Oregon Administrative Code

111-050-0016 Life and Accidental Death and Dismemberment Termination Dates for Early Retirees (1) Eligible Early Retirees may continue to participate in any or all coverage and plan options selected by the Entity for his or her Employee Group until they reach age 65, unless other…

111-050-0020 Initial Enrollment (1) An Eligible Early Retiree has 60 calendar days from the end date of active eligible employee insurance coverage to: (a) Continue enrollment in OEBB-sponsored medical, dental, vision, basic life, basic accidental death and dismemberment, optiona…

111-050-0025 Effective Dates (1) Benefit plan changes or initial elections, unless otherwise specified in a collective bargaining agreement or documented entity policy in effect on June 30, 2008, are effective on the first of the month following termination of the active employee…

111-050-0030 Correcting Enrollment and Processing Errors (1) Enrollment Errors. Enrollment errors occur when an Eligible Early Retiree employee provides incorrect information or fails to make correct selections when making benefit plan changes. The Eligible Early Retiree is respo…

111-050-0035 Late Enrollment (1) Late enrollment occurs when an Eligible Early Retiree fails to enroll for benefits within 60 days of retirement or fails to notify their Entity of the Qualified Status Change within 31 calendar days of: (a) The date a spouse, domestic partner, or …

111-050-0045 Termination Dates (1) Effective October 1, 2011, if an Eligible Early Retiree requests a termination of coverage for them self, a spouse, a domestic partner, or a child, coverage ends on the last day of the month that eligibility is lost. Requests for coverage termin…

111-050-0050 Removing an Ineligible Individual from Benefit Plans (1) An Eligible Early Retiree who enrolls themselves and/or an eligible person is responsible for removing ineligible spouses, domestic partners and children from their OEBB-sponsored benefit plans by submitting co…

111-050-0060 Continuation of Coverage for Eligible Employees Covered under the Federal Family Medical Leave Act OEBB will allow Entities to continue medical, dental and vision coverage for Active Eligible Employees when the employee is granted leave under the Federal Family Medic…

111-050-0065 Continuation of Coverage for Eligible Employees Covered under the Oregon Family Leave Act OEBB will allow Entities to continue medical, dental and vision coverage for Active Eligible Employees when the employee is granted leave under the Oregon Family Leave Act (OFLA…

111-050-0070 Continuation of Coverage for Eligible Employees during an Approved Leave of Absence. OEBB will allow Entities to continue medical, dental and vision coverage for Active Eligible Employees when the employee is granted a leave of absence based on collective bargaining …

111-050-0075 Continuation of coverage for Eligible Employees on Active Military Service OEBB will allow Entities to continue medical, dental, and vision coverage for Active Eligible Employees as required under the Uniformed Services Employment and Reemployment Rights Act (USERRA)…

111-050-0080 Portability and Conversion of Coverage (1) OEBB medical, life and accidental death and dismemberment carrier(s) will make portability plans available to members in accordance with related state and federal laws, rules and regulations. Eligibility criteria for this co…

111-060-0001 Use of Social Security Numbers (1) The Oregon Educators Benefit Board (OEBB) will comply with the requirements of Section 7 of the Privacy Act of 1974 and the Oregon Consumer Identity Theft Protection Act, ORS 646A.600 to 646A.628 when requesting or requiring complet…

111-065-0001 Definitions For the purpose of this rule: (1) “Direct Debit” for purposes of this OAR refers to a payment through an Automated Clearing House (ACH) credit or ACH debit that initiates the movement of funds electronically from the early retiree’s individual banking acc…

111-065-0005 Untitled The following administrative rules in Division 65 apply to OEBB Administered Early Retirees in addition to OEBB’s Division 50 rules which apply to all Early Retirees. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Implemented: ORS 243.864(1)(a) …

111-065-0010 OEBB Early Retiree Invoicing (1) OEBB will enroll the Early Retiree after OEBB has received the enrollment form and one of the following is completed: (a) The required ACH Authorization for a recurring Direct Debit Payment is received from the Early Retiree to initia…

111-065-0015 Early Retiree Payment Methods and Due Dates (1) Premium payments will be made through Direct Payment via ACH (ACH Debit) on the 2nd business day of the month unless otherwise prior authorized by designated OEBB staff. (2) As necessary, or upon written request of a pa…

111-065-0020 Early Retiree Overpayments (1) OEBB will include overpayment amounts on the monthly invoice. The invoice will include the total payment received, the date it was received, the amount of premium payment due, and any remaining balance of additional premiums paid. (2) O…

111-065-0025 Early Retiree Underpayments (1) Premiums must be paid in full on or before the 2nd business day of the month, unless otherwise pre-approved by OEBB under OAR 111-065-0015(2). (2)(a) Early Retirees will be notified if their coverage was terminated due to the premium n…

111-065-0030 Termination (1) OEBB shall not be responsible for any unpaid portion of premiums for coverage and will terminate the early retiree and dependent coverage for non-payment or underpayment of premiums due. (2) OEBB coverage will be terminated under the following circums…

111-065-0035 Appeals Early Retirees have the right to use the OEBB Appeals and Administrative Review process as defined in OAR 111-080-0030. (1) Early Retirees may appeal OEBB’s eligibility decision. (2) Early Retirees have the right to request a review of benefit and claim issue…

111-065-0040 Continuation of Coverage (1) Early Retirees and dependents have COBRA rights consistent with 111-050-0001. (2) Loss of coverage due to failure to make a premium payment is not a Qualified Status Change. Statutory/Other Authority: 243.860 - 243.886 Statutes/Other Impl…

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(2…

111-080-0001 Payment Methods and Dates (1) For the purpose of this rule: (a) "ACH credit" means a payment initiated by an Entity that is cleared through the Automated Clearing House (ACH) network for deposit to the OEBB account; (b) "ACH debit" means a payment initiated by OEBB a…

111-080-0005 Overpayments and Underpayments (1) For the purpose of this rule: (a) “Overpayment” means the amount of an Entity's monthly payment to OEBB that exceeded the amount due. (b) “Underpayment” means a payment submitted by an Entity that is less than the invoiced amount. (…

111-080-0030 Appeals and Administrative Reviews (1) Eligibility, enrollment issues or rescissions. OEBB has an Appeal process consisting of three levels that a member can use if they disagree with an eligibility determination or enrollment record. If the appeal is a result of a r…

111-080-0040 Eligibility and Policy Term Violations — Definitions For the purposes of OAR 111-080-0045 and 111-080-0050, the following definitions will apply: (1) “Eligibility or Enrollment Violations” means and includes a violation of the OEBB's eligibility or enrollment rules o…

111-080-0045 Eligibility Violations (1) Unintentional Violation: (A) OEBB will remove from coverage an ineligible OEBB 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…

111-080-0050 Policy Term Violations (1) An OEBB-contracted insurance carrier may remove from coverage and/or deny the claims of an OEBB member due to policy term violations. Removal from coverage for policy term violations is at the discretion of the insurance carrier. (A) If a p…

111-080-0055 Eligibility Verifications and Reviews (1) OEBB shall plan and conduct eligibility verifications and reviews to monitor compliance with OEBB administrative rules. Reviews shall include, but are not be limited to the following: (a) Dependent eligibility; (b) Employee e…

111-080-0060 Dependent Eligibility Verifications and Review Appeals (1) Following the termination of dependents due to a dependent eligibility verification review, Eligible Employees, Eligible Early Retirees, or COBRA participants may file an appeal and submit requested documenta…

111-080-0065 Hospital Payments (1) Except as provided in section (10), the maximum reimbursement amount for each claim subject to ORS 243.879 and these rules shall be determined by the carrier applying the applicable percentage of the Medicare rate, or the Medicare rate for simil…

111-080-0070 Exempt Hospitals (1) As specified in ORS 243.879, these payment limits do not apply to reimbursements paid by a carrier or third-party administrator to: (a) Type A or type B hospitals (defined in ORS 442.470); (b) Rural critical access hospitals (defined in ORS 315.6…

114-001-0000 Notice to Interested Persons Except as permitted by ORS 183.335(5), prior to adoption, amendment, or repeal of any rule, the Long Term Care Ombudsman shall give notice of the intended action: (1) In the Secretary of State’s Bulletin referred to in ORS 183.360 at leas…

114-001-0005 Model Rules of Procedure Pursuant to ORS 183.341, the Long-Term Care Ombudsman adopts the Attorney General’s Model Rules of Procedure under the Administrative Procedure Act as amended and effective March 3, 1988. [ED. NOTE: The full text of the Attorney General’s Mod…

114-001-0010 Fee for Copies of Public Records The Ombudsman shall provide within a reasonable time copies of any public records in its files upon written request from any person and may charge a fee reasonably calculated to cover its costs. Statutory/Other Authority: ORS 441 Hist…

114-002-0000 Goals The goals of the Ombudsman Program are to identify and be responsive to citizen needs and concerns with respect to all aspects of Oregon’s Long-Term Care System, including but not necessarily limited to the sufficient quality of provider service, government rul…

114-002-0010 Definitions The following definitions apply to all rules in chapter 114: (1) “Administrative Action” means any action which may adversely affect a resident’s health, safety, welfare or rights. (2) “Area Planning District” means the geographical areas designated by th…

114-003-0000 Appointment of Screening Committee Members (1) All screening committee members shall be appointed by the Ombudsman. (2) There shall be at least one local screening committee in each area planning district. (3) Except for individuals already appointed by the Ombudsman…

114-003-0010 Duties of the Local Screening Committee (1) Duties of the local screening committee shall consist of the following: (a) Publicizing the Ombudsman Program’s goals, needs and benefits; (b) Recruiting potential designees; (c) Screening potential designees, including che…

114-004-0000 Appointment of Designees (1) The Ombudsman shall review each designee applicant approved by a local screening committee. The Ombudsman shall approve the applicant if the applicant meets the qualifications of a designee as set forth in OAR 114-004-0010. (2) Once the O…

114-004-0010 Designee Qualifications (1) Designees shall not have a conflict of interest with the Ombudsman Program. (2) Designees shall have experience with long term care facilities or residents thereof or elderly individuals at risk of institutionalization or requiring assista…

114-004-0020 Designee Training (1) A designee applicant who has been approved by the local screening committee and by the Ombudsman shall, before being appointed as a designee by the Ombudsman: (a) Complete 48 hours of training provided, sponsored or approved by the Ombudsman Pro…

114-004-0030 Designee Contracts (1) Prior to being assigned to a long term care facility, a designee shall sign a contract with the Ombudsman Program which meets the requirements of ORS 441.131(3) and (6). (2) Noncompliance with the terms of the contract is cause for immediate te…

114-004-0040 Designee Assignments (1) The Ombudsman shall assign a designee to particular long term care facilities or to act as a back-up designee. Designees shall not be assigned to a long term care facility where an immediate family member is a resident. (2) Each designee’s co…

114-004-0050 Duties of Designees A designee shall: (1) Visit each assigned long term care facility on a regular basis: (a) Upon arrival and departure, inform a specified staff member; (b) Review any problems or concerns relating to the assigned long term care facility with admini…

114-004-0060 Complaints Against Designees and Rights of Designees (1) Any complaints regarding inappropriate actions or inactions relating to the official conduct of designees shall be referred to the Ombudsman. (2) The ombudsman shall investigate any complaint concerning designe…

114-005-0000 Access to Long-Term Care Facilities (1) Upon entering a long-term care facility, the Ombudsman or designee shall present identification provided by the Ombudsman Program to the specified staff person and request that the Ombudsman or designee be directed to the perso…

114-005-0010 Access to Resident (1) The Ombudsman or designee may communicate privately with any consenting resident. The Ombudsman and designee shall have access to each resident in private to determine if the resident wishes to communicate with the Ombudsman or designee. The re…

114-005-0020 Reporting the Investigation Upon completion of an investigation, the Ombudsman or designee shall report, either verbally or in writing, opinions or recommendations to the administrator or other staff in charge, his/her designated representative, and affected parties.…