[MyOEBB] What qualifies as “other group coverage” for opt-out incentives

[MyOEBB system updates]

Dear Benefits Administrators and Business Managers:

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:

111-040-0050

Declination of Coverage

(1) As used in this section:

(a) “Opting out of coverage” means that an otherwise Eligible Employee elects not to enroll in a medical plan and is eligible to receive a portion of the cash contribution or other type of remuneration as provided for under a collective bargaining agreement, documented Entity policy, or employment contract.

(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 is not eligible to receive any portion of a cash contribution or other type of remuneration.

(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. Eligible Employees electing to opt out must:

(a) Maintain coverage under another employer-sponsored group medical benefit plan;

(b) Meet the requirements of the Entity opt out program in which they are participating;

(c) Submit their election to opt out through the OEBB benefit management system; and

(d) If requested, provide proof of current coverage under another employer-sponsored
group medical benefit plan.


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.

We have updated the enrollment and change forms on the OEBB website (http://www.oregon.gov/oha/OEBB/Pages/Forms.aspx) to make this clearer for OEBB members.

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.

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.

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 oebb.benefits at oregon.gov<mailto:oebb.benefits at oregon.gov>.

Thank you,

Jackie Cowsill
Communications Coordinator, Oregon Educators Benefit Board
Health Policy and Analytics
jackie.cowsill at oregon.gov<mailto:jackie.cowsill at oregon.gov>
Phone: 503.378.5353

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