Oregon Administrative Rules › Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD › Division 40 - ENROLLMENT › Section 111-040-0040 - Qualified Status Changes (QSCs)

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An Eligible Employee experiencing a
			 change in family or work status as noted below after an annual open enrollment,
			 or anytime during the plan year, has 31 calendar days beginning on the date of
			 the event to make allowable changes. If the event is gaining a child, as
			 defined by 111-040-0040(4)(c), or results in a loss of eligibility, the
			 Eligible Employee has 60 calendar days after the event to make allowable
			 changes.
(2) An Eligible Employee
			 can only make changes that are consistent with the event for them self and/or
			 dependents.
(3) An Eligible
			 Employee must report the Qualified Status Change (QSC) to the employee's Entity
			 within the specified timeframe. Failure to report a QSC that will result in
			 removal of a spouse, domestic partner, or child within the timeframe stated in
			 111-040-0040(1)  may be considered intentional misrepresentation, and OEBB may
			 rescind the individual's coverage back to the last day of the month in which
			 the individual lost eligibility. Please refer to the QSC matrix for details on
			 what changes can occur with each event.
(4) Qualified Status Changes which allow an
			 employee to make changes to his or her coverage are:
(a) Gaining a spouse by marriage or domestic
			 partner by meeting domestic partner eligibility;
(b) Loss of spouse or domestic partner by
			 divorce, annulment, death or termination of domestic partnership,
(c) Gaining a child by birth, placement
			 for/or adoption, or Domestic Partner's children (by affidavit of domestic
			 partnership),
(d) Change in
			 employee group which affects plan option availability;
(e) Spouse, domestic partner or child starts
			 new employment or other change in employment status which affects eligibility
			 for benefits;
(f) Spouse, domestic
			 partner's or child's employment ends or other change in employment status
			 resulting in a loss of eligibility for benefits under their employer's
			 plan;
(g) Event by which a child
			 satisfies eligibility requirements under OEBB plans;
(h) Event by which a child ceases to satisfy
			 eligibility requirements under OEBB plans;
(i) Changes in the residence of the active
			 eligible employee, spouse, domestic partner, or child (i.e., moving out of the
			 service area of an HMO or limited network service area plan);
(j) Significant changes in cost of the
			 Eligible Employee's or Early Retiree's current plan and tier level that result
			 in a negative or positive impact of 10 percent or more to:
(A) The amount an Eligible Employee or Early
			 Retiree must contribute toward benefits.
(B) The amount a spouse or domestic partner
			 must contribute toward his or her group health insurance plan cost.
(k) Different Open Enrollment/Plan
			 Year under a spouse/domestic partner's employer plan.
(l) Related laws or court orders. For
			 example: Qualified Medical Child Support Order (QMSCO), Entitlement to Medicare
			 or Medicaid, HIPAA, or Children's Health Insurance Program (CHIP) Changes are
			 determined by the applicable law or court order.