Or. Admin. R. 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(2021). "SB
551 eligible member" does not mean or include a part-time faculty member who is
currently eligible for employer-paid benefits through the Public Employees
Benefit Board (PEBB) or the Oregon Educators Benefit Board (OEBB).
(b) "SB 551 program" is the benefits program established by SB
551(2021) and codified in ORS 350.355.
(c) "OEBB coverage" means coverage that is available to
part-time faculty members who are eligible for employer-paid benefits.
(2) SB 551 eligible members may only enroll in employee-only
medical/pharmacy, dental, and vision coverage, or a combination thereof,
subject to carrier specific requirements.
(3) SB 551 members shall not receive any monetary incentives
for opting out, declining, or waiving any combination of or all available
coverage.
(4)
(a) Individuals currently eligible for and enrolled in OEBB
or PEBB coverage as a subscriber or dependent are not eligible to enroll in the
SB 551 program, and individuals eligible for and enrolled in the SB 551 program
are not eligible to enroll in OEBB coverage.
(b) Individuals enrolled in the SB 551 program, who gain
eligibility for OEBB coverage during the plan year, may terminate coverage
under the SB 551 program and enroll in OEBB coverage, with no break between
coverages. Individuals enrolled in OEBB coverage, who gain eligibility for
coverage under the SB 551 program during the plan year, may terminate OEBB
coverage and enroll in coverage under the SB 551 program, with no break between
coverages. OEBB reserves the right to audit and retroactively terminate OEBB SB
551 coverage.
(5) If the SB 551 eligible member misses their enrollment
period to enroll in coverage, they will have the ability to appeal to OEBB for
enrollment.
(6) Coverage elected under this section is effective the entire
plan year unless the SB 551 eligible member is terminated by OEBB or an Oregon
public institution of higher education for failure to meet SB 551 eligibility
or participation requirements or enrolls in OEBB coverage under section (4) of
this rule.
(7) OEBB will not credit deductibles or out of pocket maximums
for SB 551 members who transfer between an OEBB medical plan and PEBB medical
plan.
(8) It shall be the sole responsibility of the Oregon public
institution of higher education to determine eligibility for coverage pursuant
to ORS 350.355.
(9) It shall be the sole responsibility of the part-time
faculty member to submit all information necessary for the Oregon public
institution of higher education to make an eligibility determination for SB 551
coverage pursuant to ORS 350.355.
(10) The SB 551 eligible member is eligible to continue
coverage through COBRA should their coverage end, and they meet the criteria
for COBRA continuation coverage as per OAR 111-050-0001.
Notes
Statutory/Other Authority: ORS 243.860 - ORS 243.886
Statutes/Other Implemented: ORS 243.864(1)(a) & ORS 350.355
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