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<p class="MsoNormal">Dear Benefits Administrators and Business Managers:<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">It has come to OEBB’s attention that for members who decline OEBB medical coverage, there may be some confusion between the terms “opt-out” and “waive”. Below are the specific definitions from OEBB’s Administrative Rules, with key phrases
bolded and underlined here for emphasis:<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><span style="font-size:10.0pt">111-040-0050<o:p></o:p></span></b></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><span style="font-size:10.0pt"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><span style="font-size:10.0pt">Declination of Coverage<o:p></o:p></span></b></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><span style="font-size:10.0pt"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><span style="font-size:10.0pt">(1) As used in this section:<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><span style="font-size:10.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt">(a) “Opting out of coverage” means that an otherwise Eligible Employee elects not to enroll in a medical plan and
<b>is eligible to receive a portion of the cash contribution or other type of remuneration</b> as provided for under a collective bargaining agreement, documented Entity policy, or employment contract.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt">(b) “Waiving benefits” means that an otherwise Eligible Employee elects not to enroll in any one of the benefit plans available under the OEBB-sponsored benefits
program and <b>is <u>not</u> eligible to receive any portion of a cash contribution or other type of remuneration</b>.
<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:10.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><span style="font-size:10.0pt">(2) Unless otherwise specified in a collective bargaining agreement, documented Entity policy or employment contract in effect on July 1, 2008, an Eligible Employee
may opt out of the OEBB-sponsored medical benefit plans. <b>Eligible Employees electing to opt out must</b>:<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><span style="font-size:10.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt">(a)
<b>Maintain coverage under another employer-sponsored group medical benefit plan</b>;
<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt">(b) Meet the requirements of the Entity opt out program in which they are participating;<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt">(c) Submit their election to opt out through the OEBB benefit management system; and<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><span style="font-size:10.0pt">(d) If requested, provide proof of current coverage under another employer-sponsored<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in"><span style="font-size:10.0pt">group medical benefit plan.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">It is important to note that participation or enrollment in the Oregon Health Plan/Medicaid, Veteran’s Administration Benefit Programs, Medicare or Student Health Insurance does not qualify as an “employer-sponsored group medical benefit
plan” and therefore these plans do not qualify for OEBB Opt Out.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">We have updated the enrollment and change forms on the OEBB website (<a href="http://www.oregon.gov/oha/OEBB/Pages/Forms.aspx">http://www.oregon.gov/oha/OEBB/Pages/Forms.aspx</a>) to make this clearer for OEBB members.
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">We are also exploring ways to improve our systems and processes to ensure compliance. Within the next few weeks, we will begin identifying members who are opting out and have listed a non-compliant source of other coverage, such as those
listed above. OEBB will contact the associated entities for assistance in correcting the member status – either changing them to “waive” if they are not receiving compensation, or updating the “other coverage” field to reflect their qualifying plan.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">If you would like to review the medical opt-outs and waives for your entity and make corrections before OEBB starts this process, you can go into the MyOEBB Admin Module, click on “ReportMart” and run the report titled “Entity_Opt-Out_and_Waive”.
This report shows all members who are opting out and waiving, as well as the “Other Coverage” field.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">If you have any questions about this clarification, qualifying other coverage, or how to correct an employee’s record, please call OEBB Member Services at 888-469-6322 or send an email to
<a href="mailto:oebb.benefits@oregon.gov">oebb.benefits@oregon.gov</a>.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Thank you,<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b>Jackie Cowsill</b><o:p></o:p></p>
<p class="MsoNormal">Communications Coordinator, Oregon Educators Benefit Board<span style="font-family:"Arial",sans-serif"><o:p></o:p></span></p>
<p class="MsoNormal">Health Policy and Analytics<o:p></o:p></p>
<p class="MsoNormal"><a href="mailto:jackie.cowsill@oregon.gov">jackie.cowsill@oregon.gov</a><o:p></o:p></p>
<p class="MsoNormal">Phone: 503.378.5353<o:p></o:p></p>
<p class="MsoNormal"><span style="color:#44546A"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#44546A"><img border="0" width="199" height="75" id="Picture_x0020_2" src="cid:image001.jpg@01D11D64.AADF6FC0" alt="cid:image001.jpg@01D10D96.C6B9DCE0"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#44546A"><o:p> </o:p></span></p>
<p class="MsoNormal">CONFIDENTIALITY NOTICE<o:p></o:p></p>
<p class="MsoNormal">This email 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 email in
error, please advise me immediately by reply email, keep the contents confidential, and immediately delete the message and any attachments from your system.
<o:p></o:p></p>
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