OAR 836-053-0461: Self-Funded Group Health Plan, Public Employees' Benefit Board and Oregon Educators Benefit Board, Election to Participate

(1) A self-funded group health plan, the Public Employees’ Benefit Board, and the Oregon Educators Benefit Board may elect to participate in the provisions of ORS 743B.292. (2) Notice of election must be provided to the d irector of the Department of Consumer and Business Services on a form prescribed by the department. (a) The self-funded group health plan, the Public Employees’ Benefit Board or the Oregon Educators Benefit Board that has elected to participate must agree and attest to: (A) Be bound by ORS 743B.292 and rules adopted to implement the provisions of the law. (B) Participate for a full year and elect to initiate its participation on January 1 or on the first day of the plan year of any year. (C) Inform any entity that administers or insurers the plan of their election to participate. (b) On its election form, the plan must indicate whether it chooses to affirmatively renew its election on an annual basis or whether it should be presumed to have renewed on an annual basis until the department receives advance notice from the plan that it is terminating its election as of either December 31 of a calendar year or the last day of its plan year. (3) Notices under subsection (2) must be submitted to the department at least 15 days in advance of the effective date of the election to initiate participation and the effective date of the termination of participation. Notices submitted January 1, 2026 through January 31, 2026 may have an effective date of January 1, 2026 or later. (4) The form will be posted on the department’s division of financial regulation public website at dfr.oregon.gov for use by self-funded group health plans, the Public Employees’ Benefit Board and the Oregon Educators Benefit Board. (5) A self-funded group health plan operated by an out-of-state employer that has at least one employee who resides in Oregon may elect to participate in ground ambulance balance billing protections as provided in ORS 743B.292 on behalf of their Oregon resident employees and dependents. If a self-funded group health plan established by an Oregon employer has elected to participate in balance billing protections under ORS 743B.292 and has employees that reside in other states, those employees are protected from ground ambulance balance billing when receiving care from an Oregon ground ambulance service provider. (6) Self-funded group health plan sponsors and their third party administrators may develop their own internal processes related to member notification, member appeals and other functions associated with their fiduciary duty to enrollees under the Employee Retirement Income Security Act of 1974 (ERISA).