justicedao/ipfs_state_laws huggingface dataset:
111-050-0045 Termination Dates (1) Effective October 1, 2011, if an Eligible Early Retiree requests a termination of coverage for them self, a spouse, a domestic partner, or a child, 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 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 Eligible Early Retiree 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October 1, 2011, benefit coverage termination that is considered by OEBB to be intentional misrepresentation may be rescinded in compliance with the law.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 a spouse, domestic partner, or child ends on the last day of the month that a retired eligible employee dies, unless otherwise determined by a collective bargaining agreement or documented entity policy in effect on June 30, 2008. 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 3-2009, f. & cert. ef. 1-30-09 OEBB 13-2008(Temp), f. & cert. ef. 8-15-08 thru 2-11-09
111-050-0050 Removing an Ineligible Individual from Benefit Plans (1) An Eligible Early Retiree who enrolls themselves and/or an eligible person is responsible for removing ineligible 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 111-050-0045. (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 Early Retiree’s eligibility, or (b) The receipt of notification of an event resulting in loss of eligibility of the Early Retiree’s spouse, domestic partner or child. (3) If coverage of an Early Retiree’s spouse, domestic partner or child is terminated retroactively then: (a) The Early Retiree 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. (3) OEBB long term care carrier(s) will transfer the coverage from a Group Long Term Care to an Individual Long Term Care policy and premiums will be paid directly to the carrier upon request. 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 16-2013, f. & cert. ef. 10-23-13 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
111-050-0060 Continuation of Coverage for Eligible Employees Covered under the Federal Family Medical Leave Act OEBB will allow Entities to continue medical, dental and vision coverage for Active Eligible Employees when the employee is granted leave under the Federal Family Medical Leave Act (FMLA) as required under related federal rules and regulations. 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 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 16-2008(Temp), f. & cert. ef. 10-16-08 thru 4-13-09
111-050-0065 Continuation of Coverage for Eligible Employees Covered under the Oregon Family Leave Act OEBB will allow Entities to continue medical, dental and vision coverage for Active Eligible Employees when the employee is granted leave under the Oregon Family Leave Act (OFLA) as required under related state rules and regulations. 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 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 16-2008(Temp), f. & cert. ef. 10-16-08 thru 4-13-09
111-050-0070 Continuation of Coverage for Eligible Employees during an Approved Leave of Absence. OEBB will allow Entities to continue medical, dental and vision coverage for Active Eligible Employees when the employee is granted a leave of absence based on collective bargaining agreements and/or documented entity policies in effect on or before October 1, 2008. 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 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 16-2008(Temp), f. & cert. ef. 10-16-08 thru 4-13-09
111-050-0075 Continuation of coverage for Eligible Employees on Active Military Service OEBB will allow Entities to continue medical, dental, and vision coverage for Active Eligible Employees as required under the Uniformed Services Employment and Reemployment Rights Act (USERRA) and related federal rules and regulations. 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 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 16-2008(Temp), f. & cert. ef. 10-16-08 thru 4-13-09
111-050-0080 Portability and Conversion of Coverage (1) OEBB medical, life and accidental death and dismemberment carrier(s) will make portability plans available to members in accordance with related state and federal laws, rules and regulations. Eligibility criteria for this coverage can be found in carrier member handbooks. (2) OEBB life insurance carrier(s) will make conversion plans available to members in accordance with related state and federal laws, rules and regulations. Eligibility criteria for this coverage can be found in the carrier’s member handbook. (3) OEBB long term care carrier(s) will transfer the coverage from a Group Long Term Care to an Individual Long Term Care policy and premiums will be paid directly to the carrier upon request. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: 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 16-2008(Temp), f. & cert. ef. 10-16-08 thru 4-13-09
111-065-0001 Definitions For the purpose of this rule: (1) “Direct Debit” for purposes of this OAR refers to a payment through an Automated Clearing House (ACH) credit or ACH debit that initiates the movement of funds electronically from the early retiree’s individual banking account within the United States to the OEBB Treasury account. (2) “OEBB Administered Early Retiree” means an individual who meets the definition of Eligible Early Retiree in OAR 111-010-0015 and whose benefits are administered by OEBB. (3) “Overpayment” means the amount of the Early Retiree’s monthly payment to OEBB that exceeded the amount due. (4) “Payment in full” means payment received by OEBB which is equal to the current monthly amount due for all benefit premiums which the early retiree is currently enrolled in. (5) “Underpayment” means a payment submitted on or before the due date by the Early Retiree that is less than the invoiced amount. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 11-2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
111-065-0005 Untitled The following administrative rules in Division 65 apply to OEBB Administered Early Retirees in addition to OEBB’s Division 50 rules which apply to all Early Retirees. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 11-2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
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. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 5-2013, f. & cert. ef. 7-12-13 OEBB 2-2013(Temp), f. & cert. ef. 4-22-13 thru 10-18-13 OEBB 11 2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
111-065-0015 Early Retiree Payment Methods and Due Dates (1) Premium payments will be made through Direct Payment via ACH (ACH Debit) 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 SCH 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) An Exception Request Form must be complete including the reason why or special circumstance that would not allow the member to submit payment via ACH 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 an Exception Request Form declining to use the Direct Debit payment method, a $35.00 processing fee shall be applied to the Early Retiree’s monthly premium. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 5-2013, f. & cert. ef. 7-12-13 OEBB 2-2013(Temp), f. & cert. ef. 4-22-13 thru 10-18-13 OEBB 11 2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
111-065-0020 Early Retiree Overpayments (1) OEBB will include overpayment amounts on the monthly invoice. The invoice will include the total payment received, the date it was received, the amount of premium payment due, and any remaining balance of additional premiums paid. (2) OEBB will automatically apply any overpayments to the next month’s premium due. The Early Retiree may complete a Request for Reimbursement form if a refund of an overpayment is desired. The Early Retiree may be responsible for processing fees associated with refunds less than $100. Reimbursements will be refunded via check. (3) Remaining balances on coverage that has ended will be refunded in full within 30 days of the coverage end date or the date OEBB is notified that coverage should end, whichever occurs later. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 11-2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
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. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 5-2013, f. & cert. ef. 7-12-13 OEBB 2-2013(Temp), f. & cert. ef. 4-22-13 thru 10-18-13 OEBB 11 2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
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. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 5-2013, f. & cert. ef. 7-12-13 OEBB 2-2013(Temp), f. & cert. ef. 4-22-13 thru 10-18-13 OEBB 11 2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
111-065-0035 Appeals Early Retirees have the right to use the OEBB Appeals and Administrative Review process as defined in OAR 111-080-0030. (1) Early Retirees may appeal OEBB’s eligibility decision. (2) Early Retirees have the right to request a review of benefit and claim issues that are not resolved following the completion of the carrier appeal process. Administrative Review requests relating to denied benefits are limited to a determination of whether or not a benefit was intended to be covered under the current contract. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 11-2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
111-065-0040 Continuation of Coverage (1) Early Retirees and dependents have COBRA rights consistent with 111-050-0001. (2) Loss of coverage due to failure to make a premium payment is not a Qualified Status Change. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 7-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 11-2012, f. & cert. ef. 10-9-12 OEBB 6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12
111-080-0001 Payment Methods and Dates (1) For the purpose of this rule: (a) "ACH credit" means a payment initiated by an Entity that is cleared through the Automated Clearing House (ACH) network for deposit to the OEBB account; (b) "ACH debit" means a payment initiated by OEBB and cleared through the ACH network to debit an Entity's account and credit the OEBB account; (c) “Due date” means the seventh business day into the current month of coverage; (d) "Electronic funds transfer" refers to a payment through ACH credit or ACH debit; (e) “Entity Payment” means the monthly entity payment to OEBB that includes the contributions of both the Entity and members required to pay the monthly premiums for selected OEBB benefit plans; (f) “Entity Payment Invoice" means a monthly itemized statement provided by OEBB that includes the contributions of both the entity and members required to pay the monthly premiums for selected OEBB benefit plans; (2) Entities will receive a final Entity Payment Invoice from OEBB on the first of the month that details the payments due for that month. (3) If the final Entity Payment Invoice is received on a weekend or legal holiday the receipt date is recognized as the next business day. (4) Entities are required to submit payment to OEBB through electronic funds transfer no later than the due date. (5) OEBB reserves the right to issue surcharges or other appropriate measures to Entities that submit monthly payments after the due date. (6) Entities will select an electronic funds transfer method by: (a) Submitting an electronic funds transfer authorization form to OEBB by August 15th for payments starting October 1st of the plan year; (b) Submitting a new electronic funds transfer authorization form to OEBB by August 15th to change the type of payment or update their account information starting October 1st of the plan year. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 9-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 4-2009, f. & cert. ef. 1-30-09 OEBB 11-2008(Temp), f. & cert. ef. 8-13-08 thru 2-6-09
111-080-0005 Overpayments and Underpayments (1) For the purpose of this rule: (a) “Overpayment” means the amount of an Entity's monthly payment to OEBB that exceeded the amount due. (b) “Underpayment” means a payment submitted by an Entity that is less than the invoiced amount. (2) Entities seeking a refund of overpayments must: (a) Notify OEBB within 90 calendar days from the date overpayment occurred; (b) OEBB will resolve member overpayments by requesting a refund from the carrier in accordance with the law. The carrier shall refund the premium to OEBB back to the date of the termination or the date allowed by law for recoupment of paid claims. (c) OEBB will generally reimburse Entity overpayments through adjustments to future monthly payments. (3) The Entity shall submit any underpayment to OEBB as soon as it is discovered. (4) OEBB reserves the right to issue surcharges or use other appropriate means for Entities that submit underpayments. Statutory/Other Authority: ORS 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 9-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 25-2011, f. & cert. ef. 12-14-11 OEBB 19-2011(Temp), f. 9-30-11, cert. ef. 10-1-11 thru 3-29-12 OEBB 4-2009, f. & cert. ef. 1-30-09 OEBB 11-2008(Temp), f. & cert. ef. 8-13-08 thru 2-6-09
111-080-0040 Eligibility and Policy Term Violations — Definitions For the purposes of OAR 111-080-0045 and 111-080-0050, the following definitions will apply: (1) “Eligibility or Enrollment Violations” means and includes a violation of the OEBB's eligibility or enrollment rules or policies including fraud or material misrepresentation. Misstatements, misrepresentations, omissions or concealments on the part of the OEBB member are not fraudulent unless they are made with intent to knowingly defraud. OEBB 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 111-080-0050 would also apply. (a) “Intentional Violation” is a violation that has occurred in which OEBB has electronic or written documentation that the eligible employee took action resulting in a non-eligible member being enrolled in OEBB 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 OEBB 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 243.860 – 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) History: OEBB 9-2017, amend filed 11/07/2017, effective 11/07/2017 OEBB 12-2011, f. & cert. ef. 6-22-11 OEBB 8-2011(Temp), f. & cert. ef. 2-15-11 thru 8-13-11 OEBB 16-2010, f. & cert. ef. 12-10-10