ORS 243.866
Benefit plans
- criteria
- coverage options
- payroll deductions
- rules
(1)
The Oregon Educators Benefit Board shall contract for benefit plans best designed to meet the needs and provide for the welfare of eligible employees, the districts and local governments. In considering whether to enter into a contract for a benefit plan, the board shall place emphasis on:(a)
Employee choice among high-quality plans;(b)
Encouragement of a competitive marketplace;(c)
Plan performance and information;(d)
District and local government flexibility in plan design and contracting;(e)
Quality customer service;(f)
Creativity and innovation;(g)
Plan benefits as part of total employee compensation;(h)
Improvement of employee health; and(i)
Health outcome and quality measures, described in ORS 413.017 (Public Health Benefit Purchasers Committee, Health Care Workforce Committee, Health Plan Quality Metrics Committee and Behavioral Health Committee) (4), that are reported by the plan.(2)
The board may approve more than one carrier for each type of benefit plan offered, but the board shall limit the number of carriers to a number consistent with adequate service to eligible employees and family members. The board shall impose a surcharge in an amount determined by the board on an eligible employee who arranges coverage for the employee’s spouse or dependent under this subsection if the spouse or dependent has access to medical coverage as an employee in another health benefit plan offered by the board or the Public Employees’ Benefit Board.(3)
When appropriate, the board shall provide options under which an eligible employee may arrange coverage for family members under a benefit plan.(4)
A district or a local government shall provide that payroll deductions for benefit plan costs that are not payable by the district or local government may be made upon receipt of a signed authorization from the employee indicating an election to participate in the benefit plan or plans selected and allowing the deduction of those costs from the employee’s pay.(5)
In developing any benefit plan, the board may provide an option of additional coverage for eligible employees and family members at an additional premium.(6)
The board shall adopt rules providing that transfer of enrollment from one benefit plan to another is open to all eligible employees and family members. Because of the special problems that may arise involving acceptable provider-patient relations between a particular panel of providers and a particular eligible employee or family member under a comprehensive group practice benefit plan, the board shall provide a procedure under which any eligible employee may apply at any time to substitute another benefit plan for participation in a comprehensive group practice benefit plan.(7)
An eligible employee who is retired is not required to participate in a health benefit plan offered under this section in order to obtain dental benefit plan coverage. The board shall establish by rule standards of eligibility for retired employees to participate in a dental benefit plan.(8)
The board shall evaluate a benefit plan that serves a limited geographic region of this state according to the criteria described in subsection (1) of this section.(9)
Intentionally left blank —Ed.(a)
The board shall use payment methodologies in self-insured health benefit plans offered by the board that are designed to limit the growth in per-member expenditures for health services to no more than 3.4 percent per year.(b)
The board shall adopt policies and practices designed to limit the annual increase in premium amounts paid for contracted health benefit plans to 3.4 percent.(10)
As frequently as is recommended as a commercial best practice by consultants engaged by the board, the board shall conduct an audit of the health benefit plan enrollees’ continued eligibility for coverage as spouses or dependents or any other basis that would affect the cost of the premium for the plan.(11)
By January 1, 2023, the board shall spend at least 12 percent of its total medical expenditures in self-insured health benefit plans on payments for primary care.(12)
No later than February 1 of each year, the board shall report to the Legislative Assembly on the board’s progress toward achieving the target of spending at least 12 percent of total medical expenditures on payments for primary care. [2007 c.7 §4; 2010 c.49 §2; 2013 c.731 §18; 2015 c.389 §5; 2017 c.489 §11; 2017 c.746 §28; 2019 c.484 §3](a)
Employee choice among high-quality plans;(b)
Encouragement of a competitive marketplace;(c)
Plan performance and information;(d)
District and local government flexibility in plan design and contracting;(e)
Quality customer service;(f)
Creativity and innovation;(g)
Plan benefits as part of total employee compensation;(h)
Improvement of employee health; and(i)
Health outcome and quality measures, described in ORS 413.017 (Public Health Benefit Purchasers Committee, Health Care Workforce Committee, Health Plan Quality Metrics Committee and Behavioral Health Committee) (4), that are reported by the plan.(2)
The board may approve more than one carrier for each type of benefit plan offered, but the board shall limit the number of carriers to a number consistent with adequate service to eligible employees and family members. The board shall impose a surcharge in an amount determined by the board on an eligible employee who arranges coverage for the employee’s spouse or dependent under this subsection if the spouse or dependent has access to medical coverage as an employee in another health benefit plan offered by the board or the Public Employees’ Benefit Board.(3)
When appropriate, the board shall provide options under which an eligible employee may arrange coverage for family members under a benefit plan.(4)
A district or a local government shall provide that payroll deductions for benefit plan costs that are not payable by the district or local government may be made upon receipt of a signed authorization from the employee indicating an election to participate in the benefit plan or plans selected and allowing the deduction of those costs from the employee’s pay.(5)
In developing any benefit plan, the board may provide an option of additional coverage for eligible employees and family members at an additional premium.(6)
The board shall adopt rules providing that transfer of enrollment from one benefit plan to another is open to all eligible employees and family members. Because of the special problems that may arise involving acceptable provider-patient relations between a particular panel of providers and a particular eligible employee or family member under a comprehensive group practice benefit plan, the board shall provide a procedure under which any eligible employee may apply at any time to substitute another benefit plan for participation in a comprehensive group practice benefit plan.(7)
An eligible employee who is retired is not required to participate in a health benefit plan offered under this section in order to obtain dental benefit plan coverage. The board shall establish by rule standards of eligibility for retired employees to participate in a dental benefit plan.(8)
The board shall evaluate a benefit plan that serves a limited geographic region of this state according to the criteria described in subsection (1) of this section.(9)
Intentionally left blank —Ed.(a)
The board shall use payment methodologies in self-insured health benefit plans offered by the board that are designed to limit the growth in per-member expenditures for health services to no more than 3.4 percent per year.(b)
The board shall adopt policies and practices designed to limit the annual increase in premium amounts paid for contracted health benefit plans to 3.4 percent.(10)
As frequently as is recommended as a commercial best practice by consultants engaged by the board, the board shall conduct an audit of the health benefit plan enrollees’ continued eligibility for coverage as spouses or dependents or any other basis that would affect the cost of the premium for the plan.(11)
If the board spends less than 12 percent of its total medical expenditures in self-insured health benefit plans on payments for primary care, the board shall implement a plan for increasing the percentage of total medical expenditures spent on payments for primary care by at least one percent each year.(12)
No later than February 1 of each year, the board shall report to the Legislative Assembly on any plan implemented under subsection (11) of this section and on the board’s progress toward achieving the target of spending at least 12 percent of total medical expenditures on payments for primary care.
Source:
Section 243.866 — Benefit plans; criteria; coverage options; payroll deductions; rules, https://www.oregonlegislature.gov/bills_laws/ors/ors243.html.
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