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October 2010
Download the October 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 October Agency Update (pdf) 
 
 
Shortcuts and Instructions:

 
 

OAR Changes
PEBB is in the process of changing its Oregon Administrative Rules. Federal law requires several changes that affect eligibility, enrollment processes, and requirements for agencies and employees. These changes are related to:
  • Extension of coverage to eligible adult children to age 26
  • Rescission of coverage and effect on enrollment processes and PEBB appeal
Following are highlights. See the attachment for a list of PEBB OAR changes in process. Read PEBB OARs as they are posted on the Secretary of State’s website at arcweb.sos.state.or.us/rules/OARS_100/OAR_101/101_tofc.html.
 
Extension of coverage of eligible adult children to age 26 beginning 2011. To be eligible for coverage, the child must be
  • The eligible employee’s, spouse’s, or domestic partner’s son, daughter, stepson, stepdaughter, adopted child or child placed for adoption, foster child or other legally placed child; or
  • A biological child of an eligible dependent child of an eligible employee, spouse or domestic partner (a grandchild) and meets one of the following criteria
  • The child’s parent will not be older than the age of 26 on the last day of the plan year, is unmarried and without a domestic partner, both the child’s parent and the child live in the household of the employee and both receive over half of their financial support from the employee; or
  • The child lives with the eligible employee and the employee is legally responsible for the welfare of the grandchild. (Legal documentation of guardianship, conservatorship, or other custody documents required.)
The exception is a child of any age when the health plan has certified the child’s disability.
 
Changes from current rule - Eligible Adult Children include those who are age 19 to 26 who will not turn 27 in the plan year for which they are being enrolled. They are no longer required to be a tax dependent, a full time student or live in the employee’s household over half the year and receive over half support from the employee. They can be married or have a domestic partner. They can have be employed or in the military. They can have other coverage through an employer, parent, individually, etc. They do not need to live in the employee’s home. See examples on the next page.
 
Effect on Enrollment Processes
  • To cover a grandchild, the employee must provide an affidavit (new form) and possibly legal documentation of responsibility
  • The child will not have attained age 27 as of December 31 in the plan year
  • Coverage terminates at midnight December 31 of the year in which a child reaches age 26
  • The exception for termination of coverage is a child certified disabled by the employee’s PEBB medical plan
 
 

 Examples of Eligible and Ineligible Dependents in PEBBEligibleIneligible
A 15-year-old biological grandchild of an eligible employee lives in the employee’s household, and the employee has legal custody.X 
A 25-year-old child is married and lives in Colorado. (Note: check your health plan’s service area.)
X 
An 18-year-old child has health coverage through another parent or the child’s own employment.
X 
An eligible employee has a son-in-law or daughter in-law of any age.
 X
An eligible employee’s, spouse’s, or domestic partner’s eligible dependent child has a biological child (grandchild) who lives with the eligible employee, the child’s parent is not married an does not have a domestic partner,  and the employee provides more than half the grandchild’s and the parent’s support.
X 
An eligible employee’s biological grandchild of any age does not live with the employee.
 X
A newborn is placed for adoption with the employee.
X 
An employee has child who is 27 years old. X
An employee’s 23-year-old child does not live with the employee and does not attend school.X 
The eligible employee has a mother or father at any age or level of dependency. X
An eligible employee has an eligible dependent who has a three-year-old stepchild, and the employee wants to cover the stepchild. X
An eligible employee’s eight-year-old sister lives with the employee, and the employee has legal guardianship of the sister.X 
An eligible employee’s eight-year-old sister lives with the employee, and the employee does not have a legal obligation to provide for the child’s welfare. X
 
Rescission of Coverage. Federal law (and now OAR) defines rescission as follows:
“Rescission” means a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation or discontinuation of coverage that is prospective only, or one that is effective retroactively but is attributable to nonpayment of premiums or contributions, is not a rescission.
 
This definition prohibits PEBB from rescinding coverage once an individual receives coverage – except in cases of fraud, intent to misrepresent the facts, or for nonpayment of premiums or contributions. This means termination of coverage must be prospective beginning 2011, and PEBB cannot terminate coverage retroactively.
 
An employee’s failure to report a family member’s or domestic partner’s loss of eligibility during the 12 month period before the start of each annual open enrollment period can result in civil or criminal charges against the employee for fraud or the intent to misrepresent the material facts of enrollment. To the extent allowed by law, PEBB may rescind coverage back to the last day of the month of the plan year when eligibility was lost. Rescission of coverage can occur to an employee, or an individual for whom the employee provides coverage.
 
Prospective termination requires the following changes to rules and timelines beginning 2011:
  • An employee must request termination of coverage within 30 days (not 60 days) of the event that caused the individual to lose eligibility.
  • Agencies will terminate the coverage prospectively, the last day of the month following receipt of the forms from the employee.
  • PEBB must receive all employee requests for termination of coverage of ineligible individuals beyond the allowed 30 days.
  • PEBB will communicate an imputed value to add to the employee’s taxable wages for each month’s coverage provided to the individual when the individual was not eligible.
  • The individual must receive a COBRA notice.
  • Employees should not use Open Enrollment to remove individuals who lost eligibility before or during the Open Enrollment period. They must use a midyear change form.
When a rescission occurs
   PEBB will
  • Provide 30 calendar days advance notice of the rescission date (last day of the month and plan year in which eligibility was lost)
  • Offer appeal rights to the rescission
Agencies can
  • Determine that that an employee must repay to the agency premiums paid for all coverage during the period of ineligibility
  • Take disciplinary action against the employee for failure to remove an ineligible individual
  • Have imputed value added to taxable income
The plan may
  • Determine that an employee must repay insurance claims paid during the period of ineligibility
 
When an individual appeals a rescission to PEBB:
  • Premium and claim payments for the individual will continue until the appeal is exhausted
  • If the rescission is upheld, the employee will be responsible to pay all claims and premium payments by the plan or PEBB during the period of ineligibility
 
Effect on Enrollment Processes
Open Enrollment, Oct. 1-31, 2010, for the 2011 Plan Year
  • Employees must actively choose 2011 medical and dental enrollments, or they will roll to employee-only coverage in the Statewide Plan and ODS Traditional; all family members and domestic partners will be dropped Jan. 1, 2011
  • Employees may enroll electronically for Opt Out, Domestic Partner by Affidavit, Dependent Child by Affidavit and Grandchild by Affidavit; however all affidavits and required documentation must be submitted to the agency by November 5, or the enrollment will not occur.
 
Enrollment and Midyear Changes beginning November 1 for the 2010 plan year
  • Newly eligible and newly hired employees, and employees requesting midyear changes that include opt out, domestic partner by affidavit, dependent child by affidavit and grandchild by affidavit must enroll by submitting ALL forms to the agency within 60 days.(No electronic enrollment)
  • The agency must not complete the employee’s enrollment until all documentation is complete.
 
Enrollment and Midyear Changes beginning 2011
  • Newly eligible employees, new hires, and employees requesting midyear changes that include opt out, domestic partner by affidavit, dependent child by affidavit and grandchild by affidavit must enroll by submitting forms to the agency within 30 days(not 60 days).
  • The agency must not complete the employee’s enrollment until all documentation is complete.
 
Correcting Enrollment or Processing Errors beginning November 1 forward
  • Once the enrollment is effective, enrollment for core benefits may terminate prospectively only.
  • Coverage for a new domestic partner may terminate only prospectively and only with an eligible midyear plan change request (see the Imputed Value Chart at www.oregon.gov/das/pebb/pdb).
 

pebb.benefits
Open Enrollment Changes
 
Mandatory Medical and Dental. PEBB’s Open Enrollment Oct. 1-31, 2010, requires mandatory enrollment for 2011 medical and dental coverage – either by choosing to continue in current plans or enrolling in new plans or they will roll to employee-only coverage in the Statewide Plan and ODS Traditional; all family members and domestic partners will be dropped Jan. 1, 2011
  • Selecting the action button for no changes will continue current enrollments in 2011 and avoid default enrollment for medical and dental coverage.
  • An agency selecting Medical opt-out requires choosing one of two icons: black icon for Medical Only opt out; orange icon for Combined Medical and Dental opt out.
  • Grandchild by Affidavit will be included in the system as a new relationship type.
  • Zip codes for Deschutes and Jackson counties will be removed from Rural County designation and updated as non-rural in weekly files sent to the plans.
  • Zip codes for Providence Choice expansion will be added to the system; employees who live or work (at least 50 percent of the time) in the plan’s service area may enroll.
Changes improve user experience for employees and agencies
  • Using “Forgot User Name/Password,” employees can request temporary password; delivered via e-mail in less than 30 seconds.
  • “Notice of Change to Your Benefit Record” delivered to employees via e-mail; once per day ~ 7 p.m.
 

Open Enrollment Processes
9-30-2010
PDB terminates all FSA coverage effective 12-31-2010
PDB reflects the new age group enrollment for optional life insurance effective 1-1-2011
PDB terminates all PEBB Basic Life coverage effective 12-31-2010
10-1-2010
Member, Agency and PEBB Open Enrollment modules open
10-31-2010
Member Open Enrollment module closes
11-05-2010
Agency deadline for processing opt-out and affidavit documentation
11-13-2010
Agency and PEBB Open Enrollment modules close
11-14-2010
PEBB default process
  • PSWP and ODS Traditional – Employee only
  • Part-time employees to part-time plans
  • All family members and domestic partners dropped effective 12-31-2010; COBRA notice
11-15/16-2010
Open Enrollment transactions sent to payroll systems
11-20-2010
Weekly files contain Open Enrollment changes
Enrollment Changes in New Hire Module
11-1-2010
Selection of opt out no longer available; only paper form and documentation acceptable
Selection of relationship by affidavit no longer available; only paper form and documentation acceptable
Changes to Plan Change Requests (QSC)
1-1-2011
Plan change requests accepted only within 30 days (not 60) of event date
All changes must be prospective; no retroactive changes
QSC Event Date field allows only “today’s date” or later; no retroactive dates allowed
Must enter date when all documentation is received; may or may not be original date stamp

Open Enrollment Communications
Open Enrollment Packets with federally required notices were mailed mid-September to all employees using the contact address in their benefit record.
 
2011 benefit materials are online at http://www.oregon.gov/DAS/PEBB/2011Benefits/2011toc.shtml.
 
FAQs are posted at www.oregon.gov/DAS/PEBB/Questions.shtml and will be updated as warranted. Agencies should point employees with questions to these sets of questions and answers.
 
The October newsletter, to be posted online Oct 4 will include information on Open Enrollment, Providence Choice Medical Homes, and effects of rule changes.
 
PEBB will post updates for agencies as warranted at www.oregon.gov/das/pebb/pdf and send e-mail notifications to agencies.
 
Targeted e-mails on opt out, coverage by affidavit and not enrolled to date, will be sent to employees Oct. 11, 18 and 25. Statewide e-mails are scheduled Oct. 7, 14, 21 and 28. E-mail messages to agency heads on employee enrollments to date are scheduled Oct. 11 and 25.
 
Posters for display in worksites are being printed and distributed. These and other materials sized for printing and posting at worksites and “benefit fairs” will be available Oct. 5 at www.oregon.gov/DAS/PEBB/PDB.
 

Weight Watchers Program
Beginning Oct. 1, 2010, one call does it all to enroll. No need to call health plan first. No form for renewal (except Online). A set of questions and answers on this topic is posted at www.oregon.gov/das/pebb/questions.shtml.
 
New Process to Enroll. Call 1-866-454-2144,* provide name and ID number from insurance card and choose path – At Work, Local Meetings, Online
  • Meetings path: receive meeting pass by mail
  • Online path: receive 14-digit promo code in phone call
 
New process to renew for meetings. Show pocket guide to Leader or Receptionist to verify attendance at least 10 of 13 weeks. Receive single-use renewal coupon. Call 1-866-454-2144*
  • Provide name and ID number from insurance card
  • Receive renewal coupon by mail
 
New process to renew for online. Complete Participation Form. Send form and Weight Tracker summary: Fax 1-888-598-7704; E-mail PEBBWeightWatchersRenewal@callTSC.com 
  • Receive new access code in 5 to 7 business days
  • Call 1-866-454-2144 and provide access code
  • Receive new 14-digit promotion code for online renewal
 
New requirement for 2011. For no-cost Weight Watchers in 2011, all principal subscribers must complete annual online health assessment
 
To Access Online Health Assessment, register on health plan’s website
  • Kaiser:  kp.org
  • PEBB Statewide: myprovidence.org
  • Providence Choice: myprovidence.org
Complete health assessment (takes about 30 minutes)
 
Why do online health assessment?
  • No cost Weight Watchers
  • Entirely confidential
  • Identifies health risks; helps set personal health goals
  • Easy access beginning October 1
  • Required before enrolling for first series of the year
 
Get ready for New Year (takes about 3 weeks after completion for name to appear on eligibility list)
  • Members not changing medical plans in Open Enrollment can take the online health assessment beginning October 1 and have it count for 2011
  • Members who are changing medical plans between Kaiser Permanente and plans administered by Providence Health Plans will have to wait until January 1 to complete the assessment with their new 2011 medical plan
 
The source for Weight Watchers Information
 
*1-800-651-6000 for meetings in Lane, Douglas, Coos, Curry, Josephine, Jackson, Klamath counties
 

PEBB OARs in Process
As of Sept. 25, 2010
Part 1 of 3: The following OARs are temporaries for Oct. 1, 2010:
  • Temporary OAR101-015-0013 replaces temporary OAR101-015-012 effective October 1, 2010 - Clarifies required enrollment and eligibility for dependent children by affidavit and grandchildren by affidavit beginning November 1, 2010.
  • 101-015-0025 Domestic Partner - Repeal and replace with temporary rule 101-015-0026 (new number) effective October 1, 2010. Clarifies the required enrollment process for domestic partners by a newly eligible employee or for an employee’s midyear plan change.
 
Part 2 of 3: The following amended OARs are in process for Oct. 1, 2010 (approved by board and heard at public hearing):
  • 101-20-66 Appeal- New rule, added appeal rights for rescission
  • 101-20-0015 Opt Out- Amended to provide TRICARE and clarify required enrollment process for newly eligible or midyear changes starting November 1, 2010.
 
Part 3 of 3: The following OARs are being amended for Jan. 1, 2011:
 
101-010-0005 Definitions – Provides new definitions for agency, core benefits, rescission, etc.
 
101-015-0005 Eligible Individuals – decreases enrollment time from 60 to 30 days
 
101-015-0011 Dependent Child – Brings dependent eligibility from the two OARs used in 2010 to only one OAR for the plan year 2011. Temporary OAR 101-15-0013 will repeal and tax dependency criteria in 0011 are deleted.
 
101-015-0026 Domestic Partner- Temporary OAR from October 1 made permanent. (Same number used)
 
101-020-0002 Effective Dates and Termination – Clarifies coverage effective dates, and special enrollment changes from 60 days to 30 days. 
 
101-020-0005 Newly Hired and Newly Eligible Employee – Changes the allowable enrollment time from 60 to 30 days.
 
101-020-0018 Declining Benefits – Language
 
101-020-0025 Removing an Ineligible Individual from Benefit Plans - Changes the allowable time to notify employer of an ineligible individual from 60 to 30 days. Makes termination of an ineligible person prospective, clarifies when imputed value will be added to an employee’s taxable wages, and provides rescission for ineligible individuals. Sets out rescission guidelines.
 
101-020-0032 Open Enrollment – Clarifies Open enrollment rights and employee responsibilities.
 
101-020-0037 Correcting Enrollment and Processing Errors – clarifies that core benefit elections may terminate prospectively only during correction processes. Change to allowable time for corrections requests from 60 to 30 days in most instances.
 
101-020-0045 Returning to Work – Language and change of allowable time to change elections in some eligible returning to work instances from 60 to 30 days.
 
101-020-0050 Midyear Benefit Plan Changes – Language and change of allowable time to request a change from 60 to 30 days
 
101-030-0070 Life, Disability and Accidental Death and Dismemberment Insurance - Continuation of Coverage – Repealed 101-020-0070 and replaced with 101-030-0070 due to incorrect division assignment of 020.
 
101-030-0010 Continuation of Group Medical Insurance Coverage for Injured Workers (CBIW) – Language and change of allowable time to request changes to elections upon returning to work from 60 to 30 days.
 
101-030-0015 Continuation of Group Medical and Dental Insurance Coverage for Employees Covered under the Federal Family Medical Leave Act (FMLA) – Change of allowable time to request changes to elections from 60 to 30 days.
 
101-030-0022 Continuation of Insurance Coverage for Employee on Active Military Leave – Change of allowable time to request changes to elections from 60 to 30 days.