Oregon Administrative Rules
Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD
Division 20 - ENROLLMENT RULES
Section 101-020-0052 - Surcharges
Universal Citation: OR Admin Rules 101-020-0052
Current through Register Vol. 63, No. 9, September 1, 2024
(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
Board in Oregon.
(c)
Subscriber/employee means the individual who subscribes to their employer's
health plan. For the purposes of this rule, a subscriber excludes a COBRA
participant, part-time employee, retiree or self-pay member.
(d) Dependent means and includes a dependent
child as defined by OAR 101-015-0011, Spouse as defined by OAR 101-015-0005,
and Domestic Partner as defined by OAR 101-015-0011.
(e) Surcharge means an extra fee deducted
from the employee's monthly pay.
(2) Tobacco Use Surcharge:
(a) Employees and spouses/Domestic Partners
who are enrolled in a PEBB medical plan and use tobacco products may pay a
monthly surcharge. The surcharge is deducted from the employee's monthly
paycheck. The monthly surcharges are determined by the PEBB Board.
(b) Employees who opt-out of a PEBB medical
plan are not subject to this surcharge.
(c) Tobacco usage status can be updated
prospectively at any time during the plan year by completing and submitting a
Midyear change form.
(3) Spouse/Domestic Partner Other Group Coverage Surcharge:
(a) Employees will pay a monthly surcharge if
the spouse/Domestic Partner is covered on the employee's PEBB plan and chooses
to not enroll in their own employer's medical coverage (non-PEBB coverage). The
monthly surcharges are determined by the PEBB Board.
(b) Employees who have a spouse/Domestic
partner who opts out of PEBB coverage are not subject to this
surcharge.
(c) Employees may submit
a Midyear change form if this changes anytime during the plan year. The change
request form must be submitted to their employer's payroll or university
benefits office within 30 days of the change. Changes take effect prospectively
upon receipt of the appropriate form.
(4) Double Coverage:
(a) Effective January 1, 2021, any active
full-time employees who cover an eligible dependent that is also enrolled as a
subscriber for either a PEBB or an OEBB-sponsored medical plan will be assessed
a monthly surcharge.
(b) The amount
of the surcharge is determined annually by the PEBB Board.
(c) The monthly surcharge will only be
charged to the subscriber.
(d) The
subscriber will only pay one double coverage surcharge no matter how many
dependents are double covered.
(e)
The Double Coverage surcharge does not apply to Opt Out, Retirees, COBRA
participants, self-pay participants or part-time employees.
Statutory/Other Authority: ORS 243.061 - 243.302
Statutes/Other Implemented: ORS 243.125(1), ORS 243.125(3)
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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