Oregon Health Authority
Oregon Educators Benefit Board - Chapter 111
Division 80
OPERATIONS
111-080-0060
Dependent Eligibility Verifications and Review Appeals
(1) Following the termination of dependents due to a dependent eligibility verification review, Eligible Employees, Eligible Early Retirees, or COBRA participants may file an appeal and submit requested documentation within 60 days from the date coverage ended. If approved, coverage will be reinstated retroactively with no lapse in coverage.
(2) For Eligible Employees, if the appeal and submitted requested documentation is received by OEBB after 60 days from the date the coverage ended, and dependents are verified, OEBB will unlock the dependent records in the MyOEBB benefit management system. Coverage can be added back following and consistent with a Qualified Status Change (QSC) during the current plan year, or during the next open enrollment period. Adding a dependent to dental or vision coverage at open enrollment will result in the 12 month waiting period being applied where only preventive and routine services will be covered for the first 12 months of coverage.
(3) For Eligible Early Retirees, if the appeal and submitted documentation is received by OEBB after 60 days from the date the coverage ended, and dependents are verified, OEBB will unlock the dependent records in the MyOEBB benefit management system. Coverage can be added back following and consistent with a Qualified Status Change (QSC) during the current plan year, or during the next open enrollment to the plans that they were previously enrolled in.
Statutory/Other Authority: ORS 243.860 to 243.886
Statutes/Other Implemented: ORS 243.864(1)(a)
History:
OEBB 9-2017, adopt filed 11/07/2017, effective 11/07/2017