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The Oregon Administrative Rules contain OARs filed through July 15, 2014
 
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OREGON HEALTH AUTHORITY,
PUBLIC EMPLOYEES' BENEFIT BOARD

 

DIVISION 30

CONTINUATION OF INSURANCE -- ACTIVE EMPLOYEES

101-030-0005

Continuation of Group Medical and Dental Insurance Coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA)

COBRA allows an eligible individual who is losing an employer’s group health plan coverage due to a qualifying event to continue coverage for a limited time. PEBB COBRA is a self-pay premium by the eligible individual.

(1) PEBB participating organizations will issue an initial COBRA notice to all newly eligible employees and individuals that explains the right to continue employer medical and dental insurance plans if lost.

(a) The notice must be mailed to the eligible employee's address of record immediately following enrollment in PEBB medical or dental insurance plans or personally delivered to the employee. The notice must include all PEBB covered individuals residing at the address, including family members, a domestic partner, and a domestic partner's dependent children. Agencies must send a separate notice to the address of record for eligible individuals residing separately from the eligible employee.

(b) An initial COBRA notice must be mailed to individuals who become newly eligible for PEBB coverage due to marriage or the formation of a domestic partnership.

(2) To initiate COBRA eligibility a COBRA triggering event must occur causing the loss of benefit coverage. COBRA triggering events include:

(a) An involuntary reduction in hours or layoff.

(b) A strike or lockout.

(c) The beginning of an unpaid leave of absence.

(d) The termination of employment.

(e) Retirement.

(f) A dependent child no longer satisfying eligibility requirements.

(g) The loss of employer-sponsored group coverage for dependents due to Medicare eligibility.

(h) A divorce or termination of a domestic partnership.

(i) The death of the employee.

(3) All individuals losing eligibility due to a triggering event must receive a COBRA continuation notice. PEBB participating organizations must notify PEBB’s Third Party Administrator (TPA) within 30 days of the date of benefit eligibility. The date eligibility is lost is the COBRA triggering event date.

(a) The PEBB TPA mails a COBRA notice of continuation, which includes a Certificate of Group Health Plan Coverage, to each eligible individual at their last address of record when eligibility for PEBB-sponsored insurance coverage is lost. The TPA must mail the notice to each eligible individual within 14 days of receiving the notification.

(b) An eligible employee has 60 days from the receipt of the COBRA notice to activate their COBRA rights of continuation. PEBB-sponsored insurance coverage must be continuous through COBRA implementation.

(4) Generally, health plans may be continued under COBRA provisions for the following basic maximum coverage periods:

(a) For termination or reduction in hours, section (2)(a)–(e) of this rule, 18 months after the date of the triggering event; or

(b) For Section (2)(f)–(i) of this rule, 36 months after the date of the triggering event.

(5) An eligible employee's spouse or domestic partner who is 55 years of age or older and who loses benefit coverage due to divorce, termination of a domestic partnership, or death of the employee, section (2)(h) and (i) of this rule, may continue PEBB health insurance coverage for themselves and their dependent children beyond the general 36 month COBRA continuation period. An eligible spouse or domestic partner may continue their PEBB health insurance coverage until they are entitled to Medicare, are covered under another group medical insurance plan, or otherwise lose eligibility.

(6) An eligible individual continuing PEBB medical or dental insurance coverage or both under COBRA provisions has the same rights as active eligible employees for making changes during the open enrollment period and is eligible for qualified midyear changes.

(7) An eligible employee ending employment may continue to participate in the Healthcare Flexible Spending Account through COBRA up to the end of the current plan year if when the triggering event occurs:

(a) They have a positive balance in their account; and

(b) They self-pay contributions to the account. Contributions after employment ends are paid on an after-tax basis.

Stat. Auth.: ORS 243.061 - 302
Stats. Implemented: ORS 243.061-302, 659A.060-069 & 743.600-602
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2002, f. 7-30-02, cert. ef. 8-1-02; PEBB 1-2003, f. & cert. ef 12-4-03; PEBB 1-2004, f. & cert. ef. 7-2-04; PEBB 3-2004, f. & cert. ef. 10-7-04; PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07; PEBB 1-2013, f. & cert. ef. 9-24-13

101-030-0007

Portability of Medical Insurance Coverage

Some PEBB sponsored group medical insurance plans allow portability. An eligible individual enrolled in one of these medical plans may continue insurance coverage under the plan's portability provisions before, during, or at the end of the period that medical insurance coverage is provided under COBRA, if:

(1) They were continuously covered for 180 days or more under one or more PEBB sponsored group medical insurance plans and they lost eligibility for group medical insurance coverage;

(2) They are not covered by another group medical insurance plan, Medicare, or TriCare;

(3) They enroll in a continued medical insurance plan under the portability provisions within 63 days after termination of the group medical insurance coverage; and

(4) They comply with all requirements of the applicable insurance carrier for continuation of medical insurance coverage under the carrier's portability plan provisions.

Stat. Auth.: ORS 243.061-302

Stats. Implemented: ORS 243.061-302
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2001, f. & cert. ef. 9-6-01; PEBB 1-2004, f. & cert. ef. 7-2-04; Renumbered from 101-030-0035, PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07

101-030-0010

Continuation of Group Health Benefit Coverage for Injured Workers (CBIW)

(1) The state is required by ORS 659A.060-069 to continue to pay the benefit amount for PEBB health benefit coverage in effect at the time an eligible employee has a work-related injury or illness. The benefit amount may continue for up to 12 consecutive months or until one of the events listed in ORS 659A.063 occurs, whichever occurs first. Health benefit coverage for this purpose includes the medical, dental, vision, and prescription drug coverage of the employee, family members, and domestic partner.

(2) An eligible employee may continue coverage for life, short term and long -term disability, and accidental death and dismemberment insurance plans for up to 12 months if they self-pay the premiums to the agency.

(3) When an employee returns to work within 12 months, they will have their previous enrollment for medical, dental, life, and disability insurance reinstated the first of the month following their return to work. The employee may make midyear plan changes within 30 days of the date they return to work.

(4) An employee returning to work will not be reinstated in any pretax Flexible Spending Accounts. They may reenroll within 30 days of the date they return to work.

(5) An employee returning to work immediately following CBIW is not required to work at least half-time in the month they return to be eligible for benefits the following month.

(6) A COBRA qualifying event occurs at the end of the CBIW continuation period if the employee has not returned to work.

Stat. Auth.: ORS 243.061-302 & 659A.060-069
Stats. Implemented: ORS 243.061-302 & 659A.060-069
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2004, f. & cert. ef. 7-2-04, PEBB 3-2004, f. & cert. ef. 10-7-04; PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07; PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11

101-030-0015

Continuation of Core Benefit Coverage for Employees Covered under the Federal Family Medical Leave Act (FMLA)

(1) The state will continue to pay the benefit amount for core benefits in effect at the time the eligible employee begins an approved FMLA leave.

(2) An eligible employee may continue the following optional plans during the approved FMLA leave by self-paying premiums or contributions to the agency:

(a) Optional Life Insurances,

(b) Short Term and Long Term Disability,

(c) Accidental Death and Dismemberment Insurance, and,

(d) Healthcare Flexible Spending Account (FSA) — The total contribution amount for the complete expected leave duration must be prepaid prior to the start of the leave.

(3) An eligible employee on FMLA leave during open enrollment may make open enrollment benefit elections.

(4) An eligible employee returning to work or paid regular status the first day following the end of approved FMLA leave will have previous enrollments reinstated retroactive to the first day of the month the employee returns. The returning employee is not required to work at least half-time in the month they return to be eligible for benefits the following month.

(a) The employee must self-pay premiums for optional insurance plan reinstatements for the month in which they return.

(b) An employee returning to work will not be reinstated in Long Term Care and FSA unless they continued contributions to a Healthcare FSA while on approved FMLA leave. In this case, the employee will be reinstated in the Healthcare FSA.

(c) The employee may make midyear plan changes within 30 days of the date they return to work.

(5) An employee who does not return to work or to paid regular status the first work day immediately following the end of approved FMLA leave is considered the same as if returning from leave without pay. See OAR 101-020-0045(2).

(6) A COBRA qualifying event occurs when the employee does not return to work and is not in paid regular status the first day after the qualified FMLA leave ends or the employee terminates employment.

Stat. Auth.: ORS 243.061 - 302
Stats. Implemented: ORS 243.061 - 302
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2004, f. & cert. ef. 7-2-04; PEBB 3-2004, f. & cert. ef. 10-7-04; PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07; PEBB 2-2008, f. & cert. ef. 8-1-08; PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11

101-030-0020

Continuation of Group Medical and Dental Insurance Coverage for Employees Covered under the Oregon Family Leave Act (OFLA) -- ORS 659A.150-186

An eligible employee who does not qualify for FMLA and who qualifies for and takes an OFLA leave, has a COBRA triggering event the date their active PEBB insurance coverage ends. See OAR 101-030-0005.

Stat. Auth.: ORS 243.061-302 & 659A.150-186
Stats. Implemented: ORS 243.061-302 & 659A.150-186 |
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2004, f. & cert. ef. 7-2-04; PEBB 3-2004, f. & cert. ef. 10-7-04; PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07

101-030-0022

Continuation of Benefit Coverage for Employees on Active Military Leave

(1) The state will continue to pay the benefit amount for core benefit coverage in effect at the time an eligible employee begins active military duty. This benefit coverage will continue for the duration of the active military leave, up to 24 consecutive months. The agency may end this coverage before or during the 24 months of active duty only if the member submits a signed written request to end the coverage.

(2) An eligible employee may continue the following optional plans during active military duty up to 12 months by self-paying premiums or contributions to the agency:

(a) Optional Life Insurances,

(b) Accidental Death and Dismemberment Insurance, and,

(c) Health Flexible Spending Account (FSA).

(3) An eligible employee on active military leave during open enrollment may make open enrollment benefit elections. The employee may allow another individual to make plan elections in the employee’s absence by providing documentation of a power of attorney to the agency. Enrollment in a Health FSA must occur during open enrollment in order to participate in the new plan year.

(4) An eligible employee who returns to work within 24 months will have available previous optional plan enrollments reinstated retroactive to the first day of the month the employee returns. A returning employee is not required to work at least half-time in the month they return to be eligible for benefits the following month.

(a) The employee must self-pay premiums for optional insurance plan reinstatements for the month in which they return.

(b) An employee returning to work will not be reinstated in Long Term Care or any FSA, unless contributions to their Health FSA while on military leave continued.

(c) The employee may make midyear plan changes within 30 days of the date they return to work.

(5) A COBRA qualifying event occurs when an eligible employee:

(a) Is no longer in active duty status or paid regular status, and does not return to work following the allowed decompression time;

(b) Remains in active duty status after 24 months of active duty, or;

(c) Terminates employment.

Stat. Auth.: ORS 243.061 - 302
Stats. Implemented: ORS 243.061-302 & 408.240
Hist.: PEBB 1-2003, f. & cert. ef 12-4-03; PEBB 1-2004, f. & cert. ef. 7-2-04; PEBB 3-2004, f. & cert. ef. 10-7-04; PEBB 3-2005, f. 8-31-05, cert. ef. 9-1-05; PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07; PEBB 2-2008, f. & cert. ef. 8-1-08; PEBB 3-2009, f. 9-29-09 cert. ef. 10-1-09; PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11

101-030-0026

Employer Designated Furlough Leaves

The State of Oregon as the employer may designate furlough leave without pay. Furlough leave does not affect an employee’s eligibility or current enrollment in medical, dental, and employee basic life insurance.

Stat. Auth.: ORS 243.061 - 302
Stats. Implemented: ORS 243.061-302 & 292.05
Hist.: PEBB 1-2009(Temp), f. & cert. ef. 2-24-09 thru 8-22-09; PEBB 2-2009, f. 7-29-09, cert. ef. 8-1-09

101-030-0027

Non-medical Leave Without Pay (LWOP) -- Continuation of Optional Insurance Plans

An eligible employee who is in a non-medical LWOP status may continue coverage for optional life and accidental death and dismemberment insurance plans for up to 12 months if they self-pay the premium to the agency. The employee is not eligible to continue short term or long term disability insurance plans while on LWOP.

Stat. Auth.: ORS 243.061-302
Stats. Implemented: ORS 243.061-302
Hist.: PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07

101-030-0070

Life, Disability, and Accidental Death and Dismemberment Insurance — Continuation of Coverage

(1) When an eligible employee separates from state service optional life insurance coverage may continue through the plan, not PEBB, as follows:

(a) Portability. An eligible employee terminating employment, other than for disability or retirement, may continue the employee’s optional employee, spouse, and domestic partner life insurance coverage at the group rate, plus billing fees. The policy remains a term life insurance policy. The employee must apply directly to the plan within 30 days of the date coverage ends. Portability is not available for employee basic life or dependent life coverage. A survivor of a covered eligible employee may continue optional life insurance through the plan upon the death of the employee.

(b) Conversion Rights. An eligible employee terminating employment for any reason, including disability or retirement, or experiencing a reduction in hours to less than 80 paid regular hours in the month, may be eligible to convert the employee’s term life insurance coverage. Not all policy types are available for conversion. The employee must apply directly to the plan within 30 days of the date insurance coverage ends. A survivor of a covered eligible employee may convert life insurance coverage through the plan upon the death of the employee.

(c) Retiree Life Insurance Option. An eligible employee who retires may purchase the Retiree Life Insurance Option without submitting evidence of insurability. The employee must apply directly to the insurance plan within 30 days of the date insurance coverage ends.

(d) Transfer of Premium Payment for Optional Employee Life Insurance. When two active eligible employees are married or in a domestic partnership and both are state employees, one employee can transfer their optional life insurance coverage to the other employee's life insurance coverage or to themselves upon:

(A) Terminating employment for any reason;

(B) Beginning an active military leave;

(C) Divorce;

(D) Termination of their domestic partnership, or;

(E) Retirement. The remaining employed eligible employee must submit the completed and signed transfer form to their agency within 30 days of the date of the events listed in (1)(d) of this rule.

(2) There are no portability, conversion, or rollover continuation options for short term or long term disability or accidental death and dismemberment insurance coverage.

Stat. Auth.: ORS 243.061 – 302
Stats. Implemented: ORS 243.061 – 302
Hist.: PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07; Renumbered from 101-020-0070, PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11; PEBB 1-2013, f. & cert. ef. 9-24-13

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