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January 2011
Download the 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 January Agency Update (pdf) 
 

 
 

Enrollments and Plan Changes
 
The new 30-day window for enrollment and plan changes includes process changes for PEBB and agencies. The following information will help ensure smooth processing. This information does not apply to appeals.
 
Employee Action.  While only PEBB can complete retroactive enrollments for agencies, the agency – not the employee – must submit forms and other required documentation to PEBB for this process. The employee can’t “jump” the process and submit forms directly to PEBB.
 
Agency Action. Agencies must fax to PEBB all enrollments and plan change requests that employees submit too late for activation by the agency for the first of the following month. These should be only those requests submitted too late in the month for agency PDB action. If you receive forms and documentation within the 30-day window and you can activate them for the first of the following month, do not send them to PEBB. We will return them to you, which may cause further delay.
 
Before you begin to process an enrollment or plan change:
  • Review the employee’s submission for completeness; if the employee failed to provide needed information or documentation, notify the employee.
  • Date stamp the forms and documentation on the date completed items are submitted.
Fax to PEBB only those requests for enrollment or plan changes that you cannot implement within the 30-day window. The date the agency received and reviewed the completed forms from the employee must be on the form submitted to PEBB.
 
PEBB Action. PEBB will not verify receipt of each fax and will not begin action on enrollments that are incomplete or are not date-stamped by the agency. Instead, PEBB will notify the agency to complete the forms and resubmit. PEBB has a goal of processing all retroactive enrollments and changes submitted in the 30 day window within 24 hours of receipt – 48 hours at the maximum. These requests have daily priority.  
 
Tracking PEBB Action. The employee’s benefit record will show activation of any enrollment or plan change completed by PEBB. When required, you will be contacted to complete an adjustment in the payroll system (for example, when an enrollment requires a change in tier). If you do not see activation of enrollment or changes in an employee’s benefit record within five business days, contact PEBB.
 

Coverage Terminations within the 30 Day Employee Window
 
Agencies cannot terminate coverage retroactively. This means that, once premium is paid and coverage is in effect, agencies cannot terminate coverage. Agencies may terminate coverage only prospectively. The exception to prospective termination is termination of coverage for ex-spouses, ex-domestic partners, and the dependent children that must be removed with removal of these individuals. These individual’s coverage terminates the last day of the month that eligibility is lost (date of the divorce or dissolution of the partnership). This coverage termination can be retroactive in the 30-day window when the agency is unable to complete the termination before the end of the month of the event date. Agencies should review their relevant processes and modify them as needed.
 
Agency Action. Employees may submit midyear change requests to terminate enrollments of a divorced spouse, ex domestic partner, and accompanying children within the 30-day window when the event occurred in the previous month. Agencies must fax these requests to PEBB for retroactive termination of the coverage.
 
PEBB Action. Only PEBB can implement retroactive termination of enrollments. PEBB will follow the process as outlined above in retroactive enrollments.
 

Premium Reconciliation
 
Effective with payment of premium for January coverage, PEBB has implemented new processes related to refunding of premium and termination of benefits in employee records.
 
Agency Action. Agencies cannot refund (pulled back) premium after premium is paid and coverage is effective. There are no exceptions. Please ensure that all personnel in your agency are aware of this requirement of federal regulation.
This will be a significant change for agencies that refunded premiums in certain circumstances. Agencies should especially note that premiums can’t be refunded when:
  • Managers provide late notice of employment terminations
  • Managers or employees provide late notice of reduced work hours (below the required 80 hours in a month)
  • Coverage is terminated with termination of employment after protected leave
  • Premium has been paid in error
PEBB Action. PEBB will terminate coverage in employee records when the employees’ premiums are not included in the premium file. The only exception is for late enrollment new hires and reinstatement of employee benefits upon employee’s return to benefit eligibility.
When these late enrollments occur in PDB after the payroll cutoff date (day 15 for OUS, day of Run 1 for OSPS, and day 5 for BHS), PEBB will mark the record in the premium reconciliation file as “Agency – Pending.”
 
Subsequent Agency Action. The agency must ensure the premium is included in the next month’s premium file.
 
Subsequent PEBB Action. If the premium is not paid with the next month’s file, PEBB will terminate coverage as of the month the premium was not paid. Employees will be billed at the non-group rate for any services they received in the month the premium was not paid.
 

Communications
 
Web Updates. PEBB’s website includes the updated Summary Plan Description, and links to all the plans’ member handbooks (evidence of coverage). The updated New Hire Resource section will be posted no later than January 14.  
 
Newsletter. The January newsletter will be posted this evening at http://oregon.gov/das/pebb/Jan11.shtml. Content covers changes to timeframes for enrollment and plan changes; Q&A related to the new plan year; and health and wellness resources.
 

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