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Stat. Auth:ORS243.061-302, 659A.060-069, 743.600-602 & 743.707 Stats. Implemented:ORS243.061-302 & Ol 2007 Ch. 99 Hist.: Pebb 3-2013(Temp), F. & Cert. Ef. 12-17-13 Thru 6-15-14: Pebb 1-2014, F. & Cert. Ef. 5-1-14


Published: 2015

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The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

PUBLIC EMPLOYEES'
BENEFIT BOARD

 

DIVISION 70
LOCAL GOVERNMENT PARTICIPATION
101-070-0001
Definitions
“Local Government” has the
meaning given to it in House Bill 2279 (2013).
Stat. Auth: ORS 243.061-302, 659A.060-069,
743.600-602 & 743.707
Stats. Implemented: ORS 243.061-302
& OL 2007 Ch. 99
Hist.: PEBB 3-2013(Temp),
f. & cert. ef. 12-17-13 thru 6-15-14; PEBB 1-2014, f. & cert. ef. 5-1-14
101-070-0005
Participation Requirements
(1) Notice of Intent to Participate
(a) Local Governments choosing
voluntarily to participate in PEBB must complete and submit to PEBB a written Notice
of Intent to Participate. The following notification timeline applies if the Local
Government employs:
(A) 50 or fewer participating,
eligible employees - 90 days prior to the PEBB Open Enrollment start date (usually
October 1), or;
(B) More than 50 participating,
eligible employees but fewer than 500 participating, eligible employees —
120 days prior to the PEBB Open Enrollment start date, or;
(C) More than 500 participating,
eligible employees — 180 days prior to the PEBB Open Enrollment start date.
(b) Local Governments employing
more than 500 participating, eligible employees that submit a Notice of Intent to
Participate may allow individual employee groups entry into PEBB plans upon expiration
of collective bargaining agreements that govern employee health and welfare benefits
for the individual employee groups.
(2) Financial Participation
(a) Local Governments must
provide PEBB with the most recent two years of medical premiu — equivalent
rates for self-insured groups and the most recent two years of medical premium rates
for fully insured groups either before submitting a Notice of Intent to Participate
or accompanied with the Notice of Intent to Participate. Demographic data and logistical
data may be requested as well.
(A) If an actuarial plan
comparison completed by PEBB’s Consultant demonstrates these rates are less
than 10% over PEBB’s costs during the same two year period, the Local Government
may enter participation at current PEBB rates.
(B) If an actuarial plan
comparison demonstrates these rates are equal to or over 10% of PEBB’s costs
during the same two year period, PEBB may add a rate surcharge for up to three years.
(i) Upon entry into PEBB
participation, Local Governments with more than 500 self-insured employees must
either:
(I) Deposit a sufficient
monetary reserve by February 1 of the first plan year to finance the stabilization
account of the PEBB revolving fund to the PEBB risk-adjusted level as determined
by the PEBB Consultant ; or
(II) Agree to pay an additional
surcharge to premiums to establish a reserve fund for the Local Government over
a period of time as determined by PEBB’s Consultant.
(ii) When a Local Government
with more than 500 self-insured employees terminates participation in PEBB, it may
take its initial contribution paid into the stabilization account of the PEBB revolving
fund as determined by PEBB’s Consultant.
(iii) When a Local Government
provides a cash incentive to a member for opting-out of health coverage and the
value of the incentive is 50% or more than the PEBB premium rate for an employee-only
tier, PEBB may assess a surcharge to the Local Government.
(iv) Monthly Remittance.
For the purpose of subsections (6) through (11), the terms below have the following
meanings:
(I) "ACH credit" means a
payment initiated by a participating Local Government that is cleared through the
Automated Clearing House (ACH) network for deposit to the PEBB treasury account;
(II) "ACH debit" means a
payment initiated by PEBB and cleared through the ACH network to debit a participating
Local Government’s financial account and credit the PEBB treasury account;
(III) “Local Government
Payment” means the monthly Local Government Payment to PEBB that includes
the contributions of both Local Government as the employer, and its employees as
required to pay the monthly premiums in full for selected PEBB benefit plans;
(IV) “Local Government
Payment Invoice" means a monthly itemized statement provided by PEBB that includes
the enrollment elections of the employees and dependents of a Local Government and
the PEBB premium rate associated with the benefit coverage enrollment month.
(V) “Pay-As-Billed”
means billing a Local Government based upon its monthly enrollment file in the PEBB.benefits
system.
(VI) “Overpayment”
means the amount of a Local Government’s monthly payment to PEBB that exceeds
the amount due.
(VII) “Underpayment”
means a payment submitted by a Local Government that is less than the invoiced amount.
(VIII) “Electronic
Funds Transfer” refers to a payment through ACH credit or ACH debit.
(IX) “Cover Oregon”
refers to the Oregon Health Insurance Exchange public corporation.
(X) “Due date”
means the third business day into the current month of coverage.
(v) Local Governments will
receive a monthly invoice from PEBB by the first business day of the month of coverage
that details the payments due for that month of coverage.
(vi) Local Governments are
required to submit payment to PEBB through Electronic Funds Transfer no later than
the due date.
(vii) PEBB reserves the right
to issue surcharges or take other appropriate measures to Local Governments that
submit monthly payments after the due date.
(viii) Local Governments
must select an electronic funds transfer method by submitting an Electronic Funds
Transfer authorization form to PEBB 45 days prior to participation in a PEBB plan
year.
(ix) Local Governments seeking
a refund of an overpayment must notify PEBB within 45 calendar days from the date
the overpayment occurred;
(I) PEBB will request a refund
from a carrier in accordance with the law. The carrier will refund the premium to
PEBB back to the date of the termination or the date allowed by law for recoupment.
(II) PEBB will generally
reimburse a Local Government overpayment by making an adjustment to the next monthly
invoice.
(3) General Participation
Requirements
(a) Local Governments who
choose to participate in PEBB must comply with PEBB eligibility, enrollment, and
continuation of insurance rules as defined in OAR Division 101-10, 101-015 and 101-030,
regardless of whether the Local Government is administering a Section 125 Cafeteria
Plan.
(b) Local Governments must
agree to and sign an inter-governmental agreement with PEBB along with the Notice
of Intent to Participate that includes provisions of their participation in PEBB,
including, but not limited to, the following participation requirements. Local Governments
must:
(A) Retain full authority
to define employee-employer premium cost share arrangements compliant with Affordable
Care Act (ACA) regulations.
(B) Participate in all benefit
coverage types approved and provided by PEBB. All PEBB plans must be available to
all benefit eligible employees.
(C) Use the PEBB tiered-rate
structure for all benefit coverage types.
(D) Participate in all PEBB
health and wellness and programs offered by PEBB.
(E) Comply with the PEBB
benefit plan-year cycle, Open Enrollment period, and plan renewal timeline.
(F) Submit all premium payments
to PEBB on a monthly basis. Premium submission to PEBB is completed through Electronic
Funds Transfer, no later than the due date as indicated by PEBB.
(G) Not transfer to any PEBB
plan any deductibles or annual out-of-pocket maximums met with a prior carrier.
(H) Agree that PEBB.benefits
is the authority for managing and reporting all billing, eligibility and enrollment
information communicated to the insurance plan carriers by PEBB and Local Governments
will update employment changes in PEBB.benefits as they occur.
(c) Local governments may
allow currently enrolled Early Retirees to participate in PEBB retiree plans only
if the retirees participated in the Local Government’s retiree medical plan
for at least two years prior to January 1, 2014. The PEBB Retiree Rules as defined
in OAR Division 101-50-0005 et. seq. apply to all Early Retirees.
(d) Local Governments may
request transfer of term life insurance coverage through the Local Government group
life policy to the PEBB term life insurance policy. PEBB will transfer the life
insurance amount in force on the last day the prior group coverage was in effect
if requested and documented by the Local Government rounded to the nearest multiple
of $10,000. Premium rates for the coverage will be at the current PEBB life insurance
rate tier structure.
(e) Local Governments that
elect to participate in benefit plans provided by PEBB may elect to terminate participation
in PEBB, subject to the following rules:
(I) Termination of participation
will be allowed on a one-time basis only; however, Local Governments electing to
terminate PEBB plan coverage and electing to participate in Cover Oregon, can elect
to return to participate in plans provided by the PEBB. Upon returning to PEBB,
a Local Government must again satisfy all Notice of Intent to Participate and other
participation requirements.
(II) PEBB may terminate participation
of a Local Government within three months of entering PEBB if the Local Government
fails to perform any action required by Oregon Revised Statutes (ORS) 243.105 to
243.285 and 292.051 or by PEBB rule.
(f) Local Governments may
purchase employee benefits not offered by PEBB or Cover Oregon.
Stat. Auth: ORS 243.061-302, 659A.060-069,
743.600-602 & 743.707
Stats. Implemented: ORS 243.061-302
& OL 2007 Ch. 99
Hist.: PEBB 3-2013(Temp),
f. & cert. ef. 12-17-13 thru 6-15-14: PEBB 1-2014, f. & cert. ef. 5-1-14

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