DIVISION 80

OPERATIONS

111-080-0001

Payment Methods and Dates

(1) For the purpose of this rule:

(a) "ACH credit" means a payment initiated by a Participating District that is cleared through the Automated Clearing House (ACH) network for deposit to the OEBB account;

(b) "ACH debit" means a payment initiated by OEBB and cleared through the ACH network to debit a Participating District's account and credit the OEBB account;

(c) “District Payment” means the monthly district payment to OEBB that includes the contributions of both Participating District and members required to pay the monthly premiums for selected OEBB benefit plans;

(d) “District Payment Invoice" means a monthly itemized statement provided by OEBB that includes the contributions of both Participating District and members required to pay the monthly premiums for selected OEBB benefit plans;

(e) “Due date” means the seventh business day into the current month of coverage;

(f) "Electronic funds transfer" refers to a payment through ACH credit or ACH debit;

(g) "Participating District" means a Subject District, Provisional Non-subject District and Non-subject District participating in OEBB.

(2) Participating Districts will receive a final District Payment Invoice from OEBB on the first of the month that details the payments due for that month.

(3) If the final District Payment Invoice is received on a weekend or legal holiday the receipt date is recognized as the next business day.

(4) Participating Districts are required to submit payment to OEBB through electronic funds transfer no later than the due date.

(5) OEBB reserves the right to issue surcharges or other appropriate measures to Participating Districts that submit monthly payments after the due date.

(6) Participating Districts will select an electronic funds transfer method by:

(a) Submitting an electronic funds transfer authorization form to OEBB by August 15th for payments starting October 1st of the plan year;

(b) Submitting a new electronic funds transfer authorization form to OEBB by August 15th to change the type of payment or update their account information starting October 1st of the plan year.

Stat. Auth.: ORS 243.860 - 243.886
Stats. Implemented: ORS 243.864(a)
Hist.: OEBB 11-2008(Temp), f. & cert. ef. 8-13-08 thru 2-6-09; OEBB 4-2009, f. & cert. ef. 1-30-09

111-080-0005

Overpayments and Underpayments

(1) For the purpose of this rule:

(a) “Overpayment” means the amount of a Participating District’s monthly payment to OEBB that exceeded the amount due.

(b) “Underpayment” means a payment submitted by a Participating District that is less than the invoiced amount.

(2) Participating Districts seeking a refund of overpayments must:

(a) Notify OEBB up to 90 calendar days from the date overpayment occurred;

(b) OEBB will resolve member overpayments by requesting a refund from the carrier; except for overpayments submitted after 90 calendar days and overpayments resulting from member misrepresentation;

(c) OEBB will generally reimburse Participating District overpayments through adjustments to future monthly payments.

(3) The Participating District shall submit any underpayment to OEBB as soon as it is discovered.

(4) OEBB reserves the right to issue surcharges or use other appropriate means for Participating District’s that submit underpayments.

Stat. Auth.: ORS 243.860 - 243.886
Stats. Implemented: ORS 243.864(a)
Hist.: OEBB 11-2008(Temp), f. & cert. ef. 8-13-08 thru 2-6-09; OEBB 4-2009, f. & cert. ef. 1-30-09

111-080-0030

Appeals and Administrative Reviews

(1) OEBB eligible employees may request a review to determine if an educational entity’s eligibility decision is based on OAR 111-010-0015, or an educational entity’s enrollment decision is based on OAR 111-040-0001 through 0050.

(2) OEBB members have the right to request a review of benefit and claim issues that are not resolved following the completion of the carrier appeal process.

(3) OEBB members have the right to request a hearing by the Office of Administrative Hearings (OAH) following completion of the OEBB appeal and administrative review process. The request for a hearing must be received by OEBB in writing by close of business within 30 calendar days from the receipt date of the certified letter notifying the member of OEBB’s decision.

Stat. Auth.: ORS 243.860 - 243.886
Stats. Implemented: ORS 243.864(a)
Hist.: OEBB 17-2008(Temp), f. & cert. ef. 10-16-08 thru 4-13-09; OEBB 7-2009, f. 3-24-09, cert. ef. 4-1-09; OEBB 18-2009(Temp), f. & cert. ef. 10-26-09 thru 4-23-10