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

 

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OREGON HEALTH AUTHORITY,

OREGON EDUCATORS BENEFIT BOARD

 








DIVISION 65
OEBB ADMINISTRATION OF
EARLY RETIREE GROUPS
111-065-0001
Definitions
For the purpose
of this rule:
(1) "Direct
Debit” for purposes of this OAR refers to a payment through an Automated Clearing
House (ACH) credit or ACH debit that initiates the movement of funds electronically
from the early retiree’s individual banking account within the United States
to the OEBB Treasury account.
(2) “OEBB
Administered Early Retiree” means an individual who meets the definition of
Eligible Early Retiree in OAR 111-010-0015 and whose benefits are administered by
OEBB.
(3) “Overpayment”
means the amount of the early retiree’s monthly payment to OEBB that exceeded
the amount due.
(4) “Payment
in full” means payment received by OEBB which is equal to the current monthly
amount due for all benefit premiums which the early retiree is currently enrolled
in.
(5) “Underpayment”
means a payment submitted on or before the due date by the early retiree that is
less than the invoiced amount.
Stats. Auth.: 243.860
- 243.886

Stats. Implemented:
ORS 243.864(1)(a)

Hist.: OEBB
6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert.
ef. 10-9-12
111-065-0005
Untitled
The following administrative
rules in Division 65 pertain to OEBB Administered Early Retirees in addition to
OEBB’s Division 50 rules which pertain to all Early Retirees.
Stats. Auth.: 243.860
- 243.886

Stats. Implemented:
ORS 243.864(1)(a)

Hist.: OEBB
6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert.
ef. 10-9-12
111-065-0010
OEBB Early
Retiree Invoicing
(1) OEBB will enroll the Early Retiree
after OEBB has received the enrollment form and one of the following is completed:
(a) The required ACH Authorization
for a recurring Direct Debit Payment is received from the early retiree to initiate
the setup of automated payments via ACH; or
(b) An Exception Request
Form is received from the early retiree and reviewed and approved by OEBB.
(2) OEBB will send payment
invoices to early retirees that will provide notification of the amount and payment
due date or the date the automatic checking deduction will occur. OEBB will send
invoices on or around the 15th of the month with payment due on the 2nd business
day of the following month.
(3) Advance payments may
be made only within the same Plan Year. However, any remaining balances will be
carried into the next Plan Year.
Stats. Auth.: 243.860 - 243.886
Stats. Implemented: ORS 243.864(1)(a)
Hist.: OEBB 6-2012(Temp),
f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12;
OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. &
cert. ef. 7-12-13
111-065-0015
Early Retiree Payment Methods
and Due Dates
(1) Premium payments will be made through
Direct Debit via ACH on the 2nd business day of the month unless otherwise prior
authorized by designated OEBB staff.
(2) As necessary, or upon
written request of a participating Early Retiree, OEBB staff will review and determine
if an alternative withdrawal date is warranted to avoid future payments being returned
for Non-sufficient Funds (NSF) on a recurring basis.
(3) OEBB will accept payment
from early retirees by methods other than Direct Debit when specific exceptions
apply:
(a) The individual does not
have an account with a financial institution within the United States;
(b) The individual's special
circumstances, which OEBB will review on a case by case basis.
(4) A request for exception
must be made in writing and include the reason why or special circumstance that
would not allow the member to submit payment via Direct Debit.
(5) OEBB will review the
request for exception, determine whether to allow or deny the exception, and notify
the requesting party of its decision within 21 days of receipt of the request.
(6) Notwithstanding OAR 111-065-0010,
all premium payments must be received on or before the 2nd business day of the month
for the current month’s health care coverage. All payments will be subject
to this due date.
(7) If the Early Retiree
has a checking account, but submits a written letter declining to use the Direct
Debit payment method, a $35.00 processing fee shall be applied to the Early Retiree’s
monthly premium.
Stats. Auth.: 243.860 - 243.886
Stats. Implemented: ORS 243.864(1)(a)
Hist.: OEBB 6-2012(Temp),
f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12;
OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. &
cert. ef. 7-12-13
111-065-0020
Early Retiree
Overpayments
(1) OEBB will include
overpayment amounts on the monthly invoice. The invoice will include the total payment
received, the date it was received, the amount of premium payment due, and any remaining
balance of additional premiums paid.
(2) OEBB
will automatically apply any overpayments to the next month’s premium due.
The early retiree may complete a Request for Reimbursement form if a refund of an
overpayment is desired. The early retiree may be responsible for processing fees
associated with refunds less than $100. Reimbursements will be refunded via check.
(3) Remaining
balances on coverage that has ended will be refunded in full within 30 days of the
coverage end date or the date OEBB is notified that coverage should end, whichever
occurs later.
Stats. Auth.: 243.860
- 243.886

Stats. Implemented:
ORS 243.864(1)(a)

Hist.: OEBB
6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert.
ef. 10-9-12
111-065-0025
Early Retiree
Underpayments
(1) Premiums must be paid in full on
or before the 2nd business day of the month, unless otherwise pre-approved by OEBB
under OAR 111-065-0015(2).
(2)(a) Early retirees will
be notified if their coverage was terminated due to the premium not being paid in
full on the specified due date, including payments returned by the bank for Non-Sufficient
Funds (NSF), closed bank accounts, and frozen accounts.
(b) A check or ACH transaction
that is returned for NSF, closed bank account, or frozen account is considered non-payment
of premiums.
Stats. Auth.: 243.860 - 243.886
Stats. Implemented: ORS 243.864(1)(a)
Hist.: OEBB 6-2012(Temp),
f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12;
OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. &
cert. ef. 7-12-13
111-065-0030
Termination
(1) OEBB shall not be responsible for
any unpaid portion of premiums for coverage and will terminate the early retiree
and dependent coverage for non-payment or underpayment of premiums due.
(2) OEBB coverage will be
terminated under the following circumstances:
(a) Premiums are not paid
in full by the due date. If the payment is not received in full on the 2nd business
day of the month unless otherwise preapproved by OEBB under OAR 111-065-0015(2),
the early retiree’s coverage will be terminated on the last day of the month
in which a full premium payment was received; or
(b) As referenced in 111-050-0015.
Stats. Auth.: 243.860 - 243.886
Stats. Implemented: ORS 243.864(1)(a)
Hist.: OEBB 6-2012(Temp),
f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert. ef. 10-9-12;
OEBB 2-2013(Temp) f. & cert. ef. 4-22-13 thru 10-18-13; OEBB 5-2013, f. &
cert. ef. 7-12-13
111-065-0035
Appeals
Early retirees have
the right to use the OEBB Appeals and Administrative Review process as defined in
OAR 111-080-0030.
(1) Early
retirees may appeal OEBB’s eligibility decision.
(2) Early
retirees have the right to request a review of benefit and claim issues that are
not resolved following the completion of the carrier appeal process. Administrative
Review requests relating to denied benefits are limited to a determination of whether
or not a benefit was intended to be covered under the current contract.
Stats. Auth.: 243.860
- 243.886

Stats. Implemented:
ORS 243.864(1)(a)

Hist.: OEBB
6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert.
ef. 10-9-12
111-065-0040
Continuation
of Coverage
(1) Early Retirees
and dependents have COBRA rights consistent with 111-050-0001.
(2) Loss
of coverage due to failure to make a premium payment is not a qualifying event.
Stats. Auth.: 243.860
- 243.886

Stats. Implemented:
ORS 243.864(1)(a)

Hist.: OEBB
6-2012(Temp), f. & cert. ef. 4-20-12 thru 10-16-12; OEBB 11 2012, f. & cert.
ef. 10-9-12








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