[MyOEBB] OEBB to Implement Federal Rescission Reforms on October 1, 2010

Tue Nov 2 14:56:57 PDT 2010

Was I suppose to receive this?

Linda Tibbles
Employee Benefits Specialist
Hillsboro School District
3083 NE 49th Pl #104
Hillsboro, OR 97124
Phone: 503-844-1518
Fax: 503-844-1710

Ensure a sustainable future - only print when necessary.

From: myoebb-bounces at listsmart.osl.state.or.us [mailto:myoebb-bounces at listsmart.osl.state.or.us] On Behalf Of MyOEBB system updates
Sent: Tuesday, November 02, 2010 2:22 PM
To: MyOEBB system updates
Subject: Re: [MyOEBB] OEBB to Implement Federal Rescission Reforms on October 1, 2010

I have gone in and put calendar reminders on the 15th of each month we have a termination for the 10-11 year.  So far I only have retirees that turn 65 and Tami Bonney.  I will do my best to stay ahead of it.

On 9/30/2010 4:57 PM, MyOEBB system updates wrote:
Federal Health Care Reform -- Rescission of Coverage
As you may have already heard, the federal health care reform bill enacted new restrictions on an Employers' rescission of coverage. OEBB will implement the new restrictions effective October 1, 2010.

Rescission of coverage can simply be defined as:  The retroactive cancellation of a health insurance policy.

Under the new restrictions, a rescission (retroactive cancellation) by the Employer is illegal except in cases of fraud or intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage.  Please read this entire e-mail.  It explains how this change will affect your educational entity and members.  I also encourage your educational entity benefits team to participate in one of the phone conferences listed below.

Grandfathering Medical Plans
OEBB will not grandfather any plans currently available.  This means the Rescission of Coverage will apply to all OEBB plans and that overage dependents age 19 through 25 may be enrolled regardless of whether they are eligible for or have other group coverage.

QSC Changes
Effective October 1, 2010, OEBB will limit QSC date ranges in MyOEBB.  You will not be able to back date any coverage termination date; you will only be able to go forward.  This means you will not be able to access a 60-day retro feature as you have in the past.  If you need to retro adjust someone's enrollment due to intentional misrepresentation, you will need to contact OEBB for assistance.

Invoicing Changes
Effective October 1, 2010, the following invoicing rules will apply due to rescission:
Active Employees

 *   If the Educational Entity fails to notify OEBB of a retroactive employee termination, coverage must end on the last day of the current month. *No retroactive terminations or adjustments can be allowed.
 *   If the Active Eligible Employee fails to notify their Educational Entity within 31 days in the event their spouse, domestic partner or other dependent no longer meets eligibility criteria, the affected individual's coverage will be retroactively terminated to the end of the month in which eligibility was lost.  OEBB considers this to be intentional misrepresentation and grounds for retroactive termination of coverage. *Credits for retroactive adjustments will be issued to the Entity for up to 90 days.
 *   If the Active Eligible Employee notifies the Educational Entity within 31 days after an event terminating eligibility of the employee's spouse, domestic partner or other dependent, coverage for the affected individual will end on the last day of the month in which OEBB receives notification of the event from the Educational Entity.  *No retroactive terminations or adjustments are allowed.

Retirees (Self-Pays)

 *   OEBB can retroactively terminate coverage in the case of non-payment. Retroactive terminations for failure to pay premiums or contributions are not rescissions.  Coverage will be terminated on the last day of the month for which premiums were paid in full by the retiree to the Entity and credits for retroactive adjustments will be issued to the Entity for up to 90 days.
 *   The retiree is responsible for reporting to their Educational Entity within 31 days of the date he/she or a dependent becomes eligible for Medicare coverage due to a disability.  Failure to report this loss of eligibility within 31 days is considered by OEBB to be intentional misrepresentation and grounds for retroactive termination of the affected individual's coverage back to the last day of the month prior to the Medicare effective date.
 *   OEBB automatically terminates coverage for early retirees who become eligible for Medicare due to age.

OEBB to Provide Statewide Question & Answer Phone Conferences
OEBB has scheduled several statewide phone conferences (listed below) to discuss federal health care reform, rescission of coverage, overage dependent children, and the post Open Enrollment Mail Out.

Monday, October 4th - 2:00 to 3:30 PST
Tuesday, October 5th - 2:00 to 3:30 PST
Wednesday, October 6th - 11:00 to 12:30 PST
Thursday, October 7th - 3:30 to 5:00 PST

If you would like to participate in one of the above calls, please call 503-378-2167 using code 31381.

Scenarios
Scenario

Rescind coverage?

What does this mean for my educational entity?

Employment Termination

In the event an educational entity does not enter the termination of coverage timely due to lost paperwork, untimely reconciliation, or other administrative reasons.

No, this can't be considered intentional misrepresentation and thus is not grounds for rescission.  The employer was aware of the change and the terminated employee didn't misrepresent anything. The termination of benefits in the MyOEBB system is the responsibility of the educational entity.

Coverage must end on the last day of the current month. No retroactive terminations or adjustments can be made.

This means when the educational entity discovers the error in MyOEBB they will only be able to terminate coverage in MyOEBB at the end of the month of discovery.  There will be no retro terminations allowed or credits available for the educational entity.  The terminated employee will have these extra months of benefit coverage.

Qualified Status Changes - Death, Divorce, dropping Domestic Partner, child ceasing to meet eligibility and, on retiree plans, gaining of Medicare.

In the event a member (this applies to self-pay and partial self-pay groups also) experiences a qualified status change or, on a retiree plan, gains Medicare and fails to notify their educational entity within the timeframe specified in our administrative rules.

Yes, this can be considered intentional misrepresentation only if OEBB takes the following action steps to notify educational entities and members that failure to take action in these types of scenarios is considered intentional misrepresentation.

These terminations dates would need to be effective at the end of the current month or the month the QSC is occurring the member fails to notify the educational entity of the QSC event within the timeframe specified in the OEBB administrative rules.

Only if the member fails to report this timely can we rescind coverage.

If the member did not report this change timely it will be considered misrepresentation.  When an eligibility or enrollment violation has been discovered and investigated, OEBB will notify the member and the Educational Entity of the outcome. If the outcome includes rescission of coverage, OEBB will give a 30-day notice of such rescission prior to terminating the affected individual's coverage retroactively to the date the affected individual was no longer eligible for benefits. The notice will include the specific reason(s) for the decision, a reference to the specific plan provision or OAR on which the determination was based, a description of any additional information required and a description of the OEBB appeals process, as the member has the right to appeal the decision through OEBB.

The member may be responsible for any claims paid and expenses incurred during the period of time the affected individual was enrolled inappropriately.

Policy term violations may apply to the subscriber and their dependents.

There will be up to a 90-day credit available (if applicable) for the educational entity.

If the member did report this change timely it will not be considered misrepresentation but an error originating from the educational entity.  This means when the educational entity discovers the error in MyOEBB they will only be able to terminate the benefits in MyOEBB at the end of the month of discovery.  There will be no retros allowed or credits available for the educational entity.  The terminated employee will have these extra months of benefit coverage.

100% Self-pay Groups (COBRA/HB 2557/Retiree)

In the event a member in one of OEBB's self-pay groups stops paying their premiums, coverage is terminated retroactive to the end of the month that the full premium was paid.

OEBB can retroactively terminate coverage in the case of non-payment. Retroactive terminations for failure to pay premiums or contributions are not rescissions.

Coverage will be terminated on the last day of the month for which premiums were paid in full.

OEBB or its contractor will terminate coverage on the last day of the month that premiums were paid in full.

Partial Self-pay Groups - Employees, Early retirees, or COBRA participants who pay a portion of their total premium

When a member in a partial self-pay group fails to pay their portion of the premium and the educational entity continues to "float" the entire premium (pay the entire premium to OEBB) while waiting for the employee, early retiree, or COBRA participant to make up their portion. Once the entity notifies OEBB, we will terminate coverage back to when the member stopped paying their portion and will give the entity up to a 90-day credit.

OEBB can retroactively terminate coverage in the case of non-payment - whether or not the member was responsible for the full premium or partial premium. Retroactive terminations for failure to pay premiums or contributions are not rescissions.

Coverage will be terminated on the last day of the month for which premiums were paid in full.

This means when an educational entity discovers the non-payment they will notify OEBB and provide the necessary information so OEBB can terminate coverage(s) in MyOEBB at the end of the month of last full payment was received.  There will be up to a 90-day credit available (if applicable) for the educational entity.

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