Or. Admin. Code § 101-065-0001
Current through Register Vol. 63, No. 12, December 1, 2024
Section 101-065-0001 - Administration of SB 551 Program(1) For purposes of this rule:(a) "SB 551 eligible member" is defined as a part-time faculty employee who is deemed eligible to receive coverage through PEBB by an Oregon public institution of higher education based on the requirements of SB 551 (2021). "SB 551 eligible member" does not mean or include a part-time faculty member who is currently eligible for employer-paid benefits through the Public Employees Benefit Board (PEBB) or the Oregon Educators Benefit Board (OEBB).(b) "SB 551 program" is the benefits program established by SB 551(2021) and codified in ORS 350.355.(c) "PEBB coverage" means coverage that is available to part-time faculty members who are eligible for employer-paid benefits.(2) SB 551 eligible members may only enroll in employee-only, full time medical/pharmacy, dental and vision coverage. SB 551 members may waive medical/pharmacy coverage, or a combination thereof, subject to carrier specific requirements.(3) SB 551 members shall not receive any monetary incentives for opting out, declining, or waiving any combination of or all available coverage, or from other incentive programs (i.e., HEM).(4) SB 551 eligible members are not eligible for the Health Engagement Model (HEM) program.(5)(a) Individuals currently eligible for and enrolled in PEBB or OEBB coverage as a subscriber or dependent are not eligible to enroll in the SB 551 program, and individuals eligible for and enrolled in the SB 551 program are not eligible to enroll in PEBB coverage.(b) Individuals enrolled in the SB 551 program, who gain eligibility for PEBB coverage during the plan year, may terminate coverage under the SB 551 program and enroll in PEBB coverage, with no break between coverages. Individuals enrolled in PEBB coverage, who gain eligibility for coverage under the SB 551 program during the plan year, may terminate PEBB coverage and enroll in coverage under the SB 551 program, with no break between coverages. PEBB reserves the right to audit and retroactively terminate PEBB SB 551 coverage.(6) If the SB 551 eligible member misses their enrollment period to enroll in coverage, they will have the ability to appeal to PEBB for enrollment.(7) Coverage elected under this section is effective the entire plan year unless the SB 551 eligible member is terminated by PEBB or an Oregon public institution of higher education for failure to meet SB 551 eligibility or participation requirements or enrolls in PEBB coverage under section (5) of this rule.(8) PEBB will not credit deductibles or out of pocket maximums for SB 551 members who transfer between a PEBB medical plan and an OEBB medical plan.(9) It shall be the sole responsibility of the Oregon public institution of higher education to determine eligibility for coverage pursuant to ORS 350.355.(10) It shall be the sole responsibility of the part-time faculty member to submit all information necessary for the Oregon public institution of higher education to make an eligibility determination for SB 551 coverage pursuant to ORS 350.355.(11) The SB 551 eligible member is eligible to continue coverage through COBRA should their coverage end, and they meet the criteria for COBRA continuation coverage as per OAR 101-030-0005.Or. Admin. Code § 101-065-0001
PEBB 1-2021, temporary adopt filed 09/29/2021, effective 10/1/2021 through 3/29/2022; PEBB 2-2021, adopt filed 12/27/2021, effective 12/27/2021; PEBB 1-2023, amend filed 12/20/2023, effective 12/21/2023Statutory/Other Authority: ORS 243.061 to ORS 243.302
Statutes/Other Implemented: ORS 243.125(1), ORS 350.355