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

 

DIVISION 50

RETIREE RULES

101-050-0005

PEBB Retiree Health Plan Eligibility

(1) An active employee enrolled in PEBB plans immediately prior to retirement and who meets PEBB retiree plan eligibility may continue participation in PEBB health plans upon retiring.

(2) To be eligible a retiring employee must not be eligible for Medicare and be:

(a) Receiving a service or disability retirement allowance under the Public Employees Retirement System (PERS) or under any other retirement or disability benefit plan or system offered by the State of Oregon for its officers and employees;

(b) Eligible to receive a service retirement allowance under PERS and have reached earliest retirement age under ORS Chapter 238; or;

(c) Eligible to receive a service retirement allowance or pension under another retirement benefit plan or system offered by the State of Oregon and has reached earliest retirement age under the plan or system.

(3) Retiree plan eligibility for other individuals: A spouse, domestic partner, dependent child, and domestic partner's dependent child who each meet PEBB eligibility, are not Medicare eligible, and received coverage through the employee's active PEBB plans immediately prior to retirement are eligible for retiree plan coverage. When the retiring employee is Medicare eligible and not eligible for PEBB retiree plans, individuals receiving active coverage through the employee immediately prior to the retirement are eligible for retiree plan enrollment.

(4) If an individual covered by a PEBB retiree plan becomes Medicare eligible or loses PEBB eligibility while receiving retiree plan coverage, the individual must terminate from the plan. The exception is for Medicare eligibility because of end-stage renal disease. Individuals on the retiree plan who are not Medicare eligible and continue to meet PEBB eligibility may remain on the plan. .

(5) A former eligible employee who first elects COBRA and later becomes eligible as a retired employee may enroll in PEBB retiree health plans at any time during or immediately following COBRA.

Stat. Auth.: ORS 243.061 - 243.302
Stats. Implemented: ORS 243.061 - 243.302 & 659A.060 - 659A.069
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2001, f. & cert. ef. 9-6-01; PEBB 1-2002, f. 7-30-02, cert. ef. 8-1-02; 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 3-2010, f. 9-23-10, cert. ef. 10-1-10

101-050-0010

Retiree Plan Enrollment and Termination

(1) An active employee meeting PEBB retiree eligibility may enroll themselves and other eligible individuals in PEBB retiree health plans.

(2) Retiree plan coverage must be continuous with active or COBRA PEBB plan enrollments. Employees that retire and receive PEBB plan coverage through another active employee may move to PEBB retiree coverage when the other employee coverage ends.

(3) An active employee meeting PEBB retiree eligibility must submit retiree enrollment forms within 60 days of the date the active employee insurance terminates. Enrollments submitted within this 60-day window are retroactive to the date of active coverage termination.

(4) A Retiree may elect any PEBB full time or part-time health plan. A Retiree may elect medical only, dental only, or medical and dental insurance coverage. If the retiree does not initially enroll in both medical and dental insurance plans, they may not add the other plan later.

(5) PEBB may offer a plan change period for retiree insurance plan participants. The plan change period allows the retiree to change benefit plans. The plan change period does not allow the retiree to add dependents or coverage not already in place.

(6) A retired eligible employee electing to continue PEBB health plans under COBRA can transfer to a PEBB retiree health plan at any time during or immediately following COBRA.

(7) A retired eligible employee and their eligible individuals must terminate from PEBB retiree plans when they:

(a) Fail to self-pay the premiums; or

(b) Fail to continue to meet PEBB eligibility; or

(c) Become Medicare eligible; or

(d) PEBB no longer offers retiree health plan coverage.

(8) Retiree plan coverage termination dates due to loss of eligibility:

(a) Coverage terminates the last day of the month before the month of Medicare eligibility.

Example: Joe becomes Medicare-eligible may 1st because his 65th birthday will be May 15th. Joe’s retiree health coverage will terminate April 30th.

(b) Failure to meet PEBB eligibility requirements; e.g., a dependent ages out of coverage, coverage terminates the last day of the month that the eligibility is lost.

(8) Division 20 Enrollment Rules apply to retirees in the following situations:

(a) Midyear benefit plan changes such as those resulting in the addition of a family member, domestic partner, or domestic partner's dependent child to the retiree's insurance coverage. See OAR 101-020-0050.

(b) Adding a newborn or adopted child to the retiree's insurance coverage. See OAR 101-020-0020.

(c) Removing an ineligible individual from the retiree's insurance coverage. See OAR 101-020-0025.

(d) Enrollment or processing errors. See OAR 101-020-0037.

Stat. Auth.: ORS 243.061 - 243.302
Stats. Implemented: ORS 243.061 - 243.302
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2000, f. 11-15-00, cert. ef. 1-1-01; PEBB 1-2001, f. & cert. ef. 9-6-01; 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 3-2010, f. 9-23-10, cert. ef. 10-1-10

101-050-0015

Retiree Returning to Work for a PEBB Participating Organization in a Benefit Eligible Status

(1) A retiree returning to work within a PEBB participating organization in a benefit eligible position is eligible for active employee PEBB benefit plans. Insurance coverage must be continuous between active employee benefit plans and retiree plans.

(a) A retiree returning to paid regular status within 12 months will have their previous enrollment for medical, dental, life and disability insurance reinstated the first of the month following their return to work.

(b) A retiree returning to paid regular status 12 months after an active insurance coverage end date must enroll as a newly eligible employee. There is no second guarantee issue of long-term care insurance.

(c) A retiree either enrolling as a new hire or being reinstated to active employee optional life insurance must cancel retiree life that was ported from PEBB when the employee retired.

(2) A retiree enrolled in a PEBB retiree insurance plan may suspend the retiree insurance coverage when enrolled as an active employee in PEBB benefit plans. The employee must notify and request the retiree plan administrator to suspend the retiree coverage.

(3) A retiree receiving a state premium subsidy; e.g, early retirement premium subsidy that returns to active employee status as benefit eligible but chooses to continue coverage under a PEBB retiree or COBRA plan is not eligible to opt out and receive cash in lieu of active employee medical benefits.

Stat. Auth.: ORS 243.061 - 243.302
Stats. Implemented: ORS 243.061 - 243.302
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2001, f. & cert. ef. 9-6-01; PEBB 1-2002, 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 1-2005, f. & cert. ef. 4-14-05; PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07; PEBB 3-2010, f. 9-23-10, cert. ef. 10-1-10

101-050-0020

Retiree Survivor Medical and Dental Insurance Coverage

(1) An eligible spouse, domestic partner, dependent child, and dependent child of a domestic partner enrolled in PEBB retiree health plans at the time of a retiree's death (or subscriber’s death) may elect to continue the retiree insurance coverage. The individual electing to continue the coverage becomes the subscriber. Subscribers must self-pay the premiums and maintain continuous coverage. It is the responsibility of the subscriber to notify the retiree plan administrator if they do not want continued coverage.

(2) The retiree plan coverage terminates for a surviving spouse or domestic partner when they:

(a) Remarry or form a domestic partnership; or

(b) Fail to make premium payments; or

(c) PEBB no longer offers retiree insurance plans.

(3) The retiree plan coverage terminates for the surviving dependent children of the retiree, spouse, or domestic partner when they:

(a) No longer meet PEBB dependent eligibility requirements (OAR 101-015-0011); or

(b) Fail to make premium payments; or

(c) PEBB no longer offers retiree insurance plans.

Stat. Auth.: ORS 243.061 - 243.302
Stats. Implemented: ORS 243.061 - 243.302 & 659A.060 - 659A.069
Hist.: PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2001, f. & cert. ef. 9-6-01; PEBB 1-2002, f. 7-30-02, cert. ef. 8-1-02; 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 3-2010, f. 9-23-10, cert. ef. 10-1-10

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