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Administrator Self-Pay Early Retiree Toolkit

Self-Pay Early Retiree Toolkit

Use these documents when you want OEBB to take over benefit administration for some or all of your self-pay early retirees.

100% Self-Pay Early Retiree Agreement

Complete the 100% Self-Pay Early Retiree Agreement and submit it to OEBB to request this optional service. Once OEBB has confirmed the effective date, use the documents below to communicate this change to your affected retirees. Detailed instructions are in the agreement.

Retiree Notification Packet

Once OEBB has confirmed the effective date, send a notification packet to your affected retirees. Include a cover letter from your entity (samples provided below) as well as the appropriate OEBB documents. Refer to the "100% Self-Pay Early Retiree Agreement" for detailed instructions.

Sample Letters from Entity to Retiree

Sample Cover Letter #1 (HSD)

Sample Cover Letter #2 (CSD)

OEBB Welcome Letter for "Self-Pay to Self-Pay" (do not include Enrollment Form)

OEBB Welcome Letter for "Active to Self-Pay" and "Stipend/Contribution to Self-Pay" (include the appropriate Enrollment Form for the employee's situation)

Self-Pay Early Retiree ACH Debit Form

Self-Pay Early Retiree Q&A

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