OAR 101-020-0037: Correcting Enrollment Errors and Open Enrollment Errors

(1) Employee enrollment errors occur when an eligible employee provides incorrect information or fails to make correct selections when making benefit plan elections. An employee’s failure to initiate timely enrollment rights either electronically or via paper form is not considered an employee error. For the purpose of this rule, an enrollment action means that the employee during the allowable enrollment times must take an action to enroll, add to, save an active enrollment, or change benefit plan enrollment elections, or enroll, add to, save an active enrollment, or change coverage of individuals. The eligible employee is responsible for identifying enrollment errors and maintaining a valid and accurate enrollment. (a) PEBB authorizes the agency to correct employee enrollment errors when reported by the employee within 30 days of the original eligibility date or midyear plan change date. Corrections are prospective to the first of the month following the date the agency received the correction request. (A) PEBB must review all employee requests to correct enrollment errors received after 30 days of the original eligibility date or the midyear plan change date. If the correction is approved, the effective date is the first of the month following the receipt of the employee’s correction request. (B) Enrollment error correction requests considered beyond 30 days of the eligibility date or the midyear plan change date must demonstrate facts and circumstances that clearly establish an employee error occurred. “Example: As a new employee, Anne enrolled in the Dependent Care Flexible Spending Account. Anne does not have any eligible dependents. Six months later Anne realizes the error after her first Health Care FSA claim is rejected. Anne may request an enrollment correction from PEBB.” (b) PEBB authorizes the agency to correct an employee’s open enrollment error. The agency may receive employee correction request after the open enrollment end date but no later than the last day of February of the new plan year. (c) Corrections are prospective. “Example: Ann enrolled in the wrong dental plan during open enrollment. Ann identified the error and submitted her open enrollment correction form in December. The effective date of the correction is January 1st.” “Example: Ann enrolled in the wrong dental plan. Ann identified the error and submitted her open enrollment correction form in January. The effective date of the correction is February 1st.” (d) PEBB must review all employee open enrollment correction requests received beyond the timelines for open enrollment corrections. (2) PEBB Administrator has the authority to grant exceptions to PEBB Administrative Rules when there are extenuating circumstances which can be supported by documentation and verified by PEBB staff.