Current through Register Vol. 63, No. 9, September 1, 2024
(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 eligibility;
(c) Election change limitations;
and
(c) Plan enrollment
limitations.
(2)
(a) Employee eligibility, election change and
plan enrollment reviews may occur on a random basis throughout the year, or if
anomalies in data warrant a formal review.
(b) The Eligible Employee and Entity are
responsible to submit documentation upon request.
(3) Dependent eligibility verifications shall
be completed at least once every five years per Entity.
(a) Entities may have a formal dependent
eligibility verification and review completed by a third party vendor on or
after October 1, 2013. The use of a third party vendor for a dependent
eligibility verification and review may meet the once every five years
requirement provided the vendor meets the standards and criteria set in the
OEBB verification and review plan and agrees to report all findings via a
secure electronic file. All requests to substitute a third party vendor for
this purpose must be pre-approved by OEBB.
(b) The Eligible Employee, Eligible Early
Retiree or COBRA participant is responsible to submit documentation upon
request. In the event the required documentation is not provided to
sufficiently prove the dependent meets eligibility requirements, or the
documentation provided is insufficient, the dependent's coverage will be
terminated. Retroactive terminations may occur if the documentation provided
shows the dependent was not eligible for coverage and the member misrepresented
the dependent as being an eligible dependent as defined by OAR
111-080-0045.
(4) If an
Eligible Employee does not complete the dependent eligibility review and moves
to a different Entity under OEBB, their terminated dependent records will be
locked in the MyOEBB benefit management system. The Eligible Employee must
submit documentation to OEBB to be verified before the dependent records are
unlocked.
Statutory/Other Authority: ORS
243.860 - 243.886
Statutes/Other Implemented: ORS
243.864(1)(a)
