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May 2010
Agency Update

 PEBB seeks to support agency and university administration of benefits. These periodic newsletters keep you updated on plans and changes. We look forward to your ideas and feedback.
Download the May Agency Update (pdf) 
E-mail Notication Employer Form (pdf) 
State of Oregon Online Employer Claim Submission Guide (pdf) 

Federal Legislation
Health Care Reform. PEBB’s consultant reports that many parts of the health-care reform bill have various interpretations. Federal agencies are still developing guidance. PEBB staff is working through the details. PEBB continues to communicate that the requirement on coverage of dependents to age 26 will go into effect for PEBB plans beginning Jan. 1, 2011.
COBRA. Federal law enacted April 15 extends the COBRA subsidy eligibility period under ARRA through May 31, 2010; further extensions are being considered. BenefitHelp Solutions will send revised general notices to affected individuals who received a general notice without the offer of a COBRA subsidy March 31 - May 31, 2010.

April Newsletter.  The April newsletter will be posted to the Web April 5, with notice distributed that evening. Content advises members on using their formulary to avoid surprises at the pharmacy; apprises them of PEBB attention to federal legislation; highlights online wellness resources in their plan; and reminds them about enrolling in long-term care coverage at any time. Link to newsletters: www.oregon.gov/DAS/PEBB/publications.shtml.
New Hire Resources.  Staff is finalizing a video for new hires that gives them information on available plans and on how to enroll. It should be on PEBB’s Web site the second week in April.

April Board Meeting
Coverage of Midwife Services. The Board voted to restore coverage at the out-of-plan (70 percent) level for services of licensed direct-entry midwives in the Statewide Plan. The plan administrator is revising the member handbook.
Worksite Health Screenings. The Board discussed options for worksite health screenings and chose not to fund a screening program in 2010. PEBB plans fully cover preventive services that include health tests and screenings based on recommended schedules. The plans encourage members to work with their primary care providers to make sure they get screenings that are right for them. This helps the provider know the member’s medical history and status and provide care based on the results.

Change in Processing Period for QSCs. Processing update forms timely for QSCs reduces financial risk to the agency and the employee. On May 1, the period for agencies to process a QSC request goes down from 90 days to 65 days. This means agencies have 65 days to process if they receive a request on the first day of the 60-day QSC window and five days if they receive a request on the last day of the 60-day window. Here are two examples.
  • Jane’s divorce is final on April 10, and she wants to remove her ex-husband from coverage. Her agency receives her update form on April 26. The agency has 49 days to process the request, and the ex-husband loses coverage beginning May 1.
  • John becomes Twyla’s legal guardian on April 10 and wants to add her to coverage. His agency receives his update form June 9. The agency has five days to process the form, and Twyla has coverage beginning July 1.
Date of Change
Date Form Received
Days to Process
Effective Date
Use the Right QSC. The system is programmed for qualified status changes based on administrative rules, IRS code requirements and federal regulations. Make sure the QSC you select meets the logic programmed in the system.
  • Use the New Hire QSC only to enroll newly eligible employees; use the Reinstatement QSC to reinstate employees returning to work within 12 months of departure. The New Hire QSC opens the member module for the new hire, which allows enrollment in guarantee-issue insurance – an option not available to returning employees.
  • Use the Correcting Processing Error QSC to cancel out an error. For example, if you input an incorrect beginning date when reinstating enrollments, cancel the incorrect date with the Correcting Processing QSC. Then use the Reinstatement QSC to reinstate the enrollment with the correct date.
Disability Claims Process. Because disability insurance is income-replacement insurance, both the employee and the employer must submit information on a claim. If the agency fails to provide information timely, The Standard may cancel the claim. This places the agency at risk.
Employees initiate a claim with The Standard by phone. This may be a claim upon disability or in anticipation of disability (e.g., childbirth). The agency will receive an immediate e-mail requesting completion of the employer’s statement online through AdminEase. The Standard will send additional notice at three and five days if the agency does not provide the information.
Use the screenshots and call-outs as a guide for submitting the employer’s statement through AdminEase.
PEBB and The Standard are working on an electronic eligibility feed that will improve the disability claims process. Meanwhile, following The Standard’s procedures will speed processing of claims.

Agency Resources

Suggest topics for future editions of the Agency Update via e-mail to pebb.hottopics@state.or.us. 
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