[MyOEBB] OEBB Rule Change

[MyOEBB system updates]

Dear Business Managers, Superintendents & Benefits Administrators:

We wanted to let you know about a rule change that may be of particular interest to you and some of your employees. Back in July, OEBB filed amendments to OAR 111-010-0015 (Definitions). Many of those amendments were needed in response to guidance we received related to how health reimbursement arrangements (HRAs) were to be treated under the Affordable Care Act (ACA). The guidance at that time was that an employer who contributed to an HRA that reimbursed for any qualified medical expenses could only do so if their employee was covered under a group medical plan that met the essential benefits requirement available through the employer. Our legal and consulting advisors interpreted that to mean that the employee must be covered as the primary subscriber of the employer's group medical plan.

Recently, we received further clarification and guidance from the federal government relating to permissible HRA contributions.  In reviewing this guidance, it was determined that OEBB could be more lenient in allowing an employee to opt-out of medical coverage and be eligible for a contribution into an HRA and will be filing another amendment to OAR 111-010-0015 (Definitions) as a Temporary Rule later today.  This amendment will allow an employee of an educational entity participating in the OEBB benefits program to receive a contribution into an HRA that reimburses for qualified medical expenses when opting-out of the OEBB medical coverage as the subscriber as long as the employee is covered as an eligible dependent on an OEBB medical plan.

We understand the federal guidance and definition of an integrated HRA was more lenient than what OEBB was able to be and allows employers to contribute to an HRA as long as an employee is covered under a medical plan that meets the essential benefits requirements, whether the plan is available through the employer or not.  However, under ORS 243.886(a) & (b), "A district may not provide or contract for a benefit plan unless the benefit plan is provided and administered by the Oregon Educators Benefit Board...... and " Eligible employees of a district may participate only in benefit plans provided and administered by the board." Medical plans are specifically called out under the statutory definition of a benefit plan under ORS 243.860. HRAs are considered medical plans.

As the Board looked at how to work HRAs into the OEBB definitions, it determined that HRAs could be broken into two categories - medical plans and supplemental medical plans. OEBB offers medical plans, but it does not offer supplemental medical plans at this time. Therefore, educational entities participating in OEBB cannot offer HRAs that meet the definition of a medical plan (including a Non-integrated General Purpose HRA), but can offer HRAs that meet the definition of a supplemental medical plan.  The definition of a supplemental medical plan includes a general purpose HRA when the employee is covered either as an employee or as an eligible dependent on an OEBB medical plan (i.e., an integrated HRA), a Limited Purpose HRA, a Post Separation/Retiree HRA, and a Premium Only HRA.

As this new guidance came through after the conclusion of the open enrollment period and your employees who are eligible to be covered under an OEBB medical plan as a dependent may have made a different decision had this new definition been in place prior to September 15, OEBB will allow you to contact those employees and allow those specific employees a "special change" period through the end of this month (October 31, 2013). The only changes that can be allowed under this special provision are: 1) an employee can opt-out of medical coverage; and 2) an employee can add the employee opting out as an eligible dependent under his or her medical coverage. This special change period only applies to those employees that would have "opted out" of their medical coverage and chosen to be covered as a dependent under a spouse's or domestic partner's OEBB medical plan in return for a contribution into a general purpose HRA and that employee's spouse or domestic partner.  It is important to note that this change period is "allowed" and not "required."  If your employee's spouse or domestic partner is employed by another educational entity that does not elect to allow their employees to add an eligible dependent under this special change period, OEBB cannot require the entity to do so. Any changes allowed during this special change period must be effective retroactive to October 1, 2013.

We hope this rule change and the special change period is helpful to you and any employee that might have been affected by the July 2013 amendments.  If you have any questions about this change or the special change period, please contact the OEBB Members Services Team at 1-888-469-6322.

Sincerely,

Denise L. Hall
Denise L. Hall, Deputy Administrator
Oregon Educators Benefit Board
http://egov.oregon.gov/OHA/OEBB<http://egov.oregon.gov/DAS/OEBB>

OEBB encourages all members to stay healthy and be happy!!!!     Pass it on.....
http://www.oregon.gov/OHA/OEBB/pages/welllinks.aspx




*****CONFIDENTIALITY NOTICE*****

This e-mail may contain information that is privileged, confidential, or otherwise exempt from disclosure under applicable law. If you are not the addressee or it appears from the context or otherwise that you have received this e-mail in error, please advise me immediately by reply e-mail, keep the contents confidential, and immediately delete the message and any attachments from your system.

************************************

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://omls.oregon.gov/pipermail/myoebb/attachments/20131011/06fad6ee/attachment.html>