reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0080 - RFP Protest; Request for Change; Request for Clarification

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Protest.
(a) Unless otherwise specified in the
			 procurement, a Proposer must deliver a written protest to the Board not less
			 than 10 (ten) calendar days prior to closing;
(b) Content of Protest. A Proposer's written
			 protest shall include:
(A) A detailed
			 statement of the legal and factual grounds for the protest;
(B) A description of the resulting prejudice
			 to the Proposer; and
(C) A
			 statement of the desired changes to the RFP.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0090 - Addenda to an RFP

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Issuance; Receipt. The Board may change an RFP only by written
			 addenda.
(2) Notice and
			 Distribution. The RFP shall specify how the Board will provide notice of
			 addenda and how the Board will make the addenda available.
(3) Timelines; Extensions. The Board shall
			 issue addenda within a reasonable time to allow prospective Proposers to
			 consider the addenda in preparing their Proposals. The Board may extend the
			 Closing if the Board determines prospective Proposers need additional time to
			 review and respond to addenda. Unless otherwise specified in the procurement,
			 and except to the extent required by public interest, the Board shall not issue
			 addenda less than 72 hours before the closing unless an addendum also extends
			 the Closing.
(4) Request for Change
			 or Protest. Unless a different deadline is set forth in an addendum, a Proposer
			 may submit a written request for change or protest to the addendum by the close
			 of the Board's next business day after issuance of the addendum.
Statutory/Other Authority: ORS
				  243.061  - 243.302
Statutes/Other Implemented: ORS
				  243.135  & 243.125
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0100 - Extension of Time for Acceptance of Proposal

Current through Register Vol. 63, No. 7, July 1, 2024
The Board may request, orally or in writing that Proposers
				extend, in writing, the time during which the Board may consider their
				Proposal. If a Proposer agrees to such extension, the Proposal shall continue
				as irrevocable, valid and binding on the Proposer for the agreed-upon extension
				period.
Stat. Auth.: ORS
				  243.061 -
				  243.302
Stats. Implemented: ORS.243.125(1)
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0105 - Submission of Proposals; Format; Timing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All Proposals submitted as a result of a
			 Formal Solicitation, Informal Solicitation, or Single Source Solicitation shall
			 comply with the procurement's specifications. If portions of the Proposal to
			 any solicitation are deemed unacceptable or non-responsive to the
			 specifications of the solicitation, the Proposal will be deemed non-responsive
			 and will not be given further evaluation or consideration. If a Proposal to any
			 solicitation is delivered late, it will be deemed non-responsive to the
			 specification of the solicitation and will be returned to the Proposer
			 unopened.
(2) Submission of
			 Proposals shall be in writing and shall be delivered in the written format, as
			 required by the specifications of the solicitation. Proposals may be submitted
			 entirely electronically in any reasonable format if required under the
			 procurement.
Statutory/Other Authority: ORS
				  243.061  - 243.302
Statutes/Other Implemented: ORS
				  243.125(1)
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0110 - Evaluation of Proposals

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Evaluation. The evaluation process described in this rule applies to the Formal
			 Selection Procedure set forth in OAR 101-005-0040(1). The Board and any
			 assigned representatives, including but not limited to, PEBB stakeholders
			 staff, or Consultants, hereinafter identified as the Selection Committee, shall
			 evaluate Proposals only in accordance with criteria set forth in the RFP and
			 applicable law. The Board shall evaluate Proposals to determine the Responsible
			 Proposer or Proposers submitting the best responsive Proposal or
			 Proposals.
(2) Competitive Range;
			 Protest; Award.
(a) Determining Competitive
			 Range. If the Board does not cancel the solicitation, and to the extent the
			 solicitation includes a competitive range determination, the Board will
			 evaluate all Proposals in accordance with the evaluation criteria set forth in
			 the RFP. After evaluation of all Proposals in accordance with the criteria set
			 forth in the RFP, the Board will determine the Proposers in the competitive
			 range.
(b) Protesting Competitive
			 Range. The Board shall provide written notice to all Proposers identifying
			 Proposers in the competitive range. A Proposer that is not within the
			 competitive range may protest the Board's evaluation and determination of the
			 competitive range in not more than two (2) business days after the Board has
			 sent written e-mail notice of the competitive range to all Proposers.
(c) Intent to Award; Discuss or Negotiate.
			 After the protest period provided in accordance with paragraph (2)(b) expires,
			 or after the Board has provided a final response to any protest, whichever date
			 is later, the Board may engage in discussions and negotiations with Proposers
			 in the competitive range.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0120 - Rejection of a Proposal

Current through Register Vol. 63, No. 7, July 1, 2024
Rejection of Proposals.
(1) The Board may reject any Proposal upon
			 PEBB's finding that the Proposal:
(a) Is
			 contingent upon PEBB's acceptance of terms and conditions (including
			 Specifications) that differ from the RFP;
(b) Takes exception to terms and conditions
			 set forth in the RFP;
(c) Attempts
			 to prevent public disclosure of matters in contravention of the terms and
			 conditions of the RFP or in contravention of applicable law;
(d) Offers services that fail to meet the
			 specifications of the RFP;
(e) Is
			 late;
(f) Is not in substantial
			 compliance with the RFP;
(g) Is not
			 in substantial compliance with all prescribed procurement procedures;
(h) Has been debarred as set forth in ORS 279
			 B.130;
(i) Has failed to provide
			 the certification of non-discrimination required under ORS
			 279A.110(4),
			 or;
(j) Is from a Proposer found
			 non-responsible as described in OAR 101-005-0130.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0130 - Responsible Proposer

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Before awarding a Contract, the Board must have information that indicates the
			 Proposer meets the applicable standards of responsibility. PEBB shall prepare a
			 written determination of non responsibility for a Proposer if PEBB determines
			 that the Proposer does not meet the standards of responsibility.
(2) In determining whether a Proposer has met
			 the standards of responsibility, PEBB 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. PEBB
			 shall document the Proposer's record of performance if PEBB finds under this
			 paragraph that the Proposer is not responsible.
(c) Has a satisfactory record of integrity.
			 PEBB in evaluating the Proposer's record of integrity 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. PEBB
			 shall document the Proposer's record of integrity if PEBB finds under this
			 paragraph that the Proposer is not responsible.
(d) Is legally qualified to contract with
			 PEBB.
(e) Supplied all necessary
			 information in connection with the inquiry concerning responsibility. If a
			 Proposer fails to promptly supply information concerning responsibility that
			 PEBB requests, PEBB shall determine the Proposer's responsibility based on
			 available information or may find that the Proposer is not
			 responsible.
(f) Was not debarred
			 by PEBB in accordance with ORS
			 279B.130.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 5 - RENEWAL, SCREENING AND SELECTION FOR BENEFITS AND VENDOR CONTRACTS › Section 101-005-0140 - Protest of Contractor Selection, Contract Award

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Purpose. An adversely affected or
			 aggrieved Proposer must exhaust all avenues of administrative review and relief
			 before seeking judicial review of the Board's Contractor selection or contract
			 award decision.
(2) Notice of
			 Intent to Award. Unless otherwise provided in the RFP, the Board shall provide
			 written notice to all Proposers of the Board's intent to award the contract(s).
			 The Board's award(s) shall not be final until the later of the following:
(a) Seven (7) days after the date of the
			 notice, unless the RFP provided a different period for protest, or;
(b) The Board provides a written response to
			 all timely filed protests that denies the protests and affirms the
			 award.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0005 - Eligible Individuals

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 The following individuals are eligible to participate in PEBB-sponsored benefit
			 plans:
(a) An eligible employee as defined in
			 OAR 101-010-0005(20).
(b) A
			 permanent position seasonal or intermittent employee who meets the following
			 requirements:
(A) An individual hired for the
			 first time if expected to work a 90-calendar day continual period and works at
			 least half-time or in a position classified as job share. The eligible employee
			 must enroll within 30 days of the hire or eligibility date; or
(B) An individual hired for the first time
			 working at least half-time or in a position classified as job share who was not
			 expected to work a 90-day or more continual period, and works longer than a
			 90-calednar day continual period. The employee is eligible for enrollment
			 retroactively effective to the first day of the month following the original
			 hire or eligibility date; or
(C) A
			 previously ineligible employee returning to work is eligible for benefit plans
			 after 60 calendar days of employment within the current or immediately previous
			 plan year. The 60 calendar days of employment need not be
			 consecutive.
(c) An
			 appointed temporary or impermanent employee who (i) as of the date of hire, is
			 expected to work an average of 30 or more hours per week for a 90-day continual
			 period, or (ii) has worked an average of 30 hours or more per week for a full
			 initial measurement period (1,560 hours) and is in a subsequent benefit
			 eligible stability period.
(d) A
			 current spouse, domestic partner, or an eligible dependent child listed by the
			 person who is eligible under subsection (1)(a), (b), (c), or (d) of this rule
			 on the required enrollment form or the electronic equivalent.
(e) An appointed and elected official.
			 Eligibility for benefit plans begins on the first day of the month following
			 the date the official takes the oath of office.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0026 - Domestic Partnership

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Certificate of Registered Domestic Partnership. When a Registered Domestic
			 Partnership exists and the eligible employee wants to enroll the domestic
			 partner or the domestic partner's eligible children in benefit plans, the
			 employee may electronically enroll or submit enrollment update forms to the
			 agency at the appropriate time as defined by PEBB enrollment rules.
(2) PEBB Affidavit of Domestic Partnership.
			 An eligible employee and an individual of the opposite or same sex without a
			 Certificate of Registered Domestic Partnership, who want enrollment in PEBB
			 plans as Domestic Partners must meet all of the following criteria:
(a) Are both at least 18 years of
			 age;
(b) Are responsible for each
			 other's welfare and are each other's sole domestic partners;
(c) Are not married to anyone;
(d) Share a close personal relationship and
			 are not related by blood closer than would bar marriage in the State of
			 Oregon;
(e) Currently share the
			 same regular permanent residence;
(f) Are jointly financially responsible for
			 basic living expenses defined as the cost of food, shelter, and any other
			 expenses of maintaining a household. Financial information must be provided if
			 requested, and;
(g) Eligible
			 employees must submit enrollment forms and a notarized affidavit to enroll
			 domestic partners and children. To enroll eligible dependent children of a
			 domestic partnership by affidavit in benefit plans, whether or not the
			 enrollment includes the domestic partner, the employee must submit an Affidavit
			 of Domestic Partnership.
(A) For enrollment,
			 the agency must receive the notarized affidavit within five business days
			 following close date of the enrollment period.
(B) Employees with qualified mid-year changes
			 may only enroll a domestic partner or partner's children by submitting the
			 correct enrollment forms and notarized affidavit within the allowable time for
			 the enrollment type. Agencies will not process a domestic partner or a
			 partner's children's enrollment until the enrollment documentation submission
			 is complete.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0030 - Eligibility and Policy Term Violations - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purposes of OAR 101-015-0035  and OAR 101-015-0040, the
				following definitions will apply:
(1)
			 "Eligibility or Enrollment Violations" means and includes a violation of the
			 PEBB's eligibility or enrollment rules or policies including fraud or material
			 misrepresentation. Misstatements, misrepresentations, omissions or concealments
			 on the part of the PEBB member are not fraudulent unless they are made with
			 intent to knowingly defraud. PEBB has primary responsibly in investigating such
			 violations. If an Eligibility Violation is considered a violation of the
			 insurance carrier's policy, then the violation may also be considered a Policy
			 Term Violation, and OAR 101-015-0040  would also apply.
(a) "Intentional Violation" is a violation
			 that has occurred in which PEBB has electronic or written documentation that
			 the eligible employee took action resulting in a non-eligible member being
			 enrolled in PEBB benefits.
(b)
			 "Unintentional Violation" is a violation that has occurred in which the
			 eligible employee was not aware that such violation had occurred and there is
			 no evidence of the eligible employee completing a paper form or logging in and
			 enrolling an ineligible member in PEBB benefits.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0035 - Eligibility Violations

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Unintentional Violation:
(a) PEBB will remove
			 from coverage an ineligible PEBB member due to eligibility or enrollment
			 violations. Removal from all benefit plans will be retroactive to the date the
			 individual is determined to have no longer been eligible, or the effective date
			 of coverage if eligibility criteria was never met unless in conflict with
			 federal healthcare reform.
(b) When
			 an eligibility or enrollment violation has been discovered and investigated,
			 PEBB will notify the member and the Agency Human Resource Department with the
			 outcome.
(c) The member may be
			 responsible for any claims paid during the period of time the member was
			 enrolled inappropriately.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0040 - Policy Term Violations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 PEBB-contracted insurance carrier may remove from coverage and/or deny the
			 claims of a PEBB member due to policy term violations. Removal from coverage
			 for policy term violations is at the discretion of the insurance carrier.
(a) If a policy term violation results in a
			 termination from the plan or carrier that the violation was committed, it will
			 not prevent the member from continuing enrollment in other PEBB types of
			 coverages (e.g., medical, dental, vision, life, etc.), as long as they remain
			 an employee and eligible for these benefits.
(b) If an eligible employee commits a policy
			 term violation and loses coverage, PEBB will remove the entire family from the
			 insurance plan since the benefits are extended to his or her dependents through
			 the eligible employee. If the eligible employee chooses to, and it is offered,
			 they can enroll in a different carrier plan (if applicable).
(c) If a dependent commits a policy term
			 violation, PEBB will remove only the dependent from the insurance plan. If the
			 eligible employee chooses to and it is offered, they can enroll in a different
			 carrier plan (if applicable).
(d)
			 The PEBB member who is removed from a PEBB sponsored insurance plan may appeal
			 the decision through the carrier that terminated coverage.
(e) When a policy term violation has been
			 discovered and investigated, the applicable insurance carrier will notify PEBB
			 and the member with the outcome.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0045 - Eligibility Verifications and Reviews

Current through Register Vol. 63, No. 7, July 1, 2024
(1) PEBB shall plan and conduct eligibility
			 verifications and reviews to monitor compliance with PEBB administrative rules.
			 Reviews shall include, but are not limited to the following:
(a) Dependent eligibility;
(b) Employee eligibility;
(c) Election change limitations;
			 and
(d) Plan enrollment
			 limitations.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0050 - Dependent Eligibility Verification and Review Appeals

Current through Register Vol. 63, No. 7, July 1, 2024
Dependent Eligibility Verifications and Review Appeals
(1) Following the termination of dependents
			 due to a dependent eligibility review, Eligible Employees, Retirees, Self Pays
			 or COBRA participants may file an appeal and submit requested documentation
			 within 60 days from the date coverage ended.
(2) For Eligible
			 Employees/Retirees/Self-Pay/COBRA, if the appeal and submitted requested
			 documentation is received by PEBB prior to 60 days from the date coverage
			 ended, and dependents are verified, PEBB will unlock the dependent records in
			 the PEBB benefit management system and dependents will be added
			 retrospectively.
(3) For Eligible
			 Employees/Retirees/Self-Pay/COBRA, if the appeal and submitted requested
			 documentation is received by PEBB after 60 days from the date the coverage
			 ended then dependents will be added prospectively.
Statutory/Other Authority: ORS
				  243.125  & ORS
				  243.061-302,
				  659A.060-069, 743.600-602 and 743.707
Statutes/Other Implemented: ORS 243 & ORS
				  243.061-302,
				  292.501 and 2007 OL Chap. 99
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0056

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  243.061  - 243.302
Statutes/Other Implemented: ORS
				  243.125(1)
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0061

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  243.061  - 243.302
Statutes/Other Implemented: ORS
				  243.125(1),
				  243.223(1)
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0002 - Plan Effective Dates, Employee Eligibility Continuation, and Plan Termination Dates

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Irrevocability Rule. Except as otherwise provided in OAR chapter 101, all
			 eligible employee benefit plan elections or mid-year plan changes are
			 irrevocable for the plan year and must have a prospective effective
			 date.
(2) PEBB's eligible employee
			 benefits are in whole month increments for coverage and premium cost. PEBB's
			 core benefits are part of an Internal Revenue Service Code 125 Cafeteria plan,
			 requiring an employee's monthly pay deduction for premium contribution is in
			 advance of the coverage.
(3) The
			 coverage effective date for newly eligible employees or for employees who
			 receive approved qualified midyear changes is the first of the month following
			 the later of the agency's receipt of all required appropriate forms, electronic
			 enrollment, or the actual event date.
(a) The
			 employee must be actively at work as specified in OAR 101-010-0005(2)  for
			 medical and dental coverage to become effective and as specified by optional
			 plans in optional plan policies or certificates.
(b) When an optional plan requires medical
			 underwriting prior to coverage approval, coverage will be effective the first
			 of the month following plan approval.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0005 - Newly Hired and Newly Eligible Employee

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All newly hired or a newly eligible
			 active employees have 30 days from the date of hire or date of eligibility to
			 enroll in PEBB core and optional benefit plans. Benefit plan elections are
			 irrevocable for the plan year except as specified in OAR 101-020-0050.
(a) Full time temporary or impermanent
			 employees that will be benefit eligible by the fourth month of employment
			 enroll for benefits during the third employment month for benefits to be
			 effective by the first of the fourth month.
(b) Variable hour temporary or impermanent
			 employees that become benefit eligible after an initial measurement period have
			 30 days from their benefit eligibility date to enroll.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0012 - Working in Two or More Positions or for Two or More PEBB Participating Organizations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 individual working in two or more positions or for two or more PEBB
			 participating organizations must work at least half-time or be in a current
			 benefit eligible stability period to be eligible for PEBB-sponsored benefit
			 plans. A benefit eligible employee in a job share position is not required to
			 work at least half-time to meet benefit eligibility.
(2) An eligible employee cannot receive more
			 benefits than what one full time employee is eligible for. An eligible employee
			 working in two or more positions may enroll for benefits through only one
			 position.
(3) The eligible
			 employee's enrollment will be completed with the PEBB participating
			 organization with the highest percentage of FTE position.
(a) When the employee's FTE percentages with
			 more than one PEBB participating organization are equal, the employee enrolls
			 through the organization with the earlier appointment date.
(b) When the employee has equal FTE
			 percentages and simultaneous dates of employment with two or more PEBB
			 participating organizations, the employee may choose the organization to enroll
			 through.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0015 - Opting Out of Medical Insurance Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A benefit eligible employee can Opt Out
			 of medical coverage and receive cash in lieu of medical insurance coverage.
			 PEBB determines the amount of cash paid to an employee who Opts Out of medical
			 coverage. Opt Out cash is included in employee income and is subject to
			 taxes.
(2) Opting Out of medical
			 coverage is an enrollment choice, it is not an enrollment in a PEBB medical
			 plan.
(3) PEBB can require eligible
			 employees who enroll in Opt Out to also enroll in other core benefits, such as
			 dental, vision, and employee basic life coverage. Opt out enrolled employees
			 who enroll for a core benefit plan are responsible to pay any premium share
			 required.
(4) Eligible employees
			 choosing to enroll in medical Opt Out must have minimum essential medical
			 coverage for themselves and all other individuals for whom the employee can
			 reasonably expect to claim a personal tax exemption deduction for. The
			 alternative medical coverage must be a group sponsored medical plan. The
			 employee must attest to the coverage at enrollment and annually
			 thereafter.
(5) The agency or PEBB
			 will cancel an employee's Opt Out enrollment when the attestation is not
			 completed during initial enrolment or annually during the open enrollment
			 period. If the Opt Out election is cancelled:
(a) The agency will enroll a new benefit
			 eligible employee in the Employee Only tier of a PEBB medical plan that
			 provides statewide coverage. All other employee plan elections will take effect
			 as enrolled.
(b) When the Opt Out
			 enrollment is to replace an enrolled employee's PEBB medical plan, the employee
			 and any eligible dependents will reinstate to the previous medical plan. All
			 other employee plan elections will take effect as enrolled.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0018 - Declining Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 active eligible employee who declines PEBB core benefits waives the employee's
			 right to the benefit amount and enrollment in any PEBB sponsored
			 plans.
(2) An eligible employee may
			 decline benefits at the time of hire or meeting eligibility, consistent with a
			 qualifying midyear plan change event, or during the open enrollment
			 period.
(3) An eligible employee
			 who previously declined benefits may enroll in benefit plans consistent with a
			 qualifying midyear plan change event or during the open enrollment
			 period.
Stat. Auth.: ORS
				  243.061 - 243.302
Stats. Implemented: ORS
				  243.061 -
				  302
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0020 - Newborn and Adopted Child Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An eligible employee's biological newborn
			 child receives PEBB-sponsored medical and dental insurance coverage under the
			 newborn's own coverage from the moment of birth through the first 31 days of
			 life without completing PEBB forms. To continue coverage beyond the first 31
			 days of coverage the eligible employee must enroll the newborn child to their
			 benefit plans within 30 days from the date of birth by submitting the correct
			 enrollment update forms.
(2) An
			 eligible employee's newly adopted child receives PEBB-sponsored medical and
			 dental insurance coverage under the adopted child's own coverage from the date
			 of the adoption decree or date of placement for adoption through the first 31
			 days without completing PEBB forms. To continue coverage beyond the first 31
			 days of coverage the eligible employee must enroll the adopted child to their
			 benefit plans within 30 days from the date of the decree or placement by
			 submitting the correct enrollment update forms.
(a) The eligible employee must submit the
			 adoption agreement or placement agreement with the enrollment forms to the
			 agency. Placement for adoption requires the submission of an Affidavit of
			 Dependency with enrollment forms with legal documentation of the placement.
			 Upon adoption completion, a copy of the finalized adoption document must be
			 submitted to the employee's agency.
(b) Claims payment will not occur prior to
			 the adoption decree or placement for adoption date.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0025 - Removing an Ineligible Individual from Benefit Plans

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All eligible employees have 30 days from
			 the date a spouse, domestic partner, or dependent child loses eligibility to
			 remove the individual from PEBB coverage. The individual will be removed from
			 plans the last day of the month in which eligibility was lost.
(2) An employee's failure to report a spouse,
			 domestic partner, or dependent child's loss of eligibility within 30 days of
			 the event is an intentional misrepresentation of a material fact of enrollment
			 by the employee. PEBB will rescind all coverage back to the last day of the
			 month and plan year when eligibility was lost. Under COBRA regulations
			 ineligible individuals removed more than 60 days from the eligibility loss date
			 will receive a COBRA unavailability letter due to the employee's late
			 notification.
(a) At an agency's discretion,
			 an employee may become liable to repay the agency for premiums paid by the
			 agency while the individual was ineligible.
(b) An employee may become liable for
			 repayment of insurance claims incurred and paid by a plan for the ineligible
			 individual according to contract agreements between PEBB and the plan.
(c) An employee may face
			 disciplinary action by an agency. Example: Ann's divorce is final on June 6.
			 Ann submits her update form to her agency October 10. The agency forwards the
			 update forms to PEBB. PEBB terminates the ineligible individual's coverage the
			 last day of the month that the divorce was final. The ex-spouse will receive a
			 COBRA unavailability letter.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0032 - Open Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Active and other eligible employees may make benefit plan changes, new plan
			 elections, enroll eligible individuals, or terminate only certain individuals
			 during the annual open enrollment period. All plan elections or enrollments are
			 subject to paragraph (6) of this rule. Eligible employees must submit plan
			 elections, enrollments, or enrollment terminations as instructed during the
			 designated period.
(2) Open
			 enrollment coverage begins the first day of the new plan year. When coverage
			 must receive plan-underwriting approval, the appropriate documents must be
			 submitted to the plan by December 31st of the current plan year, the effective
			 date of the coverage will be the first day of the month after approval in the
			 new plan year. The exception is UNUM, enrollment can be done at any time and
			 the effective date of coverage is the first of the month following
			 approval.
(3) During the open
			 enrollment period, the eligible employee is accountable for enrolling and
			 providing coverage to only those individuals who will meet PEBB eligibility
			 criteria for coverage the first day in the new plan year. The eligible employee
			 is accountable during open enrollment for ensuring that only those individuals
			 who meet PEBB eligibility are enrolled in the new plan year.
(a) Employees can terminate an individual
			 currently receiving coverage, electronically or by using a form, if they know
			 the individual will be ineligible for coverage the first day of the plan year
			 or the employee no longer wants to provide coverage to the individual even
			 though the individual will continue to meet eligibility. When terminated by an
			 employee as part of the open enrollment period the individual's coverage ends
			 the last day of the last month of the current plan year. PEBB can audit an
			 employee's benefit record and investigate the reason why an individual will no
			 longer receive coverage in the new plan year. When necessary PEBB can correct
			 the coverage termination date of a terminated individual and take the
			 appropriate termination of coverage action as provided by OAR
			 101-020-0025.
(b) Employees are not
			 to use the open enrollment period to remove individuals who have lost
			 eligibility or will lose eligibility. Employees must remove individuals who
			 lose eligibility from their coverage and benefit record by submitting the
			 correct midyear change forms to the agency or to PEBB. See OAR
			 101-020-0025.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0037 - Correcting Enrollment Errors and Open Enrollment Errors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Employee enrollment errors occur when an
			 eligible employee provides incorrect information or fails to make correct
			 selections when making benefit plan elections. An employee's failure to
			 initiate timely enrollment rights either electronically or via paper form is
			 not considered an employee error. For the purpose of this rule, an enrollment
			 action means that the employee during the allowable enrollment times must take
			 an action to enroll, add to, save an active enrollment, or change benefit plan
			 enrollment elections, or enroll, add to, save an active enrollment, or change
			 coverage of individuals. The eligible employee is responsible for identifying
			 enrollment errors and maintaining a valid and accurate enrollment.
(a) PEBB authorizes the agency to correct
			 employee enrollment errors when reported by the employee within 30 days of the
			 original eligibility date or midyear plan change date. Corrections are
			 prospective to the first of the month following the date the agency received
			 the correction request.
(A) PEBB must review
			 all employee requests to correct enrollment errors received after 30 days of
			 the original eligibility date or the midyear plan change date. If the
			 correction is approved, the effective date is the first of the month following
			 the receipt of the employee's correction request.
(B) Enrollment error correction requests
			 considered beyond 30 days of the eligibility date or the midyear plan change
			 date must demonstrate facts and circumstances that clearly establish an
			 employee error occurred.
"Example: As a new employee, Anne enrolled in
			 the Dependent Care Flexible Spending Account. Anne does not have any eligible
			 dependents. Six months later Anne realizes the error after her first Health
			 Care FSA claim is rejected. Anne may request an enrollment correction from
			 PEBB."
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0038 - Correcting Processing Errors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Administrative processing errors occur
			 when benefit plan elections are processed incorrectly in the payroll and
			 benefit system by the agency, PEBB, or third party administrative staff, or
			 PEBB carrier. Administrative error also includes when a newly eligible employee
			 does not receive correct enrollment information or materials within 30 days of
			 the eligibility date.
(a) PEBB must review
			 all processing errors on PEBB optional plans (non-health carriers).
(A) Approval letters for a plan that requires
			 underwriting are not official documents for enrollments unless the enrollment
			 is entered into the PEBB system.
(B) If the enrollment is not entered into the
			 system due to an administrative error, the member may pay all retro premiums
			 back to the first of the month following carrier approval or re-apply for the
			 coverage during an upcoming open enrollment period or within 30 days of a
			 qualifying midyear event (Medical evidence may be required).
(C) PEBB will not be held responsible for
			 processing errors made outside of PEBB. The eligible employee is responsible
			 for identifying enrollment errors and maintaining a valid and accurate
			 enrollment.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0040 - Late Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Late enrollment occurs when an eligible employee fails to enroll themselves,
			 eligible family members, domestic partner, or a domestic partner's child in
			 benefit plans within the required time period.
(2) An enrolled employee requesting late enrollment for a family
			 member, domestic partner, or domestic partner's dependent child must provide
			 supporting documentation that shows an inability to enroll the individual when
			 first eligible because of circumstances beyond the employee's
			 control.
(3) A newly eligible
			 employee approved for late enrollment receives only employee basic life
			 insurance coverage and may only elect medical and dental coverage for
			 themselves, spouse, domestic partner, or dependent children. If late enrollment
			 is approved, benefit coverage is effective the first of the month following
			 receipt of the completed enrollment forms.
(4) Following receipt of the completed forms, late enrollment of
			 an employees's biological newborn dependent child will be retroactive to the
			 first of the month following the date of birth if completed forms are received
			 during the first twelve months of life.
Statutory/Other Authority: ORS
				  243.061  - 302
Statutes/Other Implemented: ORS
				  243.061-302,
				  659A.060-069, 743.600-602 & 743.707
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0045 - Returning to Work

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Refer to the following rules for an employee returning to paid regular status
			 from the following leave status:
(a)
			 Continuation of Benefits for Injured Workers (CBIW). See OAR
			 101-030-0010.
(b) Federal Family
			 Medical Leave Act (FMLA). See OAR 101-030-0015.
(c) Oregon Family Leave Act (OFLA). See OAR
			 101-030-0015.
(d) Active Military
			 Duty Leave (USERRA). See OAR 101-030-0022.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0047 - Transfer

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When an
			 eligible employee transfers from one PEBB participating organization to
			 another, the organization losing the employee must pay the benefit amount for
			 the month following the transfer, regardless of hours worked at that
			 organization.
Exception:
An eligible employee transfers
				mid-month from part-time to full time and submits enrollment forms to the
				gaining organization prior to the end of the month. In this case, the gaining
				organization pays the full benefit amount for the month following the
				transfer.
(2) All PEBB
			 benefit plan elections transfer from the PEBB organization losing the employee
			 to the organization gaining the employee without a lapse in insurance
			 coverage.
(3) Benefit plan changes
			 or elections are not permitted solely due to a transfer.
Stat. Auth.: ORS
				  243.061-302
Stats. Implemented: ORS
				  243.061-302
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0050 - Midyear Benefit Plan Changes

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligible employee plan elections are
			 irrevocable for the plan year. There are limited exceptions to the
			 irrevocability rule if certain conditions or events are met. These events fall
			 into three broad groups:
(a) Qualified Status
			 Changes (QSC), which include:
(A) Changes in
			 the eligible employee's legal marital status, such as marriage or
			 divorce;
(B) Changes in the
			 eligible employee's number of dependents, such as birth or adoption of a
			 child;
(C) Changes in the
			 employment status of the eligible employee or family member, such as the start
			 or end of employment, or a change from part-time to full time;
(D) Changes in the eligibility of a
			 dependent, such as attaining a certain age;
(E) Changes in the residence of the eligible
			 employee, or;
(F) Changes in the
			 eligible employee's domestic partnership.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0052 - 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
			 PEBB/PEBB or PEBB/OEBB medical plans.
(b) OEBB means the Oregon Educators Benefit
			 Board in Oregon.
(c)
			 Subscriber/employee means the individual who subscribes to their employer's
			 health plan. For the purposes of this rule, a subscriber excludes a COBRA
			 participant, part-time employee, retiree or self-pay member.
(d) Dependent means and includes a dependent
			 child as defined by OAR 101-015-0011, Spouse as defined by OAR 101-015-0005,
			 and Domestic Partner as defined by OAR 101-015-0011.
(e) Surcharge means an extra fee deducted
			 from the employee's monthly pay.
Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 20 - ENROLLMENT RULES › Section 101-020-0059 - Commuter Accounts (Fringe Benefits)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) There are two individual account types
			 within Commuter Accounts, Transportation and Parking. Each type allows enrolled
			 employees to claim tax free reimbursement of certain employment related
			 commuter expenses. The accounts are fringe benefits and federal Internal
			 Revenue Service (IRS) regulations govern the accounts.
(2) Enrolled employees reduce their taxable
			 income because they contribute to the account monthly through a pre-tax salary
			 reduction. The employer does not contribute to the accounts.
(3) Employees can enroll, terminate, or make
			 changes to an existing account throughout a plan year. A qualifying midyear
			 change event is not required to make a change to the account.
(4) Enrollment in either account type
			 requires a minimum monthly contribution. Each year the IRS sets an available
			 maximum monthly contribution, the limit is subject to change. The Board reviews
			 and approves PEBB changes to employee monthly minimum and maximum
			 contributions. Only one contribution each month is permitted.
(5) Refunds of account funds without a claim
			 and reimbursement submission process is not permitted. Fund transfers between
			 the account types is not permitted.
(6) An employee's account funds will forfeit
			 to PEBB when an account is inactive. An inactive account means, that for six
			 consecutive months there has not been either an employee monthly contribution
			 or a claim reimbursement processed.
(7) The Transportation Account provides
			 reimbursement for employee only work-related commuting expenses for bus, ferry,
			 rail, monorail streetcar, train, or vanpooling expenses. You may not use a
			 Transportation Account to pay for agency-sponsored transit passes when payroll
			 already deducts the value of those passes from your pay pre-tax.
(a) Transit Pass Expenses are expenses
			 incurred for a pass, token, fare card, voucher, or similar item for
			 transportation using Mass Transit Facilities. These include public or
			 commercial facilities. Commercial facilities are those provided by any person
			 in the business of transporting persons for compensation or hire if such
			 transportation is provided in a vehicle with a seating capacity of at least six
			 adults (excluding the driver).
(b)
			 Commuter Highway Vehicle (Vanpool) expenses must be in connection with travel
			 between the employee's residence and place of employment. A commuter highway
			 vehicle is any highway vehicle with a seating capacity of at least six adults
			 (not including the driver). At least 80% of the mileage must be for purposes of
			 transporting employees in connection with travel between their residences and
			 their places of employment. The number of employees transported for such
			 purposes must be, on average, at least half of the adult seating capacity of
			 the vehicle.