Oregon
Rule Rule 111-040-0025
Correcting Enrollment and Processing Errors


(1)

Employee Enrollment Errors. Enrollment errors occur when an Eligible Employee provides incorrect information or fails to make correct selections when making benefit plan elections. The Eligible Employee is responsible for identifying enrollment errors or omissions.

(a)

OEBB authorizes Entities to correct enrollment errors reported by the Eligible Employee within 45 calendar days of the original eligibility date, open enrollment period end date, or Qualified Status Change date.

(b)

Enrollment errors identified after 45 calendar days of the eligibility date, open enrollment period end date or Qualified Status Change date must be submitted to OEBB for review and approval based on OAR 111-080-0030.

(c)

If an Eligible Employee receives an approval notice for additional optional coverage, and discovers it was not updated in OEBBs benefit management system, the member may:

(A)

Pay all premiums owed retroactive to the original effective date, or

(B)

Re-apply for the additional optional coverage during the next Open Enrollment period, or following and consistent with a Qualified Status Change. Evidence of Insurability may be required.

(2)

Benefit Administrator Processing Errors. Processing errors or omissions occur when benefit plan elections are processed incorrectly in the benefit system or when a newly eligible employee does not receive correct enrollment information.

(a)

OEBB authorizes Entities to correct processing errors identified within 45 calendar days of the eligibility date, open enrollment period end date, or Qualified Status Change date. The Entity must reconcile all premium discrepancies.

(b)

Processing errors identified after 45 calendar days of the eligibility date, open enrollment period end date, or Qualified Status Change date must be submitted to OEBB for review and approval based on OAR 111-080-0030. The Entity must reconcile all premium discrepancies within 30 calendar days of any adjustments made in the system.

(3)

The effective date for the correction of either an employee enrollment error or benefit administrator error is retroactive to the original effective date as identified in OAR 111-040-0001.

(4)

The OEBB Administrator has the authority to grant exceptions to OEBBs Administrative Rules when there are extenuating circumstances which can be supported by documentation and verified by OEBB staff.

(5)

Eligible Employees have a right to an Open Enrollment correction period through the last calendar day in October of the same plan year the error was made.
Source
Last accessed
Aug. 23, 2019