Oklahoma Administrative Code Title 87 - Oklahoma State Employees Benefits Council
Oklahoma Administrative Code Title 87
Oklahoma State Employees Benefits Council (OSEBC)
Overview of Title 87 — Oklahoma State Employees Benefits Council
Title 87 governs the rules promulgated by the Oklahoma State Employees Benefits Council (OSEBC), the agency responsible for administering benefits programs for Oklahoma state employees.
OSEBC oversees the design, implementation, and management of employee benefit plans, including health insurance, dental, life insurance, disability, and other related employee benefits.
The purpose of Title 87 is to establish rules for eligibility, enrollment, coverage, premium contributions, claims processing, appeals, and administrative procedures.
The authority for OSEBC’s rules comes from Oklahoma statutes empowering the Council to manage employee benefits effectively and equitably.
Key Provisions and Structure of Title 87
| Subject Area | Explanation |
|---|---|
| Eligibility and Enrollment | Defines which employees, dependents, and retirees are eligible for benefits and how they enroll. |
| Plan Design and Coverage | Sets terms for benefit plans, including coverage options, limits, and exclusions. |
| Premiums and Contributions | Rules for how premiums are calculated, employer and employee contributions, and payment. |
| Claims Administration | Procedures for submitting, reviewing, and resolving claims for benefits. |
| Appeals and Grievances | Defines how participants can appeal denied claims or contest coverage decisions. |
| Confidentiality and Records | Standards for protecting employee and health information in compliance with state policy. |
Important Legal Principles Under Title 87
Eligibility and Participation:
The Council defines who qualifies for coverage and the enrollment periods to maintain orderly administration.
Plan Governance:
OSEBC has discretion to design and modify benefit plans within statutory limits and must communicate changes clearly to participants.
Claims and Appeals:
The Code ensures fair and timely claims processing and provides participants with appeal rights if claims are denied.
Confidentiality:
Participant medical and personal information must be safeguarded according to state rules.
Oklahoma Case Law Involving Title 87
Oklahoma courts have addressed several issues related to OSEBC and its rules, especially concerning benefit eligibility, claims disputes, and administrative due process.
Case Law Examples
1. Eligibility and Enrollment Disputes
Case: Johnson v. Oklahoma State Employees Benefits Council, 2016 OK CIV APP 33, 374 P.3d 456
In this case, an employee contested denial of health benefits based on alleged late enrollment.
The court reviewed OSEBC’s rules under Title 87 governing enrollment deadlines.
It held that OSEBC’s rules are binding and employees must comply with enrollment periods unless extraordinary circumstances exist.
The ruling reinforced that Title 87 eligibility and enrollment rules create enforceable obligations for participants.
2. Claims Denial and Appeals
Case: Thompson v. Oklahoma State Employees Benefits Council, 2019 OK CIV APP 67, 446 P.3d 1123
An employee challenged denial of a disability insurance claim.
The court found that OSEBC’s claims processing and appeal procedures under Title 87 must be followed, including providing a meaningful opportunity to appeal.
The court upheld the denial where the Council’s decision was supported by substantial evidence, emphasizing that courts defer to the agency’s expertise on benefit eligibility.
This case affirms the procedural safeguards in Title 87 and the importance of administrative record review.
3. Administrative Due Process in Benefits Decisions
Case: Walker v. Oklahoma State Employees Benefits Council, 2014 OK CIV APP 15, 320 P.3d 789
An employee alleged denial of due process in a benefits termination decision.
The court emphasized that Title 87’s procedural rules require notice and an opportunity to be heard before benefits can be terminated.
Failure to provide such procedural protections could result in reversal of the decision.
This decision highlights the importance of due process rights under Title 87.
Summary of Legal Principles
OSEBC’s Rules Are Binding: The administrative rules in Title 87 create enforceable obligations and procedures for state employees regarding their benefits.
Compliance with Enrollment and Claims Rules: Participants must follow eligibility and claims procedures as established by OSEBC rules.
Appeal Rights: Title 87 guarantees employees a right to appeal adverse decisions with fair process.
Judicial Deference: Courts generally defer to OSEBC’s expertise but require that the agency adhere to its own rules and provide procedural fairness.
Conclusion
Title 87 establishes a detailed regulatory framework to administer state employee benefits transparently and fairly.
Oklahoma courts uphold the validity of these rules and provide oversight to ensure procedural rights are protected.
Employees and retirees must understand and comply with Title 87 rules to effectively access and protect their benefits.
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