Or. Admin. Code § 459-035-0050 - Contribution Payment From Retiree Health Insurance Premium Account for Eligible Retired State Employees Not Eligible for Medicare
This rule establishes the procedure for determining the amount of contribution that will be paid from the Retiree Health Insurance Premium Account (RHIPA)(ORS 238.415) on behalf of an eligible retired state employee under age 65, as described in OAR 459-035-0040, who is enrolled in a health insurance plan sponsored by PERS.
(1) On or before November 1 of each calendar
year, staff shall determine the monthly amount available to be paid from the
RHIPA on behalf of an eligible retired state employee enrolled in a PERS health
insurance plan contracted for under ORS
238.410. In determining the
average difference between the health insurance premiums paid by retired state
employees under contracts entered into by the Public Employees Retirement Board
and the health insurance premiums paid by state employees who are not retired
under contracts entered into by PEBB (without regard to employees who have
opted out of PEBB-sponsored health insurance coverage), the staff shall
calculate the change in value of the average of active PEBB plans after
adjusting for the demographic (age/sex) differences between:
(a) The active employee participants; and
(b) Retired members receiving a
subsidy and participating in one of the PERS non-Medicare health insurance
plans as follows:
(A) Obtain the average
employee participation for each health insurance plan sponsored by PEBB for the
most recent three-month period;
(B) Obtain the health insurance premium for
each health insurance plan sponsored by PEBB for the plan year next following;
(C) Obtain the average eligible
retired state employee participation for each health insurance plan sponsored
by PERS for the most recent three-month period;
(D) Compute the average health insurance
premium for all plans sponsored by PEBB pursuant to the following formula:
(i) Step 1. Multiply the average
participation in paragraph (A) of this subsection by the health insurance
premium in paragraph (B) of this subsection for each plan;
(ii) Step 2. Total the average participation
for all plans;
(iii) Step 3. Total
the result for all of the calculations in Step 1 of sub-paragraph (i) of this
paragraph; and
(iv) Step 4. Divide
the total in Step 3 of sub-paragraph (iii) of this paragraph by the total in
Step 2 of sub-paragraph (ii) of this paragraph.
(E) Compute the change in value of the
average active PEBB plan pursuant to the following formula:
(i) Step 1. Divide the total in paragraph (C)
of this subsection by the total in Step 2 of paragraph (D) of this subsection;
(ii) Step 2. Multiply the average
participation for each plan in paragraph (A) of this subsection by the result
of Step 1 of sub-paragraph (i) of this paragraph for each plan;
(iii) Step 3. Multiply the premium for each
plan in paragraph (B) of this subsection by the estimated factor of
non-Medicare retiree claims cost to active claims cost;
(iv) Step 4. Multiply the result of Step 2 of
sub-paragraph (ii) of this paragraph by the result of Step 3 of subparagraph
(iii) of this paragraph for each plan;
(v) Step 5. Total the results for all of the
calculations in Step 4 of sub-paragraph (iv) of this paragraph;
(vi) Step 6. Total the results of the average
participation calculations for all plans in Step 2 of sub-paragraph (ii) of
this paragraph; and
(vii) Step 7.
Divide the total premium in Step 5 of sub-paragraph (v) of this paragraph by
total average participation as calculated in Step 6 of sub-paragraph (vi) of
this paragraph.
(F) The
result of Step 7 of sub-paragraph (E)(vii) of this subsection minus Step 4 of
sub-paragraph (D)(iv) of this subsection is the maximum monthly amount
available to be paid by PERS on behalf of an eligible retired state employee.
Under no circumstances will this amount be less than $0.
(G) The maximum monthly amount paid by PERS
on behalf of an eligible retired state employee shall be determined using
qualifying service.
(2) The factor in Step 3 of sub-paragraph
(1)(b)(E)(iii) of this rule shall be evaluated no less frequently than every
three years.
(3) The monthly
amount available established under section (1) of this rule shall be published
by November 1 of each calendar year, or as soon as possible thereafter, and
shall be effective for the plan year next following for PERS sponsored plans.
(4) In the event an active plan is
not to be renewed for a subsequent plan year, the participants shall be deemed
to be covered by another existing plan most similar in benefits.
(5) This rule applies to the amount to be
paid by PERS for the plan year 1993 and subsequent plan years.
(6) No person eligible for a contribution
from the RHIPA as provided for in this rule shall be entitled to a contribution
from the RHIA.
Notes
Stat. Auth.: ORS 238.650
Stats. Implemented: ORS 238.415
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