reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 5 - PROCUREMENT AND CONTRACTING FOR BENEFIT PLANS AND SERVICES › Section 111-005-0047 - Renewal Process

Current through Register Vol. 63, No. 7, July 1, 2024
Renewal process. OEBB may renew Contracts with Contractors for
				as many years as OEBB determines is in the best interest of the state, Eligible
				Employees, Dependents, Eligible Domestic Partners, and Eligible Early Retirees.
				OEBB may invite renewal proposals from those Contractors who provided the same
				or similar Benefit Plans or services in the year immediately prior. A Benefit
				Plan or services Contract is similar if it is reasonably related to the scope
				of work described in the Procurement under which such a Contract was awarded.
Stat. Auth.: ORS
				  243.860 - 243.886
Stats. Implemented: ORS
				  243.864
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 5 - PROCUREMENT AND CONTRACTING FOR BENEFIT PLANS AND SERVICES › Section 111-005-0048 - Emergency Contract Process

Current through Register Vol. 63, No. 7, July 1, 2024
OEBB may select a Contractor to provide Benefit Plans or
				services without following any of the procedures under OAR
				111-005-0040,
				111-005-0042,
				111-005-0044,
				or
				111-005-0046 when required by Emergency. OEBB will determine if an Emergency exists, declare
				the Emergency, and negotiate a Contract with the Contractor based on the
				following criteria: Contractor availability; capability; experience; approach;
				compensation requirements; previous litigation and remedy applied; customer
				service history with the OEBB, members and clients; debarment status; and
				references. OEBB will place emphasis on employee choice among high-quality
				plans, plan performance and information, a competitive marketplace, employer
				flexibility in plan design and contracting, quality customer service,
				creativity, affordability, and innovation and the improvement of employee
				health.
Stat. Auth.: Ch. 7 OL 2007
Stats. Implemented: Sec. 19, Ch. 7 OL
				  2007
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 5 - PROCUREMENT AND CONTRACTING FOR BENEFIT PLANS AND SERVICES › Section 111-005-0050 - Mistakes

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Treatment of
			 mistakes. If OEBB discovers certain mistakes in a Proposal before award of the
			 Contract, and the mistakes are not identified as those qualifying as
			 non-responsive to the specifications of the Procurement, OEBB may take the
			 following action:
(a) Waive or permit a
			 Proposer to correct a minor informality. A minor informality is a matter of
			 form rather than substance that is evident on the face of the Proposal, or an
			 insignificant mistake that can be waived or corrected without prejudice to
			 other Proposers. Mistakes including, but not limited to, signatures not affixed
			 to the Proposal document, Proposals sent to the incorrect address, insufficient
			 number of Proposals submitted, or incorrect format will not be considered
			 minor.
(b) Correct a clerical error
			 if the intended Proposal and the error are evident on the face of the Proposal,
			 or other documents submitted with the Proposal, and the Proposer confirms the
			 correction in writing. A clerical error includes, but is not limited to, a
			 Proposer's error in transcribing its Proposal.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 5 - PROCUREMENT AND CONTRACTING FOR BENEFIT PLANS AND SERVICES › Section 111-005-0055 - Responsible Proposer

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Before awarding a Contract, OEBB must establish that the Proposer meets the
			 applicable standards of responsibility. OEBB shall prepare a written
			 determination of non-responsibility for a Proposer if OEBB determines that the
			 Proposer does not meet the standards of responsibility.
(2) In determining whether a Proposer has met
			 the standards of responsibility, OEBB shall consider whether a Proposer:
(a) Has available the appropriate financial,
			 material, equipment, facility and personnel resources and expertise, or has the
			 ability to obtain the resources and expertise, necessary to meet all
			 contractual responsibilities.
(b)
			 Completed previous contracts of a similar nature with a satisfactory record of
			 performance. For purposes of this paragraph, a satisfactory record of
			 performance means that to the extent that the costs associated with and time
			 available to perform a previous contract remained within the Proposer's
			 control, the Proposer stayed within the time and budget allotted for the
			 procurement and otherwise performed the contract in a satisfactory manner. OEBB
			 shall document the Proposer's record of performance if OEBB finds under this
			 paragraph that the Proposer is not responsible.
(c) Has a satisfactory record of integrity.
			 In evaluating the Proposer's record of integrity, OEBB may consider, among
			 other things, whether the Proposer has previous criminal convictions for
			 offenses related to obtaining or attempting to obtain a contract or subcontract
			 or in connection with the Proposer's performance of a contract or subcontract.
			 OEBB shall document the Proposer's record of integrity if OEBB finds under this
			 paragraph that the Proposer is not responsible.
(d) Is legally qualified to contract with
			 OEBB.
(e) Supplied all necessary
			 information in connection with the inquiry concerning responsibility. If a
			 Proposer fails to promptly supply information concerning responsibility that
			 OEBB requests, OEBB shall determine the Proposer's responsibility based on
			 available information or may find that the Proposer is not responsible.
(f) Was not debarred by OEBB in
			 accordance with ORS 279B.130.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 5 - PROCUREMENT AND CONTRACTING FOR BENEFIT PLANS AND SERVICES › Section 111-005-0080 - Contract Amendments

Current through Register Vol. 63, No. 7, July 1, 2024
OEBB may amend a Contract without additional competition in any
				of the following circumstances:
(1)
			 The amendment is within the scope of the underlying Procurement.
(2) These rules otherwise permit OEBB to
			 award a Contract without competition for the goods or services to be procured
			 under the amendment.
(3) The
			 amendment is necessary to comply with a change in law that affects performance
			 of the Contract.
(4) The amendment
			 results from renegotiation of the terms and conditions, including the contract
			 price, of a Contract and the amendment is advantageous to OEBB, subject to all
			 of the following conditions:
(a) The work or
			 services to be provided under the amended Contract are the same as the work or
			 services to be provided under the unamended Contract.
(b) OEBB determines that the amended Contract
			 is at least as favorable to OEBB as the unamended Contract.
(c) The amended Contract does not have a
			 total term greater than allowed in the underlying Procurement after combining
			 the initial and extended terms.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 10 - DEFINITIONS › Section 111-010-0015 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless the context indicates otherwise, as used in OEBB
				administrative rules, the following definitions will apply:
(1) "Actuarial value" means the expected
			 financial value for the average member of a particular benefit plan.
(2) "Adverse Benefit Determination" means a
			 denial, reduction, or termination of, or a failure to provide or make payment
			 (in whole or in part), for a benefit, including any such denial, reduction,
			 termination, or failure to provide or make payment that is based on but not
			 limited to:
(a) A determination of a member's
			 eligibility to participate in the plan;
(b) A determination that the benefit is not a
			 covered benefit; or
(c) A
			 rescission of coverage, whether or not, in connection with rescission, there is
			 an adverse effect on any particular benefit.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 15 - ELIGIBILITY RULES › Section 111-015-0001 - Eligible Individuals

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Unless otherwise defined under a separate OEBB administrative rule or a
			 collective bargaining agreement or documented district policy in effect on July
			 1, 2007, the following individuals are eligible to participate in
			 OEBB-sponsored benefit plans:
(a) An eligible
			 employee as defined in OAR 111-010-0015;
(b) A spouse or eligible domestic partner as
			 defined by OAR 111-010-0015;
(c) A
			 child as defined by OAR 111-010-0015.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 15 - ELIGIBILITY RULES › Section 111-015-0005

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  243.860  - 243.886
Statutes/Other Implemented: ORS
				  243.864(1)(a)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 20 - PROGRAM PARTICIPATION › Section 111-020-0001 - Initial Employee Group Phase-in

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any employee group in Subject Districts
			 or Provisional Non-subject Districts may elect to participate in benefit plans
			 provided by the Board beginning on October 1, 2008, October 1, 2009, or October
			 1, 2010, without having to meet the phase-in requirements outlined under
			 Sections 2, 3 and 4; however:
(a) Eligible
			 employees of a Subject District who are represented under a collective
			 bargaining agreement with an end date of July 1, 2007, through June 30, 2008,
			 must participate in benefit plans provided by the Board beginning October 1,
			 2008.
(b) Eligible employees of a
			 Subject District who are represented under a collective bargaining agreement
			 with an end date of July 1, 2008, through June 30, 2009, must participate in
			 benefit plans provided by the Board beginning October 1, 2009.
(c) Eligible employees of a Subject District
			 who are represented under a collective bargaining agreement with an end date on
			 or after July 1, 2009, must participate in benefit plans provided by the Board
			 beginning October 1, 2010.
(d)
			 Eligible employees of a Subject District who are not represented under a
			 collective bargaining agreement must participate in benefit plans provided by
			 the Board consistent with the requirements governing eligible employees of the
			 Subject District who are represented under a collective bargaining contract as
			 outlined under section 1(a), (b) and (c) above. If more than one collective
			 bargaining contract exists in the Subject District, the earliest collective
			 bargaining contract end date must be applied. If no employee group in the
			 Subject District is represented through a collective bargaining agreement, all
			 eligible employees of the district must participate in benefit plans provided
			 by the Board beginning October 1, 2008.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 20 - PROGRAM PARTICIPATION › Section 111-020-0005 - Employee Group Phase-in for Non-subject Districts

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An Employee Group in a Non-subject
			 District may elect to participate in a benefit plan provided by the Board on
			 October 1, 2008, or on October 1 of any following year, or on another date if
			 moving from a plan year other than October 1 through September 30.
(2) An Employee Group in a Non-subject
			 District electing to participate in benefit plans provided by the Board under
			 section 1 must provide notice of such election not later than June 30 of the
			 year in which they plan to move to the OEBB benefit plans on October 1, or at
			 least 90 days or more from the date benefits under OEBB will go into effect if
			 moving from a plan year other than October 1 through September 30.
(3) An Employee Group in a Non-subject
			 District who elects to participate in benefit plans provided by the Board
			 cannot return to benefit plans provided or administered by an entity other than
			 the Board.
Stat. Auth.: ch.7, OL 2007
Stats. Implemented: Sec.14, ch. 7, OL 2007, Sec.16, ch. 7, OL
				  2007
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 20 - PROGRAM PARTICIPATION › Section 111-020-0010 - Entities Electing to Join OEBB

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Effective January 1, 2014 an Entity can
			 elect to participate in benefit plans provided by the Board subject to the
			 following conditions:
(a) The Entity
			 completes and submits a Notice of Intent to join OEBB at least 90 days prior to
			 the date OEBB coverage is to go into effect;
(b) OEBB will not transfer any deductibles or
			 annual out-of-pocket maximums met with the prior carrier;
(c) For those members with an existing life
			 insurance policy through the Entity, OEBB will transfer the life insurance
			 amount in force on the last day the prior group coverage was in effect, rounded
			 to the next highest $10,000 increment, if requested and documented by the
			 Entity.
(d) Early retiree
			 participation in the OEBB plans will be limited to those individuals and
			 eligible dependents currently enrolled in the Entity's medical, dental and/or
			 vision plans and those Early Retirees who retire on or after the effective date
			 of OEBB coverage and their eligible dependents.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 30 - PLAN DESIGN DEVELOPMENT AND SELECTION › Section 111-030-0010 - Medical, Pharmaceutical, Dental and Vision Plan Selection Criteria

Current through Register Vol. 63, No. 7, July 1, 2024
Entities may choose or allow all medical, dental and vision
				plans available in the service area to be available to some or all Entity
				Employee Groups with the following exceptions:
(1) The HMO vision plan offered through
			 Kaiser Permanente is only available if the HMO medical plan offered through
			 Kaiser Permanente is available.
(2)
			 Moda Health Evergreen Medical Plan and Moda Health Fir Medical Plan may be
			 offered as a stand-alone medical plan, or may be paired with a Health Savings
			 Account (HSA). These plans are incompatible with an Integrated Post-Deductible
			 Health Reimbursement Arrangement (HRA).
(3) Kaiser Permanente Medical Plan 3 may be
			 offered as a stand-alone medical plan, or may be paired with a Health Savings
			 Account (HSA) or Health Reimbursement Arrangement (HRA).
Statutory/Other Authority: ORS
				  243.860-243.886
Statutes/Other Implemented: ORS
				  243.864(1)(a))
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 30 - PLAN DESIGN DEVELOPMENT AND SELECTION › Section 111-030-0011 - Bronze Medical Plan Offering

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Effective October 1, 2015, a bronze
			 medical plan option or options will be available for entities to offer
			 employees who:
(a) Meet the definition of a
			 full-time employee under the Affordable Care Act (ACA);
(b) Are not employed in a benefit-eligible
			 position or eligible for benefits under a collective bargaining agreement; and
(c) Do not receive any form of
			 benefit contribution from the entity.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 30 - PLAN DESIGN DEVELOPMENT AND SELECTION › Section 111-030-0040 - Long Term Care (LTC) Benefit Plan Selection Criteria

Current through Register Vol. 63, No. 7, July 1, 2024
Entities may select or allow LTC options to be available for or
				to each Employee Group unless otherwise specified in an OEBB administrative
				rule. OEBB offers employer-paid and employee-paid LTC options.
(1) Employee-paid LTC is a voluntary plan
			 where members can choose to enroll. No minimum enrollment requirement.
(2) Employer-paid LTC requires 100
			 percent eligible employee enrollment if selected.
Stat. Auth.: ORS
				  243.860 - 243.886
Stats. Implemented: ORS
				  243.864(1)(a),
				  243.868(1)
				  & 243.872(2)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 30 - PLAN DESIGN DEVELOPMENT AND SELECTION › Section 111-030-0045 - Employee Assistance Program (EAP) Plan Selection Criteria

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Entities may
			 select or allow an EAP option to be available to all Entity employees
			 including, but not limited to, OEBB benefit-eligible employees and their
			 dependents.
(2) Enrollment will
			 happen automatically if selected by an Entity.
Stat. Auth.: ORS
				  243.860 - 243.886
Stats. Implemented: ORS
				  243.864(1)(a),
				  243.868(1),
				  243.872(2)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 30 - PLAN DESIGN DEVELOPMENT AND SELECTION › Section 111-030-0046 - Development of Health Savings Accounts (HSA)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Effective October 1, 2011, OEBB will
			 offer the use of an employer sponsored vendor for Health Savings Accounts
			 (HSA). For purposes of this rule, an HSA vendor will be considered employer
			 sponsored if the Entity offers:
(a) Employer
			 contributions to the HSA; or
(b)
			 Pre-tax or direct deposit of employee contributions to the HSA.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 30 - PLAN DESIGN DEVELOPMENT AND SELECTION › Section 111-030-0047 - Development of Flexible Spending Accounts

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Effective October 1, 2012, OEBB will
			 offer the use of an employer sponsored vendor for Flexible Spending Accounts
			 (FSAs) including a Health Care Flexible Spending Account, Limited Health Care
			 Spending Account and Dependent Care Flexible Spending Account.
(2) If an Entity chooses to offer an employer
			 sponsored FSA, the Entity may offer this plan through the OEBB-contracted FSA
			 vendor.
(3) Eligible employees who
			 are eligible to enroll in an FSA, and choose the employer sponsored FSA vendor,
			 do so directly through their Entity.
(4) Eligible employees must meet requirements
			 established by the Internal Revenue Service (IRS) to qualify for enrollment in
			 an FSA. Once enrolled in an FSA, members are responsible to adhere to tax
			 requirements of the IRS.
Stat. Auth.: ORS
				  243.860-243.886
Stats. Implemented: ORS
				  243.874(5)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 30 - PLAN DESIGN DEVELOPMENT AND SELECTION › Section 111-030-0050 - Premium Rate Structure Selection Process and Limitations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Educational
			 Entities may choose a composite or tiered rate structure for each Employee
			 Group for medical, dental and vision coverage unless otherwise specified in an
			 OEBB administrative rule. The rate structure selected for each coverage type
			 applies to all individuals electing to participate as active employees within
			 an Employee Group. Local Governments are limited to using the tiered rate
			 structure for medical, dental and vision plans.
(2) Educational Entities may select a
			 composite or tiered rate structure for early retirees unless otherwise
			 specified in an OEBB administrative rule. Local Governments are limited to
			 using the tiered rate structure for medical, dental and vision plans.
(3) Educational Entities may select a
			 composite or tiered rate structure for part-time employees of an Employee Group
			 unless otherwise specified in an OEBB administrative rule. If a different rate
			 structure is selected for part-time employees that structure must apply to all
			 participating part-time employees within that Employee Group. Local Governments
			 are limited to using the tiered rate structure for medical, dental and vision
			 plans.
(4) Rate structures must be
			 selected during the plan selection process.
(5) Once an Educational Entity elects a
			 change in rate structure for a type of coverage within an Employee Group, the
			 rate structure selection cannot be changed for at least three plan years. The
			 rate structure change will go into effect on the first day of the next plan
			 year, October 1.
(6) Educational
			 Entities or Local Governments who offered LTD on a composite rate structure
			 prior to moving to OEBB coverages can continue to do so. Use of the composite
			 rate structure for LTD plans is only available on a mandatory LTD plan and
			 requires 100 percent enrollment.
(a) Employee
			 Groups using a composite rate structure for mandatory LTD plans effective
			 October 1, 2012, may continue to use either the employer-paid or employee-paid
			 option.
(b) Effective October 1,
			 2013, OEBB will expand the availability of the composite rate structure for
			 mandatory LTD plans only to those Employee Groups that chose to elect an
			 employer-paid plan option.
(c) Rate
			 structures must be selected during the plan selection period and become
			 effective the first day of the next plan year, October 1.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0001 - Effective Dates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Effective
			 Dates for Newly Eligible Employees. Initial benefit elections, unless otherwise
			 specified in a collective bargaining agreement or documented Entity policy in
			 effect on June 30, 2008, are effective on the later of:
(a) The first of the month following a
			 completed online enrollment in the OEBB benefit management system or submission
			 of a paper enrollment or change form, or
(b)
(A) The
			 first of the month following the date of hire or the date of eligibility; with
			 the following exception:
(B) The
			 first of the month following approval of Evidence of Insurability for Optional
			 Life Insurance above the guarantee issue amount, Long Term Disability, or Long
			 Term Care insurance. The approval letters sent to the member are not official
			 until entered into OEBB's benefit management system.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0005 - Termination Dates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Effective
			 October 1, 2011, if an active eligible employee 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 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.
Stat. Auth.: ORS
				  243.860 -
				  243.886
Stats. Implemented: ORS
				  243.864(1)(a)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0010 - Newly-hired and Newly-eligible Employees

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth: 2007 OL Ch. 7
Stats. Implemented: 2007 OL Ch. 7, Sec.
				  3
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0011 - Returning to Benefit Eligible Status

Current through Register Vol. 63, No. 7, July 1, 2024
(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) The 12-month late enrollment waiting
			 period for dental and/or vision coverage will only apply if it was in effect at
			 the time coverage was initially lost.
(c) 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.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0015 - Removing an Ineligible Individual from Benefit Plans

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0020 - Open Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(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. Dental coverage added
			 during the open enrollment period will be limited to preventive dental exams
			 and cleanings for the first 12 months of coverage, if the eligible individual
			 and/or their eligible dependents were eligible for the coverage directly prior
			 to the beginning 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)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0025 - Correcting Enrollment and Processing Errors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Employee Enrollment Errors. Enrollment
			 errors occur when an Eligible Employee provides incorrect information or fails
			 to make correct selections when making benefit plan elections. The Eligible
			 Employee is responsible for identifying enrollment errors or omissions.
(a) OEBB authorizes Entities to correct
			 enrollment errors reported by the Eligible Employee within 45 calendar days of
			 the original eligibility date, open enrollment period end date, or Qualified
			 Status Change date.
(b) Enrollment
			 errors identified after 45 calendar days of the eligibility date, open
			 enrollment period end date or Qualified Status Change date must be submitted to
			 OEBB for review and approval based on OAR 111-080-0030.
(c) If an Eligible Employee receives an
			 approval notice for additional optional coverage, and discovers it was not
			 updated in OEBB's benefit management system, the member may:
(A) Pay all premiums owed retroactive to the
			 original effective date, or
(B)
			 Re-apply for the additional optional coverage during the next Open Enrollment
			 period, or following and consistent with a Qualified Status Change. Evidence of
			 Insurability may be required.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0030 - Late Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0050 - Declination of Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1) As
			 used in this section:
(a) "Opting out of
			 coverage" means that an otherwise Eligible Employee elects not to enroll in a
			 medical plan and is eligible to receive a portion of the cash contribution or
			 other type of remuneration as provided for under a collective bargaining
			 agreement, documented Entity policy, or employment contract.
(b) "Waiving benefits" means that an
			 otherwise Eligible Employee elects not to enroll in any one of the benefit
			 plans available under the OEBB-sponsored benefits program and is not eligible
			 to receive any portion of a cash contribution or other type of
			 remuneration.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0055 - Surcharges

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0001 - Continuation of Group Medical and Dental Insurance Coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA)

Current through Register Vol. 63, No. 7, July 1, 2024
COBRA allows an eligible individual losing group health plan
				coverage due to a qualifying event to continue their coverage for a limited
				time on a self-pay basis.
(1) OEBB
			 will issue or cause the issuance of an initial COBRA notice explaining the
			 right to continue medical and dental insurance plans to all newly eligible
			 employees and individuals.
(a) The notice must
			 be mailed to the eligible employee's known address immediately following
			 enrollment in OEBB medical or dental insurance plans. The notice must include
			 all known eligible individuals residing at the address. Known eligible
			 individuals residing separately from the eligible employee must be mailed a
			 separate notice at their known address.
(b) The initial COBRA notice must be mailed
			 to individuals becoming newly eligible due to marriage or the formation of a
			 domestic partnership.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0010 - Eligibility for Retiree Insurance Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Active eligible employees and their
			 enrolled eligible dependents not yet eligible for Medicare may continue
			 coverage in OEBB medical, dental, vision, life and accidental death and
			 dismemberment plan options upon retirement, provided the plans are offered to
			 Eligible Early Retirees through the Entity or OEBB. Insurance coverage under
			 the OEBB or non-OEBB entity active employee benefit plans, as an employee or as
			 a dependent of an employee, and retiree benefit plans must be
			 continuous.
(2) Active eligible
			 employees and/or their enrolled eligible dependents that are eligible for
			 Medicare, and therefore not eligible to continue on the OEBB medical or vision
			 plan options, may continue coverage on OEBB dental, life, and accidental death
			 and dismemberment plan options upon retirement, provided the plans are offered
			 to retirees through the Entity or OEBB.
(3) An Eligible Early Retiree means and
			 includes a previously Eligible Employee who is:
(a) Not Medicare-eligible; or
(b) Under 65 years old; and
(A) Receiving a service or disability
			 retirement allowance or pension under the Public Employees Retirement System
			 (PERS) or under any other retirement or disability benefit plan or system
			 offered by an OEBB participating organization for its employees;
(B) Eligible to receive a service retirement
			 allowance under PERS and has reached earliest retirement age under ORS Chapter
			 238;
(C) Eligible to receive a
			 pension under ORS 238A.100 to
			 238A.245 and has reached
			 earliest retirement age as described in ORS
			 238A.165; or
(D) Eligible to receive a service retirement
			 allowance or pension under another retirement benefit plan or system offered by
			 an OEBB participating organization and has reached earliest retirement age
			 under the plan or system.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0015 - Medical, Dental and Vision Termination Dates for Early Retirees

Current through Register Vol. 63, No. 7, July 1, 2024
(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)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0016 - Life and Accidental Death and Dismemberment Termination Dates for Early Retirees

Current through Register Vol. 63, No. 7, July 1, 2024
(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)
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0020 - Initial Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 Eligible Early Retiree has 60 calendar days from the end date of active
			 eligible employee insurance coverage to:
(a)
			 Continue enrollment in OEBB-sponsored medical, dental, vision, basic life,
			 basic accidental death and dismemberment, optional life and optional accidental
			 death and dismemberment plans with the same eligible dependents which were
			 included on your coverage as an active employee; provided they are offered by
			 the Entity.
(b) Disenroll eligible
			 dependents covered during active enrollment. Dependents cannot be re-enrolled
			 once they are dropped from coverage, unless a Qualified Status Change event has
			 occured and is reported.
(c)
			 Disenroll in any or all plans. Once a retiree drops any type of coverage the
			 retiree cannot re-enroll in the coverage that was dropped.
(d) Change medical plan to a less expensive
			 medical plan if the Eligible Early Retiree is no longer receiving a monetary
			 contribution.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0025 - Effective Dates

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0030 - Correcting Enrollment and Processing Errors

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0035 - Late Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 50 - CONTINUATION OF COVERAGE › Section 111-050-0045 - Termination Dates

Current through Register Vol. 63, No. 7, July 1, 2024
(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)