Oregon Health Authority
Public Employees' Benefit Board - Chapter 101
Division 20
ENROLLMENT RULES
101-020-0038
Correcting Processing Errors
(1) Administrative processing errors occur when benefit plan elections are processed incorrectly in the payroll and benefit system by the agency, PEBB, or third party administrative staff, or PEBB carrier. Administrative error also includes when a newly eligible employee does not receive correct enrollment information or materials within 30 days of the eligibility date.
(a) PEBB must review all processing errors on PEBB optional plans (non-health carriers).
(A) Approval letters for a plan that requires underwriting are not official documents for enrollments unless the enrollment is entered into the PEBB system.
(B) If the enrollment is not entered into the system due to an administrative error, the member may pay all retro premiums back to the first of the month following carrier approval or re-apply for the coverage during an upcoming open enrollment period or within 30 days of a qualifying midyear event (Medical evidence may be required).
(C) PEBB will not be held responsible for processing errors made outside of PEBB. The eligible employee is responsible for identifying enrollment errors and maintaining a valid and accurate enrollment.
(b) PEBB authorizes the agency to correct processing errors identified within 30 days of the eligibility date or the midyear plan change date. Corrections are retroactive to the first of the month following the date the agency received the original paper form or electronic equivalent. The agency must reconcile all premium discrepancies.
(c) PEBB must review all processing error correction requests identified after 30 days of the eligibility date or the midyear plan change date. If approved, corrections are retroactive to the first of the month following the date the paper form or electronic equivalent was first received by the agency. The agency must reconcile all premium discrepancies.
(d) PEBB authorizes the agency to correct open enrollment processing errors. The agency must receive requests for correction after the open enrollment end date but no later than the last day of February of the new plan year.
(e) PEBB must review all open enrollment correction requests received after the last day of February of the new plan year.
(f) When a newly eligible employee fails to receive enrollment information within 30 days of the eligibility date or receives incorrect information, benefit plan elections will be effective retroactive to the first of the month following the eligibility date. Verification must be received by PEBB to consider the request.
Statutory/Other Authority: ORS 243.061 - 302
Statutes/Other Implemented: ORS 243.061 - 302
History:
PEBB 6-2018, adopt filed 08/15/2018, effective 08/15/2018