| Dependent Eligibility Verification |
|
|
|
 |
| Review and Audit Process 2012 |
|
|
Beginning January 2012, OEBB will be asking a random sample of educational entity employees, early retirees and COBRA participants to provide copies of documents showing individuals covered as a dependent on their medical plan meet the OEBB eligibility requirements. Covering ineligible dependents is a very serious issue that can affect whether premiums for medical, dental and vision coverage can be paid on a pre-tax basis and the total cost of your health care and other benefits -- it increases costs for members and educational entities.
Dependent eligibility verification processes have become common practice among employers and plan sponsors. OEBB believes it is an important aspect of our commitment to fiscal responsibility that we do everything possible to make sure ineligible dependents are not covered on the OEBB benefit plans. OEBB will be assisted by Towers Watson, a global professional services firm that specializes in dependent eligibility verification. Working with a third party assures the confidentiality of the verification process.
During the verification period, a random sample of 4,000 active employees, early retirees and COBRA participants who cover one or more dependents (spouse, domestic partner and/or children) on an OEBB medical plan will receive a letter requesting copies of documents -- such as birth certificates or a marriage certificate -- verifying that their dependents are eligible for OEBB benefits. This letter will include detailed instructions on who can be covered as an eligible dependent, what types of documentation are required to verify eligibility, how and where to provide copies through an easy online process, or by mail or fax, as well as related deadlines.
If you are selected as one of the 4,000 individuals included in this audit group, you will receive a letter the week of January 9, 2012, letting you know that you have been selected. You will also receive a Verification Packet with detailed instructions the following week (the week of January 16, 2012). Failure to provide documentation verifying a dependent’s eligibility, or if a dependent is deemed ineligible during the review, will result in termination of all OEBB coverages for that dependent.
If you have any questions about the process, timing and deadlines, you can contact OEBB Member Services by phone at 888-469-6322 or by e-mail at: oebb.benefits@state.or.us.
To review OEBB's definitions of eligible dependents (spouse, domestic partner, and/or child), you can scroll down to the sections below, or go to the list at the top of this webpage and click on a dependent type.
|
If you are one of the 4,000 selected to participate in this review, thank you in advance for cooperating with this important initiative to assure the integrity of the OEBB benefits program and to help reduce unnecessary costs for all participating OEBB educational entities and OEBB members.
|
|
|
| Definition of "Child" |
|
"Child" means and includes the following:
(a) An eligible employee’s, spouse’s, or domestic partner’s biological son, daughter, stepson, or stepdaughter; adopted child, child placed for adoption, or legally placed child, who is 25 or younger on the first day of the month. An eligible employee must provide the required custody or legal documents to their Educational Entity showing proof of adoption, legal guardianship or other court order if enrolling a child for whom the employee, spouse, or domestic partner is not the biological parent.
(b) A person who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. There is no age limit for a dependent child who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. When the dependent child is 26 years of age or older all the following requirements must be met:
- The disability must have existed before attaining age 26.
- The employee must provide evidence to the Educational Entity or OEBB that (1) the person had health plan coverage, group or individual, prior to attaining age 26, and (2) health plan coverage continued without a gap until the OEBB health plan effective date.
- The person’s attending physician must submit documentation of the disability to the eligible employee’s OEBB health insurance plan for review and approval. If the person receives health plan approval, the health plan may review the person’s health status at any time to determine continued OEBB coverage eligibility.
- The person must not have terminated from OEBB health plan coverage after attaining the age of 26.
(c) Eligibility for coverage under this rule includes people who may not be dependents under federal or state tax law and may require an Educational Entity to adjust an Eligible Employee’s income based on the imputed value of the benefit.
|
|
|
| Definition of "Spouse" |
|
"Spouse" means a person of the opposite sex who is a husband or wife. Except as provided in Oregon Constitution Article XV, Section 5a, a relationship recognized as a marriage in another state will be recognized in Oregon even though such a relationship would not be a marriage if the same facts had been relied upon to create a marriage in Oregon. The definition of spouse does not include a former spouse and a former spouse does not qualify as a dependent.
|
|
|
| Definition of "Domestic Partner" |
|
|
"Domestic partner," unless otherwise defined by a collective bargaining agreement or documented district policy in effect on January 31, 2008, means and includes the following:
(a) An unmarried individual of the same sex who has entered into a "Declaration of Domestic Partnership" with the eligible employee that is recognized under Oregon law; or
(b) An unmarried individual of the same or opposite sex who has entered into a partnership that meets the following criteria:
- Both are at least 18 years of age;
- Are responsible for each other's welfare and are each other's sole domestic partners;
- Are not married to anyone and have not had a spouse or another domestic partner within the prior six months. If previously married, the six-month period starts on the final date of divorce;
- Share a close personal relationship and are not related by blood closer than would bar marriage in the State of Oregon;
- Have jointly shared the same regular and permanent residence for at least six months immediately preceding the date the Affidavit of Domestic Partnership is signed and submitted to the Educational Entity; and
- Are jointly financially responsible for basic living expenses defined as the cost of food, shelter and any other expenses of maintaining a household. Financial information must be provided if requested.
- The eligible employee and domestic partner must jointly complete and submit to the Educational Entity an Affidavit of Domestic Partnership form, within five business days of the electronic enrollment date or the date the Educational Entity received the enrollment/change form. If the affidavit is not received, coverage will terminate for the domestic partner retroactive to the effective date.
(c) The domestic partner must notify the Educational Entity within 31 days of meeting all criteria as defined in 111-010-0015 (15)(b) or obtaining the "Declaration of Domestic Partnership" which is recognized under Oregon law.
(d) Educational Entities must calculate and apply applicable imputed value tax for domestic partners covered under OEBB benefit plans.
|
|
|
| Special Notes for Retirees |
|
|
A "retiree" enrolled in an OEBB retiree insurance plan who becomes eligible for Medicare coverage may not continue on an OEBB medical or vision plan, unless they are eligible for Medicare as a result of end-stage renal disease. OEBB benefits end the last day of the month prior to the Medicare effective date. The retiree is responsible for reporting to their Educational Entity and to OEBB when the retiree is covered by Medicare within 31 days after the Medicare coverage effective date. Failure to report within this timeframe may be considered intentional misrepresentation by OEBB and OEBB may retroactively terminate OEBB coverage back to the last day of the month prior to the Medicare effective date.
Eligible dependents of "retirees" who were covered on an OEBB medical plan at the time of retirement and who are eligible for Medicare, or who become eligible for Medicare, may not continue coverage on an OEBB medical or vision plan unless it is stated in a collective bargaining agreement or documented district policy in effect on or before February 1, 2010, that they may continue on OEBB medical plans until the retiree becomes eligible for Medicare with the following exception: OEBB coverage must end for Medicare-eligible dependents of a retiree enrolled on a Kaiser Permanente medical plan.
|
|
| |
|
|
