Or. Admin. Code § 111-070-0075

Current through Register Vol. 63, No. 12, December 1, 2024

Section 111-070-0075 - Administration of SB 551 Program

(1) For purposes of this rule:

(a) "SB 551 eligible member" is a part-time faculty member who is deemed eligible to receive coverage through OEBB 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) "OEBB 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 medical/pharmacy, dental, and vision 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.

(4)

(a) Individuals currently eligible for and enrolled in OEBB or PEBB 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 OEBB coverage.

(b) Individuals enrolled in the SB 551 program, who gain eligibility for OEBB coverage during the plan year, may terminate coverage under the SB 551 program and enroll in OEBB coverage, with no break between coverages. Individuals enrolled in OEBB coverage, who gain eligibility for coverage under the SB 551 program during the plan year, may terminate OEBB coverage and enroll in coverage under the SB 551 program, with no break between coverages. OEBB reserves the right to audit and retroactively terminate OEBB SB 551 coverage.

(5) If the SB 551 eligible member misses their enrollment period to enroll in coverage, they will have the ability to appeal to OEBB for enrollment.

(6) Coverage elected under this section is effective the entire plan year unless the SB 551 eligible member is terminated by OEBB or an Oregon public institution of higher education for failure to meet SB 551 eligibility or participation requirements or enrolls in OEBB coverage under section (4) of this rule.

(7) OEBB will not credit deductibles or out of pocket maximums for SB 551 members who transfer between an OEBB medical plan and PEBB medical plan.

(8) It shall be the sole responsibility of the Oregon public institution of higher education to determine eligibility for coverage pursuant to ORS 350.355.

(9) 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.

(10) 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 111-050-0001.

Or. Admin. Code § 111-070-0075

OEBB 2-2021, temporary adopt filed 09/29/2021, effective 10/1/2021 through 3/29/2022;OEBB 3-2021, adopt filed 12/27/2021, effective 12/27/2021; OEBB 3-2023, amend filed 12/20/2023, effective 12/21/2023

Statutory/Other Authority: ORS 243.860 - ORS 243.886

Statutes/Other Implemented: ORS 243.864(1)(a) & ORS 350.355