Oregon
Rule Rule 111-070-0040
Qualified Status Changes (QSCs)


(1)

HB 2557 eligible members experiencing a change in family status the plan year, have 31 calendar days beginning on the date of the event to make changes. If the event is gaining a child, as defined by 111-070-0040(2)(c), or results in a loss of eligibility, the eligible member has 60 calendar days after the event to make changes.

(a)

The member must report the Qualified Status Change (QSC) to OEBB within the specified timeframe. Failure to report a QSC that would result in a removal of a spouse, domestic partner or child within the timeframe stated in 111-070-0040(1) may be considered intentional misrepresentation by OEBB and OEBB may retroactively terminate the individuals coverage back to the last day of the month in which the individual lost eligibility. If benefits are to be terminated retroactively, OEBB shall give the affected individual 30 days notice of the termination and an opportunity to appeal before the retroactive termination takes effect.

(b)

The members failure to report timely a QSC that allows the addition of a spouse, domestic partner, or child means that the individual does not have coverage. The next opportunity the HB 2557 eligible member has to add their spouse, domestic partner, or child will be during open enrollment.

(2)

The HB 2557 eligible member can only make those changes that are consistent with the event for themselves and eligible dependent(s).

(3)

Qualified Status Changes which allow the member to make changes to his or her coverage are:

(a)

Gaining a spouse by marriage or domestic partner by meeting domestic partner eligibility;

(b)

Loss of a spouse or domestic partner by divorce, annulment, death or termination of domestic partnership,

(c)

Gaining a child by birth, placement for/or adoption, or Domestic Partners children (by affidavit of domestic partnership), 60 days from the event;

(d)

Event by which dependent child satisfies eligibility requirements under OEBB plans;

(e)

Event by which dependent ceases to satisfy eligibility requirements under OEBB plans;

(f)

Related laws or court orders. For example: Qualified Medical Child Support Order (QMSCO), Entitlement to Medicare or Medicaid, HIPAA or Childrens Health Insurance Program (CHIP). Changes are determined by the applicable law or court order.

(4)

Changes in cost or coverage do not constitute a Qualified Status Change. All changes resulting from a change in cost or coverage must be made during Open Enrollment.
Source
Last accessed
Aug. 18, 2019