OAR 101-020-0052: Surcharges

(1) For the purposes of this rule, the following definitions apply: (a) Double Coverage means a subscriber/employee that is also an eligible dependent and is enrolled in two PEBB/PEBB or PEBB/OEBB medical plans. (b) OEBB means the Oregon Educators Benefit Board in Oregon. (c) Subscriber/employee means the individual who subscribes to their employer’s health plan. For the purposes of this rule, a subscriber excludes a COBRA participant, part-time employee, retiree or self-pay member. (d) Dependent means and includes a dependent child as defined by OAR 101-015-0011, Spouse as defined by OAR 101-015-0005, and Domestic Partner as defined by OAR 101-015-0011. (e) Surcharge means an extra fee deducted from the employee’s monthly pay. (2) Tobacco Use Surcharge: (a) Employees and spouses/Domestic Partners who are enrolled in a PEBB medical plan and use tobacco products may pay a monthly surcharge. The surcharge is deducted from the employee’s monthly paycheck. The monthly surcharges are determined by the PEBB Board. (b) Employees who opt-out of a PEBB medical plan are not subject to this surcharge. (c) Tobacco usage status can be updated prospectively at any time during the plan year by completing and submitting a Midyear change form. (3) Spouse/Domestic Partner Other Group Coverage Surcharge: (a) Employees will pay a monthly surcharge if the spouse/Domestic Partner is covered on the employee’s PEBB plan and chooses to not enroll in their own employer’s medical coverage (non-PEBB coverage). The monthly surcharges are determined by the PEBB Board. (b) Employees who have a spouse/Domestic partner who opts out of PEBB coverage are not subject to this surcharge. (c) Employees may submit a Midyear change form if this changes anytime during the plan year. The change request form must be submitted to their employer’s payroll or university benefits office within 30 days of the change. Changes take effect prospectively upon receipt of the appropriate form. (4) Double Coverage: (a) Effective January 1, 2021, any active full-time employees who cover an eligible dependent that is also enrolled as a subscriber for either a PEBB or an OEBB-sponsored medical plan will be assessed a monthly surcharge. (b) The amount of the surcharge is determined annually by the PEBB Board. (c) The monthly surcharge will only be charged to the subscriber. (d) The subscriber will only pay one double coverage surcharge no matter how many dependents are double covered. (e) The Double Coverage surcharge does not apply to Opt Out, Retirees, COBRA participants, self-pay participants or part-time employees.