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August 2009
Agency Update

 PEBB is seeking new ways to support agencies, universities and members within the constraints of the new budget. These periodic updates will let you know of plans and changes. We look forward to your ideas and feedback along the way.
 
Download the August Agency Update 
 
 

Resources
 
Pebb.benefits. The system now resides on a new, higher-performance server. The URL, user names and passwords stay the same. Look for faster processing and greater reliability.
 
Member Module. The system contractor is working to make the enrollment module more member-friendly. We will test before Open Enrollment.
 

Enrollment Processes
Woman
 
Mandatory Open Enrollment. In July, the Board approved that all eligible employees must enroll for a 2010 medical plan (including opt out), Oct. 1-31. PEBB will enroll employees who fail to act in the employee-only tier of the Statewide Plan effective Jan. 1, 2010. Unless these employees initiate a remedy, coverage of their dependents will end Dec. 31, 2009.
 
Dependent Certification. The Board confirmed that, during Open Enrollment, employees must certify eligibility for coverage of dependents who will be 19 to 24 as of Jan. 1, 2010. Dependents not certified will lose coverage Jan. 1, 2010.
 
Remedies. The following remedies exist for employees who fail to act during Open Enrollment:
  • Agencies may process enrollment forms through Nov. 15.
  • PEBB will include records for dis-enrolled family members in the Nov. 20 weekly COBRA file. These individuals may enroll for COBRA coverage effective Jan.1, 2010, forward.
  • Nov.16-Dec.31, agencies may process an enrollment-remedy form to add dis-enrolled family members back to coverage under the employee’s enrollment in the Statewide Plan beginning Jan. 1.
  • From Jan. 1, forward, agencies may process medical and dental update forms to add family members to coverage; the coverage will begin the first of the month following receipt of the form.
Paper Forms. Enrollment forms for 2010 will be available online in September for employees without Internet access. Agencies must process completed forms by Nov. 15, 2009.
 

2010 Plans
 
Networks. The Statewide Plan administrator reports continued progress on provider networks, including those in eastern Idaho and Klamath County. The online provider search from the Portal Page (see Communications, below) includes nurse practitioners, behavioral health practitioners and physical therapists. A PDF on the page lists OHSU providers.
 
Rates: Access rates for medical and dental plans through the Question & Answer set on the Portal Page.

Communications
 
Plan. See the communications plan for Open Enrollment. Please remember that it is the Board that provides the benefits; you may want to ask for input from PEBB staff before distributing broad communications on Board decisions to employees.
 
Portal Page. www.oregon.gov/sites/DAS/PEBB/StatewidePortalPage.page is updated weekly.
 
Newsletter. The August edition discusses mandatory medical enrollment during Open Enrollment: www.oregon.gov/DAS/PEBB/publications.shtml. E-mail notice goes out the first week in August.
 
Kaiser Added Choice. Current members will receive a mailing this month with options for 2010.

Administrative Rules
 
Permanent Rules. Staff is working with stakeholders on changes to permanent rules that go into effect Oct. 1, 2009. The following summarizes these OAR Chapter 101 rule changes and schedule.
 
Rules
 
001-0020 Social Security Numbers. Repeals
010-0005 
Definitions. Clarifies “half time” and others
015-0011 
Dependent Child. Creates rule that comprises definitions and requirements
020-0005 
Newly Hired and Newly Eligible Employee. Clarifies requirements
020-0015 
Opting Out of Medical Insurance. Adds requirement on verification
020-0037 
Correcting Enrollment and Processing Errors. Clarifies requirements
020-0040 
 Late Enrollment. Clarifies requirements and benefits available
020-0045  Returning to Work. Clarifies
020-0060 
Dependent Care FSA. Addresses minimum contribution, reimbursement post-eligibility 
020-0065 
Healthcare FSA. Addresses minimum contribution, reservist distribution, prepayment 
030-0022 
 Continuation of Coverage on Active Military Leave. Clarifies
 
 
 
Schedule
 
 
Aug. 12
Interested Parties notice (subscribe by e-mail to cherie.m.taylor@state.or.us)    
Sept. 1
Oregon Bulletin posting
Sept. 2
Web site posting: www.oregon.gov/DAS/PEBB/adminrules.shtml                     
Sept. 23
Public hearing                                                                                             
Sept. 25
End of comment period
Oct. 1
Effective date
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rules, Denials and Appeals. When you discuss a denial with a member, please point out the rules used in your determination. See this example of how this saves time for all if the member appeals.
 
Rules and Policy on Military Leave. Members on continued leave for active military duty more than 24 months do not meet eligibility criteria for continued agency-paid benefits or for yearly benefits related to the DAS military training policy. You may enroll these individuals only when they return to work and meet eligibility requirements.

Agency Resources
 
PEBB oregon.gov/das/pebb    
 
Benefit Questions: inquiries.pebb@state.or.us
Comments for the Board: pebb.connect@state.or.us   
 
(503) 373-1102, fax (503) 373-1654        
Agency Resources
 
User Access Form 
 
Agency, University & PEBB Contacts 
 
 
Medical Plans 
Mail-order Prescriptions    
 
Dental Plans 
Optional Plans Other Benefits