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

[MyOEBB system updates]

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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