(1) Eligible employee plan elections are
irrevocable for the plan year. There are limited exceptions to the
irrevocability rule if certain conditions or events are met. These events fall
into three broad groups:
(a) Qualified Status
Changes (QSC), which include:
(A) Changes in
the eligible employee's legal marital status, such as marriage or
divorce;
(B) Changes in the
eligible employee's number of dependents, such as birth or adoption of a
child;
(C) Changes in the
employment status of the eligible employee or family member, such as the start
or end of employment, or a change from part-time to full time;
(D) Changes in the eligibility of a
dependent, such as attaining a certain age;
(E) Changes in the residence of the eligible
employee, or;
(F) Changes in the
eligible employee's domestic partnership.
(b) Cost or coverage changes. For example:
(A) An increase in out-of-pocket premium cost
imposed by the employer;
(B) A
reduction or a loss in the spouse's or domestic partner's group plan benefits,
or;
(C) A reduction or a loss of
plan coverage.
(c) Other
laws or court orders. For example: National Medical Support Notice, Medicare,
or HIPAA related special enrollments.
(2) The eligible employee may request only
those midyear plan change elections that are consistent with the event.
Example: In the middle of the plan year, John
moves from his current medical plan's service area and can no longer access the
plan's closed panel of providers. However, all of John's other coverages
(dental, life, etc.) remain active for his new address. John may request to
change his medical plan, because it is consistent with the event due to a move
from his current medical plan's service area. John may not request to change or
add any other elections at this time because that would not be consistent with
the allowable midyear event occurrence.
(3) Eligible employees experiencing a
qualified midyear event, and who request a change of enrollment elections must
complete and submit to their agency the correct update forms and all required
documentation within 30 days of the event. Agencies receiving employee midyear
change requests can make only those changes that are consistent with the event.
All election changes are effective the later of the first of the month after
receiving all required update forms and documents or the event date. Agencies
will not process enrollment request changes when enrollment and change request
information is incomplete or missing required documentation.
(4) The tag-a-long rule applies when the
eligible employee experiences a QSC addition of a new family member, domestic
partner, or domestic partner's child. The rule allows the employee to add
another eligible family member, domestic partner, or domestic partner's child
who was previously eligible for PEBB plan coverage but never added to coverage,
to be added to coverage.
Notes
Or. Admin. Code §
101-020-0050
PEBB 2-2007, f. 9-28-07,
cert. ef. 10-1-07; PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11;
PEBB
2-2017, f. & cert. ef.
8/17/2017
Stat. Auth.: ORS
243.061 - 302
Stats. Implemented: ORS
243.061 - 302, 659A.060 - 069,
743.600 - 602 & 743.707
