the insurance carrier. (a) If a policy term violation results in a termination from the plan or carrier that the violation was committed, it will not prevent the member from continuing enrollment in other PEBB types of coverages (e.g., medical, dental, vision, life, etc.), as long as they remain an employee and eligible for these benefits. (b) If an eligible employee commits a policy term violation and loses coverage, PEBB will remove the entire family from the insurance plan since the benefits are extended to his or her dependents through the eligible employee. If the eligible employee chooses to, and it is offered, they can enroll in a different carrier plan (if applicable). (c) If a dependent commits a policy term violation, PEBB will remove only the dependent from the insurance plan. If the eligible employee chooses to and it is offered, they can enroll in a different carrier plan (if applicable). (d) The PEBB member who is removed from a PEBB sponsored insurance plan may appeal the decision through the carrier that terminated coverage. (e) When a policy term violation has been discovered and investigated, the applicable insurance carrier will notify PEBB and the member with the outcome. (2) The insurance carrier may do the following when a member has violated a provision of the policy the PEBB member has enrolled in, committed fraudulent activity or misrepresentation: (a) The insurance carrier may retain the value of any expenditure it made related to the member who committed the fraudulent activity or misrepresentation. (b) The insurance carrier may deny future enrollments of the individual in accordance with the carrier’s policies. Statutory/Other Authority: ORS 243.125 & ORS 243.061-302, 659A.060-069, 743.600-602 and 743.707 Statutes/Other Implemented: ORS 243 & ORS 243.061-302, 292.501 and 2007 OL Chap. 99 History: PEBB 5-2018, adopt filed 08/15/2018, effective 08/15/2018 PEBB 3-2018, temporary adopt filed 02/23/2018, effective 02/23/2018 through 08/21/2018
101-015-0045 Eligibility Verifications and Reviews (1) PEBB shall plan and conduct eligibility verifications and reviews to monitor compliance with PEBB administrative rules. Reviews shall include, but are not limited to the following: (a) Dependent eligibility; (b) Employee eligibility; (c) Election change limitations; and (d) Plan enrollment limitations. (2) 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. The Eligible Employee is responsible to submit documentation upon request. (3) Dependent eligibility reviews shall be completed as needed. The Eligible Employee, Retiree, Self-Pay or COBRA participant is responsible to submit documentation upon request. In the event the required documentation is not provided to sufficiently prove the dependent meets eligibility requirements, or the documentation provided is insufficient, the dependent’s coverage will be terminated prospectively. 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 101-010-0005. (4) If an Eligible Employee does not complete the dependent eligibility review and moves to a different Agency under PEBB, their terminated dependent records may be locked in the PEBB benefit management system. The Eligible Employee must submit documentation to PEBB to be verified before the dependent records are unlocked. (5) An Eligible Employee adding a new or previous dependent to enrollments after failing to verify dependent eligibility will be required to provide DEV documentation along with the enrollment form to PEBB. Enrollments will not take effect until the verification of eligibility. The effective date of coverage is the first of the month following receipt of the form and all appropriate verification documents by PEBB. Statutory/Other Authority: ORS 243.061 to ORS 243.302 Statutes/Other Implemented: ORS 243.125(1) History: PEBB 1-2022, amend filed 03/31/2022, effective 03/31/2022 PEBB 9-2018, temporary amend filed 08/22/2018, effective 08/22/2018 through 02/17/2019 PEBB 5-2018, adopt filed 08/15/2018, effective 08/15/2018 PEBB 3-2018, temporary adopt filed 02/23/2018, effective 02/23/2018 through 08/21/2018
101-015-0050 Dependent Eligibility Verification and Review Appeals Dependent Eligibility Verifications and Review Appeals (1) Following the termination of dependents due to a dependent eligibility review, Eligible Employees, Retirees, Self Pays or COBRA participants may file an appeal and submit requested documentation within 60 days from the date coverage ended. (2) For Eligible Employees/Retirees/Self-Pay/COBRA, if the appeal and submitted requested documentation is received by PEBB prior to 60 days from the date coverage ended, and dependents are verified, PEBB will unlock the dependent records in the PEBB benefit management system and dependents will be added retrospectively. (3) For Eligible Employees/Retirees/Self-Pay/COBRA, if the appeal and submitted requested documentation is received by PEBB after 60 days from the date the coverage ended then dependents will be added prospectively. Statutory/Other Authority: ORS 243.125 & ORS 243.061-302, 659A.060-069, 743.600-602 and 743.707 Statutes/Other Implemented: ORS 243 & ORS 243.061-302, 292.501 and 2007 OL Chap. 99 History: PEBB 5-2018, adopt filed 08/15/2018, effective 08/15/2018 PEBB 3-2018, temporary adopt filed 02/23/2018, effective 02/23/2018 through 08/21/2018
101-020-0012 Working in Two or More Positions or for Two or More PEBB Participating Organizations (1) An individual working in two or more positions or for two or more PEBB participating organizations must work at least half-time or be in a current benefit eligible stability period to be eligible for PEBB-sponsored benefit plans. A benefit eligible employee in a job share position is not required to work at least half-time to meet benefit eligibility. (2) An eligible employee cannot receive more benefits than what one full time employee is eligible for. An eligible employee working in two or more positions may enroll for benefits through only one position. (3) The eligible employee’s enrollment will be completed with the PEBB participating organization with the highest percentage of FTE position. (a) When the employee’s FTE percentages with more than one PEBB participating organization are equal, the employee enrolls through the organization with the earlier appointment date. (b) When the employee has equal FTE percentages and simultaneous dates of employment with two or more PEBB participating organizations, the employee may choose the organization to enroll through. Statutory/Other Authority: ORS 243.061-302 Statutes/Other Implemented: ORS 243.061-302 History: PEBB 2-2016, f. & cert. ef. 8-24-16 PEBB 1-2015, f. & cert. ef. 5-12-15 PEBB 3-2014(Temp), f. & cert. ef. 11-12-14 thru 5-10-15 Renumbered from 101-040-0015, 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 1-2001, f. & cert. ef. 9-6-01 PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00
101-020-0018 Declining Benefits (1) An active eligible employee who declines PEBB core benefits waives the employee’s right to the benefit amount and enrollment in any PEBB sponsored plans. (2) An eligible employee may decline benefits at the time of hire or meeting eligibility, consistent with a qualifying midyear plan change event, or during the open enrollment period. (3) An eligible employee who previously declined benefits may enroll in benefit plans consistent with a qualifying midyear plan change event or during the open enrollment period. Statutory/Other Authority: ORS 243.061 - 243.302 Statutes/Other Implemented: ORS 243.061 - 302 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 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
101-020-0020 Newborn and Adopted Child Enrollment (1) An eligible employee's biological newborn child receives PEBB-sponsored medical and dental insurance coverage under the newborn's own coverage from the moment of birth through the first 31 days of life without completing PEBB forms. To continue coverage beyond the first 31 days of coverage the eligible employee must enroll the newborn child to their benefit plans within 30 days from the date of birth by submitting the correct enrollment update forms. (2) An eligible employee's newly adopted child receives PEBB-sponsored medical and dental insurance coverage under the adopted child's own coverage from the date of the adoption decree or date of placement for adoption through the first 31 days without completing PEBB forms. To continue coverage beyond the first 31 days of coverage the eligible employee must enroll the adopted child to their benefit plans within 30 days from the date of the decree or placement by submitting the correct enrollment update forms. (a) The eligible employee must submit the adoption agreement or placement agreement with the enrollment forms to the agency. Placement for adoption requires the submission of an Affidavit of Dependency with enrollment forms with legal documentation of the placement. Upon adoption completion, a copy of the finalized adoption document must be submitted to the employee’s agency. (b) Claims payment will not occur prior to the adoption decree or placement for adoption date. (3) A request to enroll a biological newborn or newly adopted child beyond 30 days of the date of birth, adoption decree, or placement for adoption is late enrollment as specified in OAR 101-020-0040. 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 1-2013, f. & cert. ef. 9-24-13 PEBB 2-2008, f. & cert. ef. 8-1-08 PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07 PEBB 1-2005, f. & cert. ef. 4-14-05 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