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Dependent Eligibility Verification (DEV) Reviews

Overview - Who, When, and How

Per OEBB rules (OAR 111-080-0055), OEBB must complete a Dependent Eligibility Verification (DEV) Review for each participating entity at least once every three years. The information below is intended to help Employing Entities plan for these reviews.

The responsibility to conduct the review lies with OEBB, not the employing entity. Entities are not required to incur any additional cost or provide any services related to these reviews. OEBB provides this information in order to be as transparent and efficient as possible.

Download a printer-friendly PDF of the "Who, When, and How" information shown below.

 

WHO?
The dependent eligibility verification (DEV) review will include all dependents (spouses/partners/children) active in the MyOEBB system even if the individual is not enrolled in a coverage. 
Early retirees are to be included in the entity’s review if coverage for this employee group is administered by the entity.  Employees, and early retirees if applicable, who do not have any dependents listed in MyOEBB will not be included in the review.   
 
WHEN?
A DEV review will be completed at least once every three years for each OEBB participating entity.  The monthly review schedule for the next following calendar year will be posted on the OEBB website initially in January 2014 and each September thereafter at
If the assigned time period conflicts with entity priorities, an entity may request to change the month of their review. Generally, it must be to another month within the same calendar year. OEBB will try to accommodate all requests, but cannot guarantee that all can be granted. 
 
HOW?
1.       OEBB will contact the entity at least two months prior to the review month to schedule the specific date(s) of the review. 
 
2.       OEBB will send a letter to all of the subscribers with dependents listed in MyOEBB at least six weeks prior to the review date(s) to communicate the timelines and documentation requirements. Subscribers will be allowed to mail, fax, or email the appropriate documentation to OEBB and OEBB will set specific date(s) and time(s) that OEBB staff will be onsite to conduct the review, if an employee would prefer to provide the documentation in person. 
 
3.       Members who choose to mail or fax documentation to OEBB will be asked to provide copies of documents only as all documents received by OEBB will be shredded at the conclusion of the review.  Documentation provided at the scheduled onsite review sessions will be reviewed, verified and logged and will not be retained.
 
4.       OEBB will send a reminder letter to the members who have not submitted documentation two weeks prior to the onsite review date. 
 
5.       OEBB will send a confirmation letter to each employee included in the DEV review within one week after the review is completed, including members who have not submitted documentation or who could not supply appropriate documentation.
 
6.       Coverage for dependents for whom a member cannot provide appropriate documentation will end on the last day of the month in which the determination was made and no later than the last day of the month in which the review was completed. 
 
7.       OEBB will provide a file to the entity identifying any dependents whose coverage has been terminated.
 
8.       OEBB will lock all dependents losing coverage following an eligibility review so the dependent cannot be added back onto coverage during a future enrollment period.
9.       Members have a right to appeal all eligibility decisions as provided for under OAR 111-080-0030 following the conclusion of the review.
 
 
If you have any questions, please contact Erica Hedberg at:
Phone: 503-373-1896

Email: Erica.Hedberg@oregon.gov  

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Presentation to the Benefits Information Exchange (BIE) Group

On January 23, 2014, OEBB presented information about the DEV Reviews as part of the Benefits Information Exchange (BIE) Group meeting. The slides from this presentation are available in PDF format by clicking the link below.

 

January 23, 2014 DEV Review Presentation Slides

 
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Schedule

2014 - Download OEBB's 2014 Proposed DEV Review Schedule.

2015 - Download OEBB's 2015 Proposed DEV Review Schedule.

Entities wishing to request a change to the proposed schedule should send their request via email to: Erica.Hedberg@oregon.gov.

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Required Documentation

Download the Member Documentation Requirements

OEBB will provide this document along with complete instructions to each member required to participate in an OEBB DEV review. If an entity chooses to contract with a third party vendor to conduct their DEV review, that vendor must, at a minimum, follow these same requirements.  

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Third Party Vendors

An entity may choose to contract with a third party vendor to complete their DEV review. The vendor must be approved by OEBB before the review begins in order to qualify as meeting the three-year requirement under OEBB Administrative Rule 111-080-0055.

Process for an entity wishing to submit a third party vendor's DEV Review Plan for OEBB's consideration:

  1. Review the OEBB DEV Review Third Party Checklist.
  2. Ensure that your DEV review plan follows the guidelines listed in the checklist.
  3. Complete the OEBB DEV Review Third Party Vendor Review Form.
  4. Submit your individual review plan along with the completed form via email to: OEBB.benefits@oregon.gov. The review plan should be a formal document prepared by the third party vendor specifically for your entity.
  5. OEBB will review the submitted review plan and will respond to your entity within two weeks. If the review plan is not approved, OEBB will provide feedback on areas that would need to be changed in order for the review plan to be approved. 
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FAQs (Frequently Asked Questions)

 
OEBB Dependent Eligibility Verification Review
Frequently Asked Questions and Answers

 

Download a printer-friendly PDF version of the FAQ's shown below

 
1.    Why is OEBB conducting a dependent eligibility review?
 
OEBB is required by rule (OAR 111-080-0055) to complete a dependent eligibility review for each entity participating in OEBB at least once every three years. 
 
Having ineligible dependents enrolled in the benefit plans is a significant issue that affects the overall cost of health care coverage as well as what you pay in premiums. OEBB has a responsibility to ensure that your health care dollars are being used appropriately. This review will help to monitor the plan eligibility requirements and ensure only eligible dependents are enrolled in the benefit plans.
 
 
 
OEBB’s goal with this process is to verify that only eligible dependents are covered on the OEBB benefit plans. This process will help us effectively manage your benefit plans’ costs so we can offer you the highest quality plans at the lowest possible cost.
 
 
 
Verification Process
 
3.    How do I complete the verification process?
 
To complete this process, you must verify the eligibility of each of your dependents by submitting or providing acceptable documentation.  You can do this one of four ways:
 
1.      You can mail copies of your documents to OEBB along with your completed Certification of Dependent Eligibility Form. 
2.      You can fax copies of your documents, along with your completed Certification of Eligibility Form, to our secure fax number at 503-378-5832.
3.      You can bring your documentation to your entity’s on-site review.  The date, location, and time of the on-site review is listed on the instruction letter from OEBB.  OEBB staff will be at this location to review and log your documentation..
 
Note: The Certification of Dependent Eligibility Form is mailed to members at the beginning of the review process.  You can also find this form on our website at: http://www.oregon.gov/oha/OEBB/entity/Pages/eeDEVReviews.aspx
 
If you choose to submit your Certification of Dependent Eligibility Form and required documentation by fax or mail, please allow five to seven days for processing faxes and seven to 10 days for processing mail. You may check the status of your submitted documents by calling OEBB at 1-888-469-6322.
 
 
4.    How can I get a copy of my dependent’s birth certificate, marriage certificate, or other records?
 
Copies of birth certificates and other personal vital records can only be obtained from the state where they originally were filed. Some resources for obtaining documents:
·         National Center for Health Statistics through the Centers for Disease Control – Information for all states can be found at http://www.cdc.gov/nchs/w2w.htm
·         www.vitalchek.com – Online provider of vital records
·         U.S. Department of State - A Consular Report of Birth can be obtained by writing to the U.S. Department of State for individuals born abroad to U.S. citizen parents. Visit http://www.state.gov for more information.
·         Internal Revenue Service - A free transcript of a federal tax return can be obtained by contacting the local IRS office. Local contact information is available at www.irs.gov.
 
5.    My child’s birth certificate states copies should not be made. Should I submit an original?
 
No. You should submit a copy.
 
Photocopied birth certificates are not considered a valid form of identification for state or federal government uses (e.g., state identification card, driver’s license, passport, etc.).
 
Because the OEBB dependent verification process is not a government process, photocopies of birth certificates are considered an acceptable form of documentation of dependent eligibility. If you are using a birth certificate to certify eligibility, be sure to only submit copies, not the original.
 
6.    Do I need to complete the dependent verification process if all my dependents are eligible?
 
Yes. OEBB is required to complete a dependent eligibility review for each entity at least once every three years.  If your entity is scheduled to complete their review, it is mandatory that you verify and submit acceptable documentation by deadline for your entity’s review date.  A review schedule for the current calendar year can be found on our website at: http://www.oregon.gov/oha/OEBB/entity/Pages/eeDEVReviews.aspx
 
7.    What happens if I don’t complete the dependent verification process by the review deadline for my entity?
 
If you have been selected to complete the verification process, it is critical that you provide the appropriate documentation for your dependents by the review deadline. Failing to complete the verification process will result in any listed dependent’s loss of coverage.
 
8.    If I don’t have any dependents enrolled, do I still need to complete the dependent verification process?
 
OEBB members selected for this process had at least one dependent (spouse, domestic partner or child) showing in the MyOEBB system at the time of your entity’s review. OEBB will need to receive the appropriate documentation for each dependent listed in MyOEBB. If you currently do not have anyone listed as a dependent in MyOEBB and you receive a letter from OEBB indicating you have dependents in MyOEBB, please contact OEBB Member Services by phone at 1-888-469-6322 or by e-mail at oebb.benefits@oregon.gov.
 
9.    How will I know if my completed Certification of Dependent Eligibility Form was received?
 
A formal confirmation statement that confirms the eligibility status of your dependent(s) will be sent to you within two weeks after all of your dependents are processed.
 
10.  If I have questions about the dependent eligibility review process, who should I contact?
 
If you have questions about the dependent eligibility review process, eligibility requirements, or forms of acceptable documentation, you may contact OEBB by phone at
1-888-469-6322 or email at oebb.benefits@oregon.gov.
 
 
Miscellaneous
 
11.  If I have already submitted my Qualified Medical Child Support Order (QMCSO) to confirm that my dependent is eligible for OEBB’s coverage, will I need to complete and return the Certification of Dependent Eligibility Form?
 
      Yes. You are still required to complete and return this form to verify and confirm the accuracy of the information. QMCSO verification is a separate process from the dependent eligibility verification process. It’s important for you to verify whether your dependent is eligible for OEBB’s benefit plans so his or her coverage is not affected.
 
12.  What if a dependent I recently added to my health care coverage is not listed on the Certification of Dependent Eligibility Form?
 
The data used to compile the Certification of Dependent Eligibility Form was pulled the date your entity’s review began. If your dependent’s coverage was added after this date it would not be indicated in your materials. You only need to provide documentation for the dependents listed on the Certification of Dependent Eligibility Form.
 
13.  What if the list on the Certification of Dependent Eligibility Form showing my dependents has inaccurate information about my dependent such as name or birth date?
 
If you find inaccuracies in the information listed for your dependents, please complete the Certification of Dependent Eligibility Form and submit your documentation for the review along with a description of the inaccuracy. OEBB will follow-up to identify whether additional information or documentation is necessary.
 
14.  Is this process confidential?
 
Yes. All information you provide for the dependent eligibility review will be kept confidential.  OEBB will shred all documents you provide at the conclusion of the review for your entity.  No documents will be retained. That is why it is especially important for out to provide OEBB only copies of the documents.
 
15.  What happens if my dependent is determined to be ineligible for OEBB plans?
 
Dependents identified as ineligible will be terminated from all OEBB benefit plans effective the last day of the month in which the determination was made and no later than the last day of the month in which the review is completed. COBRA continuation information will be mailed to you indicating the exact date coverage ends and COBRA eligibility begins. More information on COBRA and other insurance alternatives can be found on the OEBB website: http://www.oregon.gov/OHA/OEBB/Pages/faq/COBRA.aspx

 

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