justicedao/ipfs_state_laws huggingface dataset:
111-040-0005 Termination Dates (1) Effective October 1, 2011, coverage ends on the last day of the month that eligibility is lost. Requests for coverage termination must be made consistent with a Qualified Status Change as defined by OAR 111-040-0040. (2) Retroactive termination of coverage may be made in the event of a delay in the entities’ reconciliation process and shall generally be within 14 days of receiving notification from the employee of the Qualified Status Change event and requested benefit changes. (3) Effective October 1, 2011, benefit coverage termination that is considered by OEBB to be intentional misrepresentation may be rescinded in compliance with the law. If this occurs, OEBB shall give the affected individual 30 days’ notice of the rescission of benefit coverage and an opportunity to appeal before the rescission takes effect. (4) Benefit coverage for active eligible employees ends on the last day of the month that they retire, unless otherwise determined in a collective bargaining agreement or documented Entity policy in effect on June 30, 2008. Benefit coverage may be continued based on the requirements and limitations in OARs 111-050-0001 through 111-050-0050. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 1-2024, amend filed 10/01/2024, effective 10/01/2024 OEBB 2-2014, f. & cert. ef. 3-7-14 OEBB 23-2013(Temp), f. & cert. ef. 12-27-13 thru 6-25-14 OEBB 9-2012, f. & cert. ef. 10-9-12 OEBB 4-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 23-2011, f. & cert. ef. 12-14-11 OEBB 3-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 14-2008, f. & cert. ef. 8-15-08 OEBB 12-2010(Temp), f. 9-30-10, cert. ef. 10-1-10 thru 1-29-11 OEBB 14-2008, f. & cert. ef. 8-15-08
111-040-0010 Newly-hired and Newly-eligible Employees (1) Newly-hired and newly-eligible employees must enroll in OEBB-sponsored benefit plans through the OEBB benefit management system or paper equivalent within 31 calendar days of the date of hire or date of gaining eligibility, unless determined otherwise in a separate OEBB administrative rule or in a collective bargaining agreement or documented Entity policy in effect on June 30, 2008. (2) An employee enrolling in OEBB-sponsored benefit plans and terminating employment before the effective date of benefit coverage is not eligible to receive benefits. Statutory/Other Authority: 2007 OL Ch. 7 Statutes/Other Implemented: 2007 OL Ch. 7 & Sec. 3 History: OEBB 2-2014, f. & cert. ef. 3-7-14 OEBB 23-2013(Temp), f. & cert. ef. 12-27-13 thru 6-25-14 OEBB 9-2012, f. & cert. ef. 10-9-12 OEBB 4-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 14-2008, f. & cert. ef. 8-15-08
111-040-0011 Returning to Benefit Eligible Status (1) A former eligible employee returning to benefit-eligible status with the same entity following an unpaid leave of absence, or termination of employment, or returning from a strike, lock-out, layoff, within six months of the date eligibility was lost will have their benefit plans and coverages reinstated. (a) All coverages and plans previously enrolled in will be effective the first of the month following the date eligibility is regained, unless otherwise stipulated in a collective bargaining agreement or documented Entity policy in effect on or before May 1, 2013. (b) Plan changes or changes to covered dependents may only be made if: (A) A Qualified Status Change occurred during the period of ineligibility, consistent with OAR 111-040-0040, and requested within 31 days of returning to benefit-eligible status, or (B) Benefits are being reinstated in a new plan year from which benefits were initially lost. (2) If reinstatement occurs within the same plan year, medical, dental and vision coverage will be reinstated at the same level as was in effect immediately prior to the loss of eligibility. (i.e., dental incentive levels, amounts applied toward deductibles, annual maximum out-of-pockets and benefit maximums), if applicable. (3) The Uniformed Services Employment and Reemployment Rights Act (USERRA). USERRA gives an employee and previously covered dependents the right to reinstate coverage upon returning to employment with the Entity in a benefit eligible position with no waiting period. Statutory/Other Authority: ORS 243.860 – 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 1-2024, amend filed 10/01/2024, effective 10/01/2024 OEBB 2-2014, f. & cert. ef. 3-7-14 OEBB 23-2013(Temp), f. & cert. ef. 12-27-13 thru 6-25-14 OEBB 3-2013, f. & cert. ef. 4-26-13
111-040-0015 Removing an Ineligible Individual from Benefit Plans (1) An employee who enrolls them self and/or an eligible person is responsible for removing spouses, domestic partners and children from their OEBB-sponsored benefit plans by submitting completed, applicable forms to their Entity benefits administrator within 31 calendar days after the date the individual becomes ineligible. Coverage ends on the date identified under OAR 111-040-0005. (2) An Entity is responsible for removing ineligible individuals from the OEBB benefits management system. The Entity must complete such removal within 14 calendar days after: (a) An event resulting in loss of the employee’s eligibility, or (b) The receipt of notification of an event resulting in loss of eligibility of the employee’s spouse, domestic partner or child. (3) If coverage of an employee’s spouse, domestic partner or child is terminated retroactively then: (a) The employee may be responsible for claims previously paid by the benefit plans to the providers during the period of ineligibility at the carrier’s discretion; and (b) Premium adjustments will be made retroactively based on the coverage end date. (4) OEBB shall conduct eligibility verifications and reviews to monitor compliance with OEBB administrative rules governing eligibility and enrollment. Eligibility reviews may occur at different times throughout the plan year. The member is responsible to submit documentation upon request. In the event the member does not provide the required documentation in a timely manner 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. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 5-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 2-2014, f. & cert. ef. 3-7-14 OEBB 23-2013(Temp), f. & cert. ef. 12-27-13 thru 6-25-14 OEBB 15-2013, f.& cert. ef. 10-23-13 OEBB 9-2012, f. & cert. ef. 10-9-12 OEBB 4-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 23-2011, f. & cert. ef. 12-14-11 OEBB 17-2011(Temp), f. 9-30-11, cert. ef. 10-1-11 thru 3-29-12 OEBB 3-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 14-2008, f. & cert. ef. 8-15-08 OEBB 12-2010(Temp), f. 9-30-10, cert. ef. 10-1-10 thru 1-29-11 OEBB 9-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11 OEBB 14-2008, f. & cert. ef. 8-15-08
111-040-0020 Open Enrollment (1) Eligible employees may make benefit plan changes or elections and add or remove eligible dependents during open enrollment periods as designated by OEBB. (2) Coverage under OEBB-sponsored benefits plans for an eligible individual added during open enrollment begins on the first day of the new plan year. Coverage for an individual terminated during open enrollment ends on the last day of the month of the current plan year. (3) Benefit plan elections are irrevocable for the new plan year except as specified in OAR 111-040-0040. (4) If optional life insurance is requested beyond the guarantee issued amount, Evidence of Insurability must be submitted to the OEBB life insurance carrier(s) by December 31. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 1-2024, amend filed 10/01/2024, effective 10/01/2024 OEBB 1-2019, amend filed 03/15/2019, effective 03/15/2019 OEBB 1-2018, temporary amend filed 09/24/2018, effective 09/25/2018 through 03/23/2019 OEBB 9-2012, f. & cert. ef. 10-9-12 OEBB 4-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 3-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 14-2008, f. & cert. ef. 8-15-08 OEBB 12-2010(Temp), f. 9-30-10, cert. ef. 10-1-10 thru 1-29-11 OEBB 14-2008, f. & cert. ef. 8-15-08
111-040-0030 Late Enrollment (1) Late enrollment occurs when an active eligible employee fails to notify their Entity of the Qualified Status Change within 31 calendar days, or unless otherwise specified in rule, of: (a) The date of hire or other benefit eligibility date as identified in OAR 111-040-0001; (b) The date a spouse, domestic partner, or child gains eligibility; (c) The date of marriage to a spouse who was most recently enrolled as a domestic partner; or (d) The date of birth of the employee’s biological newborn child; (e) The date the child was adopted or the date the employee became the legal guardian. (2) OEBB authorizes Entities to add and/or enroll employees and dependents within 45 calendar days of the eligibility dates referenced in sections (1)(a), (1)(b), and (1)(c) and within 60 calendar days of the eligibility dates referenced in (1)(d) and (1)(e). (3) OEBB must review and approve all late enrollment requests based on OAR 111-080-0030 when the request and enrollment is made more than 45 calendar days after the eligibility dates referenced in sections (1)(a), (1)(b), and (1)(c), and more than 60 calendar days after the eligibility dates referenced in sections (1)(d) and (1)(e). (4) Approved late enrollment requests, unless determined otherwise in a collective bargaining agreement or documented district policy in effect on June 30, 2008, are effective the first of the month following the date the request is received by an Entity benefits administrator or OEBB, except for approved requests to add newborn children or newly adopted child which are retroactive to the month the child was born or adopted along with any premium adjustments. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 2-2014, f. & cert. ef. 3-7-14 OEBB 23-2013(Temp), f. & cert. ef. 12-27-13 thru 6-25-14 OEBB 9-2012, f. & cert. ef. 10-9-12 OEBB 4-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 3-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 21-2009, f. & cert. ef. 12-17-09 OEBB 9-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11 OEBB 21-2009, f. & cert. ef. 12-17-09 OEBB 14-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10 OEBB 14-2008, f. & cert. ef. 8-15-08
111-040-0055 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 OEBB/OEBB or OEBB/PEBB medical plans. (b) PEBB means the Public Employees’ 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 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. (e) Surcharge means an extra fee deducted from the employee’s monthly pay. (2) Double Coverage: (a) Effective October 1, 2020, any active full-time subscriber/employees who covers an eligible dependent that is also enrolled as a subscriber on either an OEBB or PEBB medical plan will be assessed a monthly surcharge. (b) The amount of the surcharge is determined annually by the OEBB 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 covered. (e) The surcharge does not apply to Retirees, COBRA participants, self-pay participants, part-time employees or medical opt-outs. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.866(2) & ORS 243.864(1)(a) History: OEBB 1-2021, adopt filed 01/08/2021, effective 01/08/2021 OEBB 5-2020, temporary adopt filed 10/15/2020, effective 10/15/2020 through 04/12/2021
111-050-0015 Medical, Dental and Vision Termination Dates for Early Retirees (1) An Eligible Early Retiree enrolled in OEBB early retiree insurance plan that becomes eligible for Medicare coverage may not continue on an OEBB medical or vision plan, unless they are eligible as a result of end-stage renal disease. OEBB benefits end the last day of the month prior to the Medicare effective date. The retiree is responsible for reporting to their Entity and to OEBB when the retiree is covered by Medicare within 31 days after the Medicare coverage effective date. Failure to report within this timeframe may be considered intentional misrepresentation by OEBB and OEBB may rescind OEBB coverage back to the last day of the month prior to the Medicare effective date. (2) If an Eligible Early Retiree becomes eligible for Medicare coverage, but his or her currently-enrolled eligible dependents are not, these eligible individuals may continue OEBB medical, dental and vision insurance coverage until such time as they no longer meet OEBB eligibility requirements or become eligible for Medicare coverage for reasons other than end-stage renal disease, whichever occurs first. The eligible individuals must confirm intent to continue coverage with the retiree plan administrator within 31days after the retiree’s eligibility for Medicare. (3) Eligible dependents who were covered on a plan at the time of retirement who are eligible for Medicare, or who become eligible for Medicare, may not continue coverage on an OEBB medical or vision plan unless it is stated in a collective bargaining agreement or documented entity policy in effect on or before February 1, 2010, that they may continue on OEBB medical plans until the retiree becomes eligible for Medicare with the following exception: OEBB coverage must end for Medicare-eligible dependents of a retiree enrolled on a Kaiser Permanente medical plan. (4) If the Eligible Early Retiree is responsible for self-paying all or partial premiums and fails to remit the premium amount to their Entity, all coverage will terminate on the last day of the month in which premiums are paid in full to OEBB. (5) Dental coverage may be continued subject to the Entity’s documented policy or collective bargaining agreement. Coverage is based on the OEBB dental plans that the Entity offers to retired OEBB Medicare-eligible individuals. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 6-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 10-2012, f. & cert. ef. 10-9-12 OEBB 5-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 24-2011, f. & cert. ef. 12-14-11 OEBB 18-2011(Temp), f. 9-30-11, cert. ef. 10-1-11 thru 3-29-12 OEBB 4-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 1-2010, f. & cert. ef. 2-1-10 OEBB 13-2010(Temp), f. 9-30-10, cert. ef. 10-1-10 thru 1-29-11 OEBB 1-2010, f. & cert. ef. 2-1-10 Reverted to OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 15-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10 OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 7-2008, f. & cert. ef. 4-15-08 OEBB 2-2007(Temp), f. & cert. ef. 9-21-07 thru 3-18-08
111-050-0016 Life and Accidental Death and Dismemberment Termination Dates for Early Retirees (1) Eligible Early Retirees may continue to participate in any or all coverage and plan options selected by the Entity for his or her Employee Group until they reach age 65, unless otherwise specified in a documented entity policy or collective bargaining agreement effective on or before February 1, 2010. (2) Eligible Early Retirees or dependents of retirees who lose eligibility for basic or optional life insurance plans due to reaching age 65 can convert their coverage if requested within 31 days of the date the coverage ends. Requests for conversion of coverage must be made to the Life and AD&D insurance carrier. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 6-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 10-2012, f. & cert. ef. 10-9-12 OEBB 5-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 4-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 1-2010, f. & cert. ef. 2-1-10 OEBB 10-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11 OEBB 1-2010, f. & cert. ef. 2-1-10
111-050-0025 Effective Dates (1) Benefit plan changes or initial elections, unless otherwise specified in a collective bargaining agreement or documented entity policy in effect on June 30, 2008, are effective on the first of the month following termination of the active employee coverages. (2) Effective Dates for Qualified Status Changes. Covered dependent changes are effective the first of the month following the date of the event causing the dependent to be eligible under OEBB administrative rules with the following exceptions: (a) Coverage for a newborn child is effective on the date of birth. Retired eligible employee must add the newborn child to their benefit plans within 60 calendar days from the date of birth for the newborn child to be eligible for benefit coverage. (b) Coverage for a newly adopted child is effective the date of the adoption decree or date of placement for adoption. Retired eligible employee must add the adopted child to their benefit plans within 60 calendar days from the date of the decree or placement for the newly adopted child to be eligible for benefit coverage; and (A) Eligible Early Retiree must submit the adoption agreement with the enrollment forms to the Entity. (B) Claims payments will not be made for expenses incurred prior to the date of decree or placement. (c) Coverage for an eligible grandchild is as follows: (A) If the legal guardianship is finalized within the first 60 days following the birth of the grandchild, coverage will be effective retroactive to the date of the birth. (B) If the legal guardianship is finalized 61 or more days from the date of birth of the grandchild, the coverage will be effective the first of the month following the date the guardianship documents are finalized. (C) If the legal guardianship is finalized 61 to 180 days from the date of birth of the grandchild, and the effective date of legal guardianship is retroactive to the grandchild’s date of birth, coverage will be effective retroactive to the date of birth. If legal guardianship is finalized after 180 days coverage will be effective the first of the month following the date the guardianship documents are finalized. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 6-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 10-2012, f. & cert. ef. 10-9-12 OEBB 5-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 24-2011, f. & cert. ef. 12-14-11 OEBB 18-2011(Temp), f. 9-30-11, cert. ef. 10-1-11 thru 3-29-12 OEBB 4-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 1-2010, f. & cert. ef. 2-1-10 OEBB 10-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11 OEBB 1-2010, f. & cert. ef. 2-1-10 Reverted to OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 15-2009(Temp), f. & cert. ef. 7-31-09 thru 1-26-10 OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 13-2008(Temp), f. & cert. ef. 8-15-08 thru 2-11-09
111-050-0030 Correcting Enrollment and Processing Errors (1) Enrollment Errors. Enrollment errors occur when an Eligible Early Retiree employee provides incorrect information or fails to make correct selections when making benefit plan changes. The Eligible Early Retiree is responsible for identifying enrollment errors or omissions. (a) OEBB authorizes Entities to correct enrollment errors reported by the Eligible Early Retiree within 45 calendar days of the original eligibility date, annual plan change period end date, or Qualified Status Change date. (b) Enrollment errors identified after 45 calendar days of the eligibility date, annual plan change period end date or Qualified Status Change date must be submitted to OEBB for review and approval based on OAR 111-080-0030. (2) Benefit Administrator Processing Errors. Processing errors or omissions occur when benefit plan changes are processed incorrectly in the benefit system. (a) OEBB authorizes Entities to correct processing errors identified within 45 calendar days of the eligibility date, annual plan change period end date, or Qualified Status Change date. Entities must reconcile all premium discrepancies. (b) Processing errors identified after 45 calendar days of the eligibility date, annual plan change period end date, or Qualified Status Change date must be submitted to OEBB for review and approval based on OAR 111-080-0030. If approved, corrections are retroactive to the original effective date as identified in 111-040-0001. The Entity must reconcile all premium discrepancies within 30 calendar days of any adjustments made in the system. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 6-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 10-2012, f. & cert. ef. 10-9-12 OEBB 5-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 24-2011, f. & cert. ef. 12-14-11 OEBB 18-2011(Temp), f. 9-30-11, cert. ef. 10-1-11 thru 3-29-12 OEBB 4-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 13-2010(Temp), f. 9-30-10, cert. ef. 10-1-10 thru 1-29-11 OEBB 10-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11 OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 13-2008(Temp), f. & cert. ef. 8-15-08 thru 2-11-09
111-050-0035 Late Enrollment (1) Late enrollment occurs when an Eligible Early Retiree fails to enroll for benefits within 60 days of retirement or fails to notify their Entity of the Qualified Status Change within 31 calendar days of: (a) The date a spouse, domestic partner, or child gains eligibility; (b) The date of marriage to a spouse who was most recently enrolled as a domestic partner; or (c) The date of birth of the retired eligible employee’s biological newborn child. (d) The date the child was adopted of the date the retiree became the legal guardian. (2) OEBB authorizes Entities to add and/or enroll Eligible Early Retirees and dependents within 45 calendar days of the eligibility dates referenced in sections (1)(a) and (1)(b), and within 60 calendar days of the eligibility dates referenced in (1)(c) and (1)(d). (3) OEBB must review and approve all late enrollment requests based on OAR 111-080-0030 when the request and enrollment is made more than 45 calendar days after the eligibility dates referenced in sections (1)(a) and (1)(b), and more than 60 calendar days after the eligibility dates referenced in sections (1)(c) and (1)(d). (4) Approved late enrollment requests, unless determined otherwise in a collective bargaining agreement or documented entity policy in effect on June 30, 2008, are effective the first of the month following the date the request is received by a district benefits administrator or OEBB, except for approved requests to add newborn children or newly adopted child which are retroactive to the month the child was born or adopted along with any premium adjustments. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 6-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 10-2012, f. & cert. ef. 10-9-12 OEBB 5-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12 OEBB 4-2011, f. & cert. ef. 2-11-11 Reverted to OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 10-2010(Temp), f. & cert. ef. 8-3-10 thru 1-29-11 OEBB 3-2009, f. & cert. ef. 1-30-09 OEBB 13-2008(Temp), f. & cert. ef. 8-15-08 thru 2-11-09