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

Tue Nov 2 15:07:27 PDT 2010

Hello‹I am not sure why I have received this.  Thanks, tv

----
Dr. Tony Valley

Director of Human Resources
Director of ELL Program
Molalla River School District

Principal
Molalla Online High School

On 11/2/10 2:21 PM, "MyOEBB system updates"
<myoebb at listsmart.osl.state.or.us> wrote:

>    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 Employers¹ 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 someone¹s
>> 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 individual¹s 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 employee¹s 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 individual¹s 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 individual¹s 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 OEBB¹s 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 ³float² 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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>>  
>>  
>>  

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