Oregon Administrative Rules Chapter 111 - OREGON HEALTH AUTHORITY, OREGON EDUCATORS BENEFIT BOARD
Oregon Administrative Rules (OAR) Chapter 111 is a crucial set of regulations governing the Oregon Educators Benefit Board (OEBB), which operates under the umbrella of the Oregon Health Authority. This chapter outlines the rules and procedures for providing health and welfare benefits to eligible employees of participating Oregon educational entities and their dependents.
Essentially, OAR Chapter 111 lays out the framework for how OEBB functions to achieve its mission of providing comprehensive and affordable benefit plans to Oregon's education workforce.
Here's a breakdown of the key areas typically covered in OAR Chapter 111:
1. Governance and Powers of the Board:
Procedural Rules: Defines the rules for the OEBB's meetings, public comment, and general administrative procedures.
Powers of the Board: Grants the OEBB the authority to design benefit plans, solicit proposals from carriers, award contracts for benefit coverage, and administer the programs. The Board is mandated to consider the welfare of employees and affordability.
Delegation of Authority: Specifies how the Board can delegate certain duties to the OEBB Administrator and staff.
2. Benefit Plan Management:
Procurement and Contracting: Details the process for OEBB to procure and contract with insurance carriers and service providers for various benefit plans (medical, dental, vision, life, disability, etc.). This includes rules for renewals, screening, and selection.
Plan Design Development and Selection: Outlines the process by which OEBB develops and selects the specific benefit plans offered to eligible individuals, emphasizing employee choice, a competitive marketplace, and quality outcomes.
3. Eligibility and Enrollment:
Definitions: Provides clear definitions for key terms, such as "eligible employee," "eligible domestic partner," "child," and "educational entity."
Eligibility Rules: Specifies who is eligible to participate in OEBB-sponsored benefit plans, including employees, early retirees, and their dependents. It also addresses the impact of collective bargaining agreements.
Enrollment: Outlines the procedures for initial enrollment, annual plan changes, and enrollment due to qualified status changes (e.g., marriage, birth of a child).
Continuation of Coverage: Covers rules related to continuation of coverage, such as COBRA.
Dependent Eligibility Verification (DEV): OEBB conducts periodic reviews to ensure that dependents covered under the plans meet eligibility requirements, and the OARs address the procedures for these reviews and the consequences of non-compliance.
4. Program Participation and Administration:
Information Requirements and Requests: Details the responsibilities of both OEBB and participating entities regarding the exchange of information.
OEBB Administration of Early Retiree Groups: Specific rules regarding the administration of benefits for early retirees.
Correction of Errors: Procedures for correcting enrollment and processing errors made by employees or benefit administrators.
SB 551 Program: Includes rules for the administration of the SB 551 program, which provides benefits to eligible part-time faculty members at Oregon public institutions of higher education.
Purpose of OAR Chapter 111:
The primary purpose of OAR Chapter 111 is to provide the legal and operational framework for the Oregon Educators Benefit Board to:
Provide health and welfare benefits: Offer a comprehensive array of benefit plans to eligible employees of participating Oregon educational institutions.
Ensure equitable access: Establish clear eligibility and enrollment rules to ensure fair access to benefits.
Maintain financial stability: Govern the procurement and contracting processes to ensure cost-effectiveness and sustainability of the benefit programs.
Protect members: Set standards for plan design, administration, and dispute resolution to protect the interests of covered individuals.
Promote health outcomes: Work to offer value-added benefit plans that support improvement in members' health status.
In essence, OAR Chapter 111 is the rulebook that enables OEBB to manage and deliver vital benefit programs to thousands of educators and their families across Oregon.
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