Oregon Administrative Rules
Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD
Division 20 - ENROLLMENT RULES
Section 101-020-0038 - Correcting Processing Errors
Universal Citation: OR Admin Rules 101-020-0038
Current through Register Vol. 63, No. 9, September 1, 2024
(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 includes when a newly eligible employee does not receive correct enrollment information or materials within 30 days of the eligibility date.
(a) PEBB must review
all processing errors on PEBB optional plans (non-health carriers).
(A) Approval letters for a plan that requires
underwriting are not official documents for enrollments unless the enrollment
is entered into the PEBB system.
(B) If the enrollment is not entered into the
system due to an administrative error, the member may pay all retro premiums
back to the first of the month following carrier approval or re-apply for the
coverage during an upcoming open enrollment period or within 30 days of a
qualifying midyear event (Medical evidence may be required).
(C) PEBB will not be held responsible for
processing errors made outside of PEBB. The eligible employee is responsible
for identifying enrollment errors and maintaining a valid and accurate
enrollment.
(b) PEBB
authorizes the agency to correct processing errors identified within 30 days of
the eligibility date or the midyear plan change date. Corrections are
retroactive to the first of the month following the date the agency received
the original paper form or electronic equivalent. The agency must reconcile all
premium discrepancies.
(c) PEBB
must review all processing error correction requests identified after 30 days
of the eligibility date or the midyear plan change date. If approved,
corrections are retroactive to the first of the month following the date the
paper form or electronic equivalent was first received by the agency. The
agency must reconcile all premium discrepancies.
(d) PEBB authorizes the agency to correct open
enrollment processing errors. The agency must receive requests for correction
after the open enrollment end date but no later than the last day of February
of the new plan year.
(e) PEBB must
review all open enrollment correction requests received after the last day of
February of the new plan year.
(f)
When a newly eligible employee fails to receive enrollment information within
30 days of the eligibility date or receives incorrect information, benefit plan
elections will be effective retroactive to the first of the month following the
eligibility date. Verification must be received by PEBB to consider the
request.
Statutory/Other Authority: ORS 243.061 - 302
Statutes/Other Implemented: ORS 243.061 - 302
Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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