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February 2011
Download the Agency Update and Attachments

 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 February Agency Update (pdf) 
 
 


Reconciling with Regulations
 
Reconciling OSPS Run 1 and Run 2. New federal regulations on health care coverage affect agencies’ actions on termination of coverage. The regulations preclude agencies from retroactively terminating coverage once premium has been paid.  This affects agencies that pay employees through OSPS, because the payroll process uses two data runs – one to calculate and distribute pay based on data available on the cutoff date, and one to true-up to the end of the month, including data on eligibility for benefits. Here’s a breakdown:
  1. OSPS Run1 generates payroll for the first of the coming month, including premium payment for health care benefits. Cutoff for Run1 is typically five days before the end of the month. Eligibility for coverage can be affected between the Run1 cutoff date and distribution of pay on the first of the month. 
  2. OSPS Run2 – typically 10 days after pay has been issued and premium was paid – matches up actual eligibility data, among other data, with premium payment.
  3. The result may show that
    1. An employee did not meet eligibility requirements for coverage in the current month and premium was paid in error. For example, a part-time employee may have forecast monthly work hours sufficient to meet eligibility requirements then did not meet that forecast.
    2. An employee lost protective-leave eligibility for coverage in the previous month, but the agency force paid the premiums in Run 1. Since Run1 generates payroll and pays premium, the employee’s coverage continues to the first of the following month.
  4. In either case, agencies cannot retroactively take back the premium or the coverage, and they cannot seek refund of premium paid through PEBB.
These occurrences affect less than 0.01 percent of premium payroll actions. PEBB has implemented changes to the reconciliation process between pebb.benefits and payroll – principally OSPS. See the attached Reconciliation Process Changes for guidance. PEBB administration understands this change affects agency time and dollars. Staff will do everything they can to ensure a smooth process.
 
Exception to Retroactive Termination. The new regulations allow PEBB to retroactively terminate coverage when an employee fails to notify the agency (and thus PEBB) of a divorce or dissolution of domestic partnership that makes the ex spouse or domestic partner ineligible for coverage.
 

Premium Adjustment on Appeals
 
When appeals are approved for retroactive changes premiums will be adjusted for self-insured plans (PEBB Statewide, Providence Choice, ODS, VSP) retroactive to six months from receipt of the form. For fully insured plans (Kaiser, Willamette), they will be adjusted retroactive to 12-months from receipt of the form.
 
Month on Form
6-Month Adjustment
12-Month Adjustment
Coverage End Date
Pay Period
Coverage End Date
Pay Period
January
7/31
6/30
1/31
12/31
February
8/31
7/31
2/28
1/31
March
9/30
8/31
3/31
2/28
April
10/31
9/30
4/30
3/31
May
11/30
10/31
5/31
4/30
June
12/31
11/30
6/30
5/31
July
1/31
12/31
7/31
6/30
August
2/29
1/31
8/31
7/31
September
3/31
2/29
9/30
8/31
October
4/30
3/31
10/31
9/30
November
5/31
4/30
11/30
10/31
December
6/30
5/31
12/31
11/30

Q&A on Processing Forms
How do I show the date the form was received? You must date stamp or date note the first page of every PEBB form you receive reflecting the date of receipt.  PEBB will not accept and will not process forms that do not show this date. A fax machine date on a cover page is not an acceptable date of receipt. PEBB will return all forms to the agency without acceptable date of receipt. This date shows that the agency received the forms from the member timely to the event date.  
 
What forms can agencies process and how long do they have?  Agencies can process most forms received within 30 days of any eligibility event. Agencies have 30 days from the date of the event to process the form. Exception: When an agency receives a form outside of the allowable 30 day window, PEBB must receive the request and forms as an appeal from the member.
 
What are the receipt and processing time frames for Open Enrollment corrections? OSPS can process corrections on forms received by Jan. 31, 2011, and must process the forms by that date (see Exception, above). OUS agencies can process corrections on forms received by Feb. 28, 2011, and must process the forms by that date (see Exception, above).
 
What are the effective dates for Open Enrollment corrections? Generally, corrections for core benefits become effective the first of the month following receipt of the form. For OSPS agencies, that’s Feb. 1, 2011. For OUS, it’s March 1, 2011. If these dates will impact access to covered medical treatment, the member can appeal to PEBB.
Exceptions: If a member added a dependent record during Open Enrollment but did not add the dependent to coverage, the coverage becomes effective Jan. 1, 2011. If the member enrolled in optional benefits and the insurer approved medical history by Dec 31, 2010, the benefit is effective Jan. 1, 2011.
How do agencies process corrections for retroactive enrollment? Agencies currently can’t process retroactive enrollments. Send all such requests to PEBB, which provides these retroactive enrollment corrections to the plans in the weekly files. PEBB prefers not to ask the plans to add enrollments manually.
 
How do agencies send forms to PEBB? Send forms via fax, shuttle or mail. Do not send scanned forms via e-mail. These forms contain personal health information that is not secure via the state e-mail system.
 

System Changes
 
Retroactive Enrollments. PEBB is actively working on system changes that will allow agencies once again to process some of the retroactive enrollments that currently must be sent to PEBB for processing. PEBB will advise when the changes are in place.
 
Eligibility by Affidavit. A recent update to pebb.benefits conforms to eligibility rules on affidavits. Adding a child or grandchild by Affidavit requires entry of the following information in the dependent’s page:
  • Affidavit/ Date: The court’s effective date of legal responsibility
  • Expiration Date: The date legal responsibility for the child expires
  • Issue Entity (Court/County Name): The name of the court or county court that issued the document
Special Process: Some grandchildren by affidavit do not require a legal document (See OARs to determine this requirement). In this case you will enter the affidavit information in these new fields. The expiration date will be the grandchild 18th birthday.
 
The system will generate a home page alert in the month prior to the Expiration Date. This will be a new home page alert. The name will be Affidavit Terminations. The home page alert will be automatically cleared when the dependent’s coverage is terminated in the system. 
 

Imputed Value on W2 Forms
Correction Letter. PEBB sent this letter to employees who covered an adult dependent in 2010 through the federal Affordable Care Act. The letter provides correct imputed value for the coverage.

Communications
New Hire Communications. PEBB has updated the New Hire Resource Center on its website. Several agencies indicate they use this section often. Like all web-based resources, it is constantly evolving, and we would appreciate your input on improvements. Please take a short survey to provide your input:  http://www.surveymonkey.com/s/PEBBNewHire by February 15.
 
February Newsletter. The newsletter will be posted February 1. It announces a Governor’s Food Drive Challenge through which member action can generate up to $31,000 in donations. It also covers the upcoming Dependent Verification Project, and new and ongoing wellness programs and benefits.
 

Resources
 
Suggest topics for future editions of the Agency Update via e-mail to pebb.hottopics@state.or.us. 
 
Agency Resources: User Access Form  
                                 Agency, University & PEBB Contacts 
 
Public Employees' Benefit Board   
1225 Ferry St SE Salem, OR 97301  
E-mail: Eligibility and Enrollment
E-mail:Comments for the Board   
(503) 373-1102, fax (503) 373-1654  
Medical PlansDental Plans
       ●   Kaiser Permanente        ●    Kaiser Permanente 
       ●   Providence Choice         ●    ODS 
       ●   PEBB Statewide Plan         ●    Willamette Dental 
       ●   VSP (Vision Service Plan)   
Mail-order PrescriptionsOptional Plans
       ●    Kaiser Permanente        ●    The Standard 
       ●    PPS        ●    UnumProvident 
       ●    Walgreens Other Benefits
       ●    Wellpartner       ●    Flexible Spending Accounts (FSA) 
        ●    Employee Assistance Program (EAP)
              (800) 433-2320