Oregon Administrative Code

101-002-0005 Powers and Duties of the Board (1) Pursuant to ORS 243.125, it will be within the powers and duties of the Board to study all matters connected with providing adequate benefit plan coverage for Eligible Employees on the best basis possible with relation both to the w…

101-002-0010 Conduct of Meetings of the Board (1) The Board will select one of its appointed voting members as chairperson and another voting member as vice chairperson. (2) Meetings will be conducted by and will be under the control of the chairperson of the Board. In the absenc…

101-005-0010 Renewal, Screening and Selection for Benefit, Vendor and Consultant Contracts (1) The Board is charged with the obligation of obtaining Benefit Plans to provide Benefits to Eligible Employees. OARs 101-005-0040 through 101-005-0140 set forth the screening, selection …

101-005-0020 Policy The policy of the Board is to select Contractors in an expeditious and efficient a manner that is consistent with the goal of delivering high quality Benefits and other services at a cost that is affordable to both the employees and the state, consistent with …

101-005-0030 Definitions For the purposes of OARs 101-005-0010 through 101-005-0140 the following terms have the meanings indicated below. (1) "Benefit Plan" includes, but is not limited to: (a) Contracts for insurance or other benefit based on life; supplemental medical, supplem…

101-005-0040 Procurement and Renewal Processes (1) Formal Selection Procedure: This procedure will be used for the procurement of Benefits Exceptions to this procedure are specified in sections (2), (3), (4) and (5). (a) Announcement: The Board will give notice of intent to contr…

101-005-0050 Mistakes (1) Treatment of Mistakes. If the Board discovers certain mistakes in a Proposal before award of the Contract, and the mistakes are not identified as those qualifying as non-responsive to the specifications of the procurement, the Board may take the followin…

101-005-0070 Contract Amendments PEBB may amend a contract without additional competition in any of the following circumstances: (1) The amendment is within the scope of the procurement as described in RFP, the sole source determination, or special procurement (the “Procurement D…

101-005-0075 Pre-Proposal Conference (1) Unless identified in the procurement as required, the Pre-Proposal Conference will: (a) Include voluntary attendance; (b) Will be held in Salem, Oregon or will be conducted via conference call or by other electronic means; and (c) Will ide…

101-005-0080 RFP Protest; Request for Change; Request for Clarification (1) Protest. (a) Unless otherwise specified in the procurement, a Proposer must deliver a written protest to the Board not less than 10 (ten) calendar days prior to closing; (b) Content of Protest. A Proposer…

101-005-0090 Addenda to an RFP (1) Issuance; Receipt. The Board may change an RFP only by written addenda. (2) Notice and Distribution. The RFP shall specify how the Board will provide notice of addenda and how the Board will make the addenda available. (3) Timelines; Extensions.…

101-005-0100 Extension of Time for Acceptance of Proposal The Board may request, orally or in writing that Proposers extend, in writing, the time during which the Board may consider their Proposal. If a Proposer agrees to such extension, the Proposal shall continue as irrevocable…

101-005-0105 Submission of Proposals; Format; Timing (1) All Proposals submitted as a result of a Formal Solicitation, Informal Solicitation, or Single Source Solicitation shall comply with the procurement's specifications. If portions of the Proposal to any solicitation are deem…

101-005-0110 Evaluation of Proposals (1) Evaluation. The evaluation process described in this rule applies to the Formal Selection Procedure set forth in OAR 101-005-0040(1). The Board and any assigned representatives, including but not limited to, PEBB stakeholders staff, or Con…

101-005-0120 Rejection of a Proposal Rejection of Proposals. (1) The Board may reject any Proposal upon PEBB's finding that the Proposal: (a) Is contingent upon PEBB's acceptance of terms and conditions (including Specifications) that differ from the RFP; (b) Takes exception to t…

101-005-0130 Responsible Proposer (1) Before awarding a Contract, the Board must have information that indicates the Proposer meets the applicable standards of responsibility. PEBB shall prepare a written determination of non responsibility for a Proposer if PEBB determines that …

101-005-0140 Protest of Contractor Selection, Contract Award (1) Purpose. An adversely affected or aggrieved Proposer must exhaust all avenues of administrative review and relief before seeking judicial review of the Board's Contractor selection or contract award decision. (2) No…

101-010-0005 Definitions Unless the context indicates otherwise, as used in OAR chapter 101, divisions 1 through 60, the following definitions will apply: (1) “ACA” means the Patient Protection and Affordable Care Act and regulations promulgated under the Act by any federal agenc…

101-015-0005 Eligible Individuals (1) The following individuals are eligible to participate in PEBB-sponsored benefit plans: (a) An eligible employee as defined in OAR 101-010-0005(20). (b) A permanent position seasonal or intermittent employee who meets the following requirement…

101-015-0011 Dependent Child (1) A dependent child must meet the following eligibility conditions to receive PEBB health plan coverage: (a) The child is: (A) An eligible employee’s, spouse’s, or domestic partner’s son, daughter, stepson, stepdaughter, adopted child; or (B) A Chil…

101-015-0026 Domestic Partnership (1) Certificate of Registered Domestic Partnership. When a Registered Domestic Partnership exists and the eligible employee wants to enroll the domestic partner or the domestic partner's eligible children in benefit plans, the employee may electr…

101-015-0030 Eligibility and Policy Term Violations - Definitions For the purposes of OAR 101-015-0035 and OAR 101-015-0040, the following definitions will apply: (1) “Eligibility or Enrollment Violations” means and includes a violation of the PEBB's eligibility or enrollment rul…

101-015-0035 Eligibility Violations (1) Unintentional Violation: (a) PEBB will remove from coverage an ineligible PEBB member due to eligibility or enrollment violations. Removal from all benefit plans will be retroactive to the date the individual is determined to have no longer…

101-015-0040 Policy Term Violations (1) A PEBB-contracted insurance carrier may remove from coverage and/or deny the claims of a PEBB member due to policy term violations. Removal from coverage for policy term violations is at the discretion of the insurance carrier. (a) If a pol…

101-015-0045 Eligibility Verifications and Reviews (1) PEBB shall plan and conduct eligibility verifications and reviews to monitor compliance with PEBB administrative rules. Reviews shall include, but are not limited to the following: (a) Dependent eligibility; (b) Employee elig…

101-015-0050 Dependent Eligibility Verification and Review Appeals Dependent Eligibility Verifications and Review Appeals (1) Following the termination of dependents due to a dependent eligibility review, Eligible Employees, Retirees, Self Pays or COBRA participants may file an a…

101-020-0002 Plan Effective Dates, Employee Eligibility Continuation, and Plan Termination Dates (1) Irrevocability Rule. Except as otherwise provided in OAR chapter 101, all eligible employee benefit plan elections or mid-year plan changes are irrevocable for the plan year and m…

101-020-0005 Newly Hired and Newly Eligible Employee (1) All newly hired or a newly eligible active employees have 30 days from the date of hire or date of eligibility to enroll in PEBB core and optional benefit plans. Benefit plan elections are irrevocable for the plan year exce…

101-020-0012 Working in Two or More Positions or for Two or More PEBB Participating Organizations (1) An individual working in two or more positions or for two or more PEBB participating organizations must work at least half-time or be in a current benefit eligible stability peri…

101-020-0015 Opting Out of Medical Insurance Coverage (1) A benefit eligible employee can Opt Out of medical coverage and receive cash in lieu of medical insurance coverage. PEBB determines the amount of cash paid to an employee who Opts Out of medical coverage. Opt Out cash is i…

101-020-0018 Declining Benefits (1) An active eligible employee who declines PEBB core benefits waives the employee’s right to the benefit amount and enrollment in any PEBB sponsored plans. (2) An eligible employee may decline benefits at the time of hire or meeting eligibility, …

101-020-0020 Newborn and Adopted Child Enrollment (1) An eligible employee's biological newborn child receives PEBB-sponsored medical and dental insurance coverage under the newborn's own coverage from the moment of birth through the first 31 days of life without completing PEBB …

101-020-0025 Removing an Ineligible Individual from Benefit Plans (1) All eligible employees have 30 days from the date a spouse, domestic partner, or dependent child loses eligibility to remove the individual from PEBB coverage. The individual will be removed from plans the last…

101-020-0032 Open Enrollment (1) Active and other eligible employees may make benefit plan changes, new plan elections, enroll eligible individuals, or terminate only certain individuals during the annual open enrollment period. All plan elections or enrollments are subject to pa…

101-020-0037 Correcting Enrollment Errors and Open Enrollment Errors (1) Employee enrollment errors occur when an eligible employee provides incorrect information or fails to make correct selections when making benefit plan elections. An employee’s failure to initiate timely enro…

101-020-0038 Correcting Processing Errors (1) Administrative processing errors occur when benefit plan elections are processed incorrectly in the payroll and benefit system by the agency, PEBB, or third party administrative staff, or PEBB carrier. Administrative error also includ…

101-020-0040 Late Enrollment (1) Late enrollment occurs when an eligible employee fails to enroll themselves, eligible family members, domestic partner, or a domestic partner’s child in benefit plans within the required time period. (2) An enrolled employee requesting late enroll…

101-020-0045 Returning to Work (1) Refer to the following rules for an employee returning to paid regular status from the following leave status: (a) Continuation of Benefits for Injured Workers (CBIW). See OAR 101-030-0010. (b) Federal Family Medical Leave Act (FMLA). See OAR 10…

101-020-0047 Transfer (1) When an eligible employee transfers from one PEBB participating organization to another, the organization losing the employee must pay the benefit amount for the month following the transfer, regardless of hours worked at that organization. Exception: An…

101-020-0050 Midyear Benefit Plan Changes (1) Eligible employee plan elections are irrevocable for the plan year. There are limited exceptions to the irrevocability rule if certain conditions or events are met. These events fall into three broad groups: (a) Qualified Status Chang…

101-020-0052 Surcharges (1) For the purposes of this rule, the following definitions apply: (a) Double Coverage means a subscriber/employee that is also an eligible dependent and is enrolled in two PEBB/PEBB or PEBB/OEBB medical plans. (b) OEBB means the Oregon Educators Benefit …

101-020-0059 Commuter Accounts (Fringe Benefits) (1) There are two individual account types within Commuter Accounts, Transportation and Parking. Each type allows enrolled employees to claim tax free reimbursement of certain employment related commuter expenses. The accounts are …

101-020-0060 Dependent Care Flexible Spending Account Employees may use a Dependent Care Flexible Spending account (Dependent Care FSA) to be reimbursed for employment-related dependent care expenses for eligible dependents that allow the employee and his or her spouse to be “gai…

101-020-0065 Health Flexible Spending Arrangement (1) An eligible employee may enroll in a pretax Health Care Flexible Spending Account (Health Care FSA). An Health Care FSA is regulated by various federal government regulations. Health Care FSAs can be defined in part by the fol…

101-020-0066 Public Employees' Benefit Board Appeal Procedure (1) Eligible employees may submit appeal requests to PEBB concerning PEBB policy, eligibility, or plan enrollments. PEBB staff and the Board Appeals Subcommittee use relevant state and federal regulations, policy, PEBB…

101-030-0005 Continuation of Group Medical and Dental Insurance Coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) COBRA allows an eligible individual who is losing an employer’s group health plan coverage due to a qualifying event to continue coverage for …

101-030-0007 Portability of Medical Insurance Coverage Some PEBB sponsored group medical insurance plans allow portability. An eligible individual enrolled in one of these medical plans may continue insurance coverage under the plan’s portability provisions before, during, or at …