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The Oregon Administrative Rules contain OARs filed through July 15, 2014
 
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OREGON PUBLIC EMPLOYEES RETIREMENT SYSTEM

 

DIVISION 35

HEALTH INSURANCE PROGRAMS

459-035-0000

Policy and Goals

(1) The health insurance plans of the Public Employees Retirement System (PERS) are established and shall be administered as provided in ORS 238.410, 238.415, 238.420 and 238A.050. The Public Employees Retirement Board (Board) may enter into one or more contracts with health insurance carriers licensed to do business in the State of Oregon, or certified in another state that is operating under the laws of that state, to obtain health insurance coverage for eligible retirees, and their spouses or dependents.

(2) Benefits shall be provided under the Board’s health insurance programs for eligible persons through retiree contributions and any other available funding to cover the Board’s costs of health care coverage and administration under insurance contract between the Board and insurance carriers.

Stat. Auth.: ORS 238.410, ORS 238.650 & 238A.450
Stats. Implemented: ORS 238.410, 238.415, 238.420 & 238A.050
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 5-1999, f. & cert. ef. 11-15-99; PERS 14-2002, f. & cert. ef. 11-18-02; PERS 1-2010(Temp), f. & cert. ef. 4-5-10 thru 9-27-10; PERS 9-2010, f. & cert. ef. 9-29-10

459-035-0001

Definitions

For purposes of this division:

(1) “Dependent” means a PERS member’s or retiree’s dependent child. For the purpose of this rule a “child” is defined as follows:

(a) A natural child.

(b) A legally adopted child, or a child placed in the home pending adoption.

(c) A step-child who resides in the household of the stepparent who is an eligible retired member.

(d) A grandchild, provided that at the time of birth, at least one of the grandchild’s parents was covered under a PERS-sponsored health insurance plan as a dependent child of the PERS member or retiree and resides in the household of the member or retiree.

(2) “Dependent Domestic Partner” means a person who has a relationship with a PERS retiree that has the characteristics described below. To qualify as a “dependent domestic partner”, the person and the PERS retiree must:

(a) Share a close personal relationship and be responsible for each other’s common welfare, including but not limited to having joint financial responsibilities;

(b) Be each other’s sole domestic partner;

(c) Not be married to anyone, nor have had another domestic partner within the previous 12 months;

(d) Not be related by blood so closely as to bar marriage in the State of Oregon;

(e) Have jointly shared the same regular and permanent residence for at least 12 months immediately preceding the effective date of coverage with the intent to continue doing so indefinitely; and

(f) Have the PERS retiree providing over one-half of the financial support for the person and qualify as a dependent of the PERS retiree as determined under section 105(b) of the Internal Revenue Code, 26 USC 105(b).

(3) “Eligible Person” means a person who is eligible for coverage under a PERS-sponsored health insurance plan. The conditions for such eligibility are set forth in OAR 459-035-0020.

(4) “Eligible Retired Member” means an eligible person who is eligible for payments toward the cost of the Medicare Companion Plan from RHIA. The conditions for such eligibility are set forth in OAR 459-035-0030.

(5) “Eligible Retired State Employee” means an eligible person who is eligible for non-Medicare insurance premium payments from the RHIPA. Conditions for such eligibility are set forth in OAR 459-035-0040.

(6) “Health Insurance Premium” means the self-sustaining premium calculated to cover the projected claims and costs incurred by the insurance company for a participant in a health care plan. “Health Insurance Premium” includes retrospective premiums and employee contributions. “Health Insurance Premium” does not include any intentional load to cover dependents or other groups or participants.

(7) “Medicare” means the federal health care insurance plan established under Title XVIII of the Social Security Act as amended.

(8) “Medicare Companion Plan” means a PERS-sponsored health insurance plan for eligible persons who are eligible for and enrolled in Medicare.

(9) “Net to Carrier” means the health insurance premium due to the insurance company. “Net to Carrier” does not include any charges for PEBB or PERS health insurance administration.

(10) “PEBB” means the Public Employees’ Benefit Board established under ORS 243.061.

(11) “PERS Member” has the same meaning as “member” provided in ORS 238.005 and 238A.005.

(12) “Plan Year” means a 12-month period beginning January 1 and ending December 31.

(13) “Qualifying Service” under ORS 238.415(1)(c) means creditable service, as defined in ORS 238.005, with a state employer, plus any periods of employment with a state employer participating in PERS that are required of the employee before becoming a PERS member.

(14) “Retiree” means a PERS member who is receiving a service or disability retirement allowance or benefit under PERS or who received a lump sum payment under ORS 238.305(3), 238.315, or 238A.195, or payment(s) under ORS 238A.400, or a person who is receiving retirement pay or pension calculated under ORS 1.314 to 1.380 (1989 Edition).

(15) “Retrospective Premium” means any additional premium liability that is determined at the end of the plan year, based on any pre-determined formula.

(16) “RHIA” means the Retirement Health Insurance Account established under ORS 238.420 to help defray the cost of the Medicare Companion Plan.

(17) “RHIPA” means the Retiree Health Insurance Premium Account established under ORS 238.415 to help defray the cost of PERS-sponsored health plans other than the Medicare Companion Plan.

(18) “SRHIA” means the Standard Retiree Health Insurance Account established under ORS 238.410 to administer employee and the employer contributions to the PERS sponsored health insurance program.

(19) “Staff” means the employees of the Public Employees Retirement System.

(20) “Third Party Administrator” means the individual or organization that the Board contracts with to provide administrative services as specified in the contract.

Stat. Auth.: ORS 238.410, 238.650 & 238A.450
Stats. Implemented: ORS 238.410, 238.415, 238.420 & 238A.050
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 15-1998, f. & cert. ef. 12-17-98; PERS 5-1999, f. & cert. ef. 11-15-99; PERS 14-2002, f. & cert. ef. 11-18-02; PERS 17-2005, f. & cert. ef. 10-3-05; PERS 1-2010(Temp), f. & cert. ef. 4-5-10 thru 9-27-10; PERS 9-2010, f. & cert. ef. 9-29-10; PERS 13-2012, f. & cert. ef. 12-5-12; PERS 6-2014, f. & cert. ef. 3-31-14

459-035-0010

Standard Retiree Health Insurance Account

(1) ORS 238.410(7) establishes the Standard Retiree Health Insurance Account (SRHIA). The SRHIA shall be used only for the purposes set forth in ORS 238.410(7).

(2) Upon receipt by PERS, all premium payments as described in OAR 459-035-0090, shall be deposited in the SRHIA.

(3) Funds in the SRHIA shall be paid out only as follows:

(a) In accordance with insurance carrier contracts, premiums charged by a carrier for eligible persons' health insurance coverage, shall be paid to the carrier(s) from the SRHIA.

(b) In accordance with contract(s) entered into by the Board under ORS 238.410(6), administrative costs incurred in administering the PERS health insurance program shall be paid from the SRHIA.

(4) The total contributions paid into the SRHIA, RHIA and RHIPA will not exceed 25% of the aggregate contributions to the retirement benefits.

(5) The Director shall provide a report at the close of each calendar year that will contain the following elements:

(a) Total contributions by participating employers into the Public Employees Retirement Fund during the calendar year immediately past and the total accumulation of such contributions since July 11, 1987.

(b) Total contributions paid by participating employers into RHIA and RHIPA, and the total accumulation of such contributions since July 11, 1987.

(c) Total contributions by all eligible persons into SRHIA.

(d) The ratio of (a) to (b)+(c) expressed as a percentage.

(6) The Director shall provide a report to the PERS Board disclosing the ratio expressed in the calculation of (5)(d) and shall note whether PERS is compliant with the 25% rule under Internal Revenue Code §401(h).

Stat. Auth.: ORS 238.410 & ORS 238.650
Stats. Implemented: ORS 238.410, ORS 238.415 & ORS 238.420
Hist.: PERS 5-1999, f. & cert. ef. 11-15-99; PERS 14-2002, f. & cert. ef. 11-18-02

459-035-0020

Eligibility, General

This rule describes the eligibility requirements for a person to be eligible to participate in a PERS-sponsored health insurance plan. An “eligible person” includes a retiree, a spouse, a dependent, a dependent domestic partner, and a surviving spouse or dependent. Each category of “eligible person” is defined as follows:

(1) A retiree as defined in OAR 459-035-0001(14).

(2) The spouse of a retiree.

(3) A dependent means a dependent child as defined in OAR 459-035-0001(1) who satisfies one of the following requirements:

(a) The child is less than 26 years of age; or

(b) The child is 26 years of age or more and has either been continuously dependent upon the retiree since childhood due to disability or physical handicap, or has been covered under a health care insurance plan as the retiree’s dependent for at least 24 consecutive months immediately before enrollment in a PERS-sponsored health insurance plan. In either case, the following additional requirements must also be satisfied:

(A) The child is not able to achieve self-support through his or her work due to a developmental disability, mental or physical handicap as verified by a physician and accepted by the carrier; and

(B) The incapacity is continuous and began before the date the child would otherwise have ceased to be an eligible dependent.

(4) A dependent domestic partner as defined in OAR 459-035-0001(2).

(5) A surviving spouse or dependent means a person who is the surviving spouse or dependent of:

(a) A deceased retiree; or

(b) A deceased PERS member who was not retired but who was eligible to retire at the time of death; or

(c) A deceased retiree who was receiving a retirement payment or benefit, or a pension calculated under ORS 1.314 to 1.380 (1989 Edition), provided that the person was covered under a PERS-sponsored health insurance plan at the time of the retiree’s death.

(6) In no event shall an eligible person as defined in this rule be entitled to coverage under more than one PERS-sponsored medical, dental, or long term care insurance plan.

(7) In no event shall an eligible person as defined in this rule be entitled to participate as a retiree and as a spouse, dependent, or dependent domestic partner.

Stat. Auth: ORS 238.410, 238.650 & 238A.450
Stats. Implemented: ORS 238.410 & 238A.050
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 14-2002, f. & cert. ef. 11-18-02; PERS 1-2010(Temp), f. & cert. ef. 4-5-10 thru 9-27-10; PERS 9-2010, f. & cert. ef. 9-29-10

459-035-0030

Eligibility, Retirement Health Insurance Account

This rule describes the requirements for an “eligible retired member” participating in a PERS-sponsored Medicare Companion Plan to be eligible for contributions from the RHIA toward the cost of premiums for that plan. The amount of the contribution is defined in OAR 459-035-0060.

(1) An “eligible retired member” includes the following:

(a) A retired member of the Tier One or Tier Two program who is enrolled in Parts A and B of Medicare and who:

(A) Is receiving a PERS service or disability retirement allowance or benefit, and had eight or more years of qualifying service at the time of retirement; or

(B) Is receiving a PERS disability retirement allowance or benefit computed as if he or she had eight years or more of creditable service.

(b) A surviving spouse or dependent of a deceased eligible retired member as described in subsection (a) of this section, who is enrolled in Parts A and B of Medicare, and who:

(A) Is receiving a retirement allowance or benefit from PERS; or

(B) Was covered under the retired member’s PERS-sponsored health insurance plan and the deceased retired member retired before May 1, 1991.

(2) An eligible surviving spouse or dependent receiving benefits under the 15-year certain optional form of benefit payment (ORS 238.305 Option 4) will be entitled to contributions from the RHIA only until the remainder of the 180 monthly benefit payments are paid, unless he or she meets the requirements in subsection (1)(b)(B) of this rule.

(3) If both an eligible surviving spouse and an eligible surviving dependent are receiving benefits at the same time under the 15-year certain optional form of benefit payment (ORS 238.305 Option 4), only the eligible surviving spouse shall be entitled to contributions from the RHIA unless the surviving spouse, in writing, waives the contribution in favor of the eligible surviving dependent.

Stat. Auth: ORS 238.650
Stats. Implemented: ORS 238.420
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 14-2002, f. & cert. ef. 11-18-02; PERS 1-2010(Temp), f. & cert. ef. 4-5-10 thru 9-27-10; PERS 9-2010, f. & cert. ef. 9-29-10

459-035-0040

Eligibility, Retiree Health Insurance Premium Account

This rule describes the eligibility requirements for an “eligible retired state employee” participating in a PERS-sponsored health insurance plan, exclusive of dental coverage and long term care coverage, to be eligible for a contribution from the RHIPA toward the cost of premiums for that health insurance plan. The amount of the contribution is established in OAR 459-035-0050.

(1) An “eligible retired state employee” includes:

(a) A Tier One or Tier Two member who is not eligible for Medicare, and whose PERS effective retirement date is the first of the month following termination of state employment, and who:

(A) Is receiving a PERS service or disability retirement allowance or benefit, and had eight or more years of qualifying service at the time of retirement; or

(B) Is receiving a PERS disability retirement allowance computed as if the member had eight or more years of creditable service, and has attained the earliest service retirement age.

(b) A surviving spouse or dependent of a deceased eligible retired state employee, as described in subsection (a) of this section, who is not eligible for Medicare, and who:

(A) Is receiving a retirement allowance or benefit from PERS; or

(B) Was covered under the eligible retired state employee’s PERS-sponsored health insurance plan, and the eligible retired state employee retired on or after September 29, 1991.

(2) An eligible surviving spouse or dependent receiving benefits under the 15-year certain optional form of benefit payment (ORS 238.305 Option 4) will be entitled to contributions from the RHIPA only until the remainder of the 180 monthly benefit payments are paid, unless he or she meets the requirement of paragraph (1)(b)(B) of this rule.

(3) If an eligible surviving spouse and a dependent are receiving benefits under the same 15-year certain optional form of benefit payment (ORS 238.305 Option 4), only the eligible surviving spouse shall be entitled to contributions from the RHIPA unless the surviving spouse, in writing, waives the contribution in favor of the eligible surviving dependent.

Stat. Auth: ORS 238.650
Stats. Implemented: ORS 238.415
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 14-2002, f. & cert. ef. 11-18-02; PERS 1-2010(Temp), f. & cert. ef. 4-5-10 thru 9-27-10; PERS 9-2010, f. & cert. ef. 9-29-10

459-035-0050

Contribution Payment From Retiree Health Insurance Premium Account for Eligible Retired State Employees Not Eligible for Medicare

This rule establishes the procedure for determining the amount of contribution that will be paid from the Retiree Health Insurance Premium Account (RHIPA)(ORS 238.415) on behalf of an eligible retired state employee under age 65, as described in OAR 459-035-0040, who is enrolled in a health insurance plan sponsored by PERS.

(1) On or before November 1 of each calendar year, staff shall determine the monthly amount available to be paid from the RHIPA on behalf of an eligible retired state employee enrolled in a PERS health insurance plan contracted for under ORS 238.410. In determining the average difference between the health insurance premiums paid by retired state employees under contracts entered into by the Public Employees Retirement Board and the health insurance premiums paid by state employees who are not retired under contracts entered into by PEBB (without regard to employees who have opted out of PEBB-sponsored health insurance coverage), the staff shall calculate the change in value of the average of active PEBB plans after adjusting for the demographic (age/sex) differences between:

(a) The active employee participants; and

(b) Retired members receiving a subsidy and participating in one of the PERS non-Medicare health insurance plans as follows:

(A) Obtain the average employee participation for each health insurance plan sponsored by PEBB for the most recent three-month period;

(B) Obtain the health insurance premium for each health insurance plan sponsored by PEBB for the plan year next following;

(C) Obtain the average eligible retired state employee participation for each health insurance plan sponsored by PERS for the most recent three-month period;

(D) Compute the average health insurance premium for all plans sponsored by PEBB pursuant to the following formula:

(i) Step 1. Multiply the average participation in paragraph (A) of this subsection by the health insurance premium in paragraph (B) of this subsection for each plan;

(ii) Step 2. Total the average participation for all plans;

(iii) Step 3. Total the result for all of the calculations in Step 1 of sub-paragraph (i) of this paragraph; and

(iv) Step 4. Divide the total in Step 3 of sub-paragraph (iii) of this paragraph by the total in Step 2 of sub-paragraph (ii) of this paragraph.

(E) Compute the change in value of the average active PEBB plan pursuant to the following formula:

(i) Step 1. Divide the total in paragraph (C) of this subsection by the total in Step 2 of paragraph (D) of this subsection;

(ii) Step 2. Multiply the average participation for each plan in paragraph (A) of this subsection by the result of Step 1 of sub-paragraph (i) of this paragraph for each plan;

(iii) Step 3. Multiply the premium for each plan in paragraph (B) of this subsection by the estimated factor of non-Medicare retiree claims cost to active claims cost;

(iv) Step 4. Multiply the result of Step 2 of sub-paragraph (ii) of this paragraph by the result of Step 3 of subparagraph (iii) of this paragraph for each plan;

(v) Step 5. Total the results for all of the calculations in Step 4 of sub-paragraph (iv) of this paragraph;

(vi) Step 6. Total the results of the average participation calculations for all plans in Step 2 of sub-paragraph (ii) of this paragraph; and

(vii) Step 7. Divide the total premium in Step 5 of sub-paragraph (v) of this paragraph by total average participation as calculated in Step 6 of sub-paragraph (vi) of this paragraph.

(F) The result of Step 7 of sub-paragraph (E)(vii) of this subsection minus Step 4 of sub-paragraph (D)(iv) of this subsection is the maximum monthly amount available to be paid by PERS on behalf of an eligible retired state employee. Under no circumstances will this amount be less than $0.

(G) The maximum monthly amount paid by PERS on behalf of an eligible retired state employee shall be determined using qualifying service.

(2) The factor in Step 3 of sub-paragraph (1)(b)(E)(iii) of this rule shall be evaluated no less frequently than every three years.

(3) The monthly amount available established under section (1) of this rule shall be published by November 1 of each calendar year, or as soon as possible thereafter, and shall be effective for the plan year next following for PERS sponsored plans.

(4) In the event an active plan is not to be renewed for a subsequent plan year, the participants shall be deemed to be covered by another existing plan most similar in benefits.

(5) This rule applies to the amount to be paid by PERS for the plan year 1993 and subsequent plan years.

(6) No person eligible for a contribution from the RHIPA as provided for in this rule shall be entitled to a contribution from the RHIA.

Stat. Auth.: ORS 238.650
Stats. Implemented: ORS 238.415
Hist.: PERS 8-1992, f. 12-14-92, cert. ef. 12-31-92; PERS 4-1996, f. & cert. ef. 6-11-96; PERS 4-1998, f. & cert. ef. 3-16-98; PERS 15-1998, f. & cert. ef. 12-17-98; PERS 12-2000(Temp), f. 12-15-00 cert. ef. 1-1-01 thru 6-29-01; PERS 2-2001, f. & cert. ef. 4-12-01; PERS 14-2002, f. & cert. ef. 11-18-02; PERS 23-2003, f. 12-15-03 cert. ef. 1-1-04; PERS 6-2014, f. & cert. ef. 3-31-14

459-035-0060

Contribution Payment from Retirement Health Insurance Account for Eligible Retired Members Who Are Covered by Medicare

This rule establishes the procedure for determining the amount of contribution that will be paid from the RHIA (ORS 238.420) on behalf of an eligible retired member, as described in OAR 459-035-0030, who is enrolled in Parts A and B of Medicare.

(1) An amount of $60 per month or the total monthly premium, whichever is less, shall be paid from the RHIA on behalf of an eligible retired member enrolled in a PERS-sponsored Medicare Companion Plan.

(2) No person eligible for a contribution from the RHIA as provided for in this rule shall be entitled to a contribution from the RHIPA.

Stat. Auth: ORS 238.650
Stats. Implemented: ORS 238.420
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96

459-035-0070

Enrollment

(1) Enrollment requirements of PERS-Sponsored health insurance plans for eligible persons are as follows:

(a) An eligible person must complete all applicable parts of PERS Medical & Dental Insurance Application form, and file the form with the Third Party Administrator including, in the case of a dependent domestic partner, an Affidavit of Dependent Domestic Partnership. The form must indicate which plan is desired and it must list individually all dependents, including the spouse, that are to be enrolled. The form can be obtained from the Third Party Administrator or PERS;

(b) An eligible person who is a retiree may enroll:

(A) Within 90 days of the retiree's effective date of retirement;

(B) At any time if covered under another group health insurance plan for 24 consecutive months immediately preceding enrollment, provided that the application for enrollment is filed within 30 days of loss of coverage. Health care coverage under workers' compensation, Medicare or any other governmental entitlement program for health care do not qualify as other group health insurance coverage for purposes of this paragraph;

(C) Within 90 days of initial Medicare eligibility, if the retiree is enrolled in Parts A and B of Medicare; or

(D) During an open enrollment period designated by the Board.

(c) Except as provided in subsection (f) of this section, an eligible spouse or dependent must be enrolled at the same time and in the same plan as the eligible retiree;

(d) An eligible surviving spouse or dependent who is enrolled under the deceased retiree's plan at the time of death may continue coverage under that plan, and must complete a Medical & Dental Insurance Application form as soon as possible following the retiree's death;

(e) An eligible surviving spouse or dependent who is not covered under the retiree's plan at the time of the retiree's death, may enroll:

(A) Within 90 days of the retiree's death;

(B) At any time if covered under another group health insurance plan for 24 consecutive months immediately preceding enrollment, provided that the application for enrollment is filed within 30 days of loss of coverage. Health care coverage under workers' compensation, Medicare or any other governmental entitlement program for health care do not qualify as other group health insurance plan coverage for purposes of this paragraph;

(C) Within 90 days of initial Medicare eligibility, if he or she is enrolled in Parts A and B of Medicare; or

(D) During an open enrollment period designated by the Board.

(f) A new spouse, dependent domestic partner, or dependent may be enrolled:

(A) Within 30 days of becoming a spouse, a dependent domestic partner or dependent;

(B) If not enrolled in Medicare, only with the same carrier that the eligible retiree is enrolled in;

(C) If enrolled in Parts A and B of Medicare, only in the Medicare Companion Plan offered by the same carrier that covers the eligible retiree.

(g) An eligible retiree's spouse may enroll within 90 days of initial Medicare eligibility, if he/she is enrolled in Parts A & B of Medicare even though the retiree remains enrolled in a non-PERS health plan.

(2) Special enrollment requirements for dental insurance plans:

(a) Only persons who are enrolled in a PERS-sponsored health insurance plan may enroll in a PERS-sponsored dental insurance plan;

(b) Dental insurance coverage is not available to any eligible person unless all family members (the retiree, spouse, dependent domestic partner and dependent(s)) who are enrolled in a PERS-sponsored health insurance plan also enroll in the same PERS-sponsored dental insurance plan;

(c) If the retiree, spouse, dependent domestic partner and dependent(s) do not enroll in a PERS-sponsored dental insurance plan when eligible, or later choose to discontinue dental coverage, they will not be allowed to re-enroll in a PERS-sponsored dental insurance plan.

Stat. Auth.: ORS 238.410 & ORS 238.650
Stats. Implemented: ORS 238.410, ORS 238.415 & ORS 238.420
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 15-1998, f. & cert. ef. 12-17-98; PERS 14-2002, f. & cert. ef. 11-18-02

459-035-0080

Effective Date of Coverage

(1) For an eligible person who enrolls in a PERS sponsored health insurance plan under the provisions of OAR 459-035-0070, the effective date of coverage shall be the first of the month following receipt of a completed PERS Medical & Dental Insurance Application form but not before the date described as follows:

(a) For an eligible retiree, the latest of the following dates:

(A) The effective date of retirement if enrolled within 90 days of the effective date of retirement;

(B) The termination date of other group health insurance coverage;

(C) For a Medicare Companion Plan, the effective date of enrollment in Parts A and B of Medicare; or

(D) The date specified in an announcement of a plan change period or an open enrollment period, if applicable.

(b) For an eligible spouse or dependent, the latest of the following dates:

(A) The date the retiree's coverage is effective;

(B) The first of the month following the termination date of other group health insurance coverage;

(C) For a Medicare Companion Plan, the effective date of enrollment in Parts A and B of Medicare; or

(D) The date specified in an announcement of a plan change period or an open enrollment period, if applicable.

(c) For a new eligible spouse, dependent, or dependent domestic partner, the first day of the month following the date the completed enrollment form is filed and in the case of a domestic partner, an Affidavit of Dependent Domestic Partnership, except in the following situations:

(A) A newborn child is covered from the moment of birth.

(B) An adopted child is covered from the date he or she is placed in the custody of the eligible retiree.

(d) For an eligible surviving spouse or dependent, the first of the month following the filing of an application for health insurance coverage.

(2) Coverage shall cease for an eligible person on the earliest of the following dates:

(a) The end of the month in which a signed notification is received by PERS from the covered person to terminate coverage.

(b) The end of the month for which the last premium is paid.

(c) The end of the month in which a person ceases to be an eligible person, subject to any continuation of coverage rights under state or federal law.

Stat. Auth: ORS 238.410 & ORS 238.650
Stats. Implemented: ORS 238.410, ORS & ORS 238.420
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 14-2002, f. & cert. ef. 11-18-02

459-035-0090

Retiree Health Insurance Premium Payment Process

(1) An eligible person who elects to participate in a PERS-sponsored health insurance plan shall choose one of the following methods for the payment of contributions for that coverage:

(a) The direct payment method by an electronic transfer of the monthly contribution for the PERS-sponsored health insurance plan from an eligible person's bank account to the Third Party Administrator; or

(b) The direct payment method by issuing a check or money order for the monthly contribution for the PERS-sponsored health insurance plan to the Third Party Administrator; or

(c) The pension deduction method wherein PERS shall deduct the monthly contribution from the service or disability retirement allowance or other benefit payable to the eligible person and forward the contribution to the Standard Retiree Health Insurance Account.

(A) The total monthly contribution due shall be deducted for the benefit option selected by the eligible person.

(B) If an eligible person's monthly PERS benefits are not sufficient to cover the monthly contribution for the PERS-sponsored health insurance plan, the deduction method may not be used.

(2) Employee contributions for the PERS-sponsored health insurance plan shall be paid monthly and shall consist of the following:

(a) The premium charged by the carrier for the eligible person's health insurance coverage, less any amount contributed on the eligible person's behalf from the RHIA or RHIPA; and

(b) The eligible person's share of the administrative costs incurred by PERS in administering the health insurance program as provided for in ORS 238.410(4).

(3) If payment is by check or money order, the check or money order must be physically received by the Third Party Administrator on or before the due date.

(4) Failure to make the payment by the due date shall result in termination of a person's PERS-sponsored health insurance coverage.

(5) On receipt of an eligible person's contribution, the Third Party Administrator shall deposit the contributions in the Standard Retiree Health Insurance Account. Amounts deposited in the Standard Retiree Health Insurance Account shall be used only to pay health insurance premiums on behalf of eligible persons and the costs incurred by PERS in administering the health insurance program.

Stat. Auth.: ORS 238.410 & ORS 238.650
Stats. Implemented: ORS 238.410, ORS 238.415 & ORS 238.420
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 5-1999, f. & cert. ef. 11-15-99; PERS 14-2002, f. & cert. ef. 11-18-02

459-035-0100

Employer Contributions for Retiree Health Insurance

(1) Each employer making contributions to the RHIPA under OAR 459-0035-0050 or the RHIA under OAR 459-035-0060 shall, at the time of making the contribution, designate whether the contribution is allocable to the RHIPA or the RHIA.

(2) Any forfeitures of amounts deposited in the RHIA or the RHIPA shall be used to pay the administrative expenses of the health insurance program or to reduce employer contributions to the RHIA and RHIPA on an equitable basis as determined by the Board.

Stat. Auth.: ORS 238.410 & ORS 238.650
Stats. Implemented: ORS 238.410, ORS 238.415 & ORS 238.420
Hist.: PERS 5-1999, f. & cert. ef. 11-15-99

459-035-0150

Continuation of Insurance Coverage Under COBRA

(1) This rule relates to the continuation of PERS-sponsored health insurance coverage under the federal Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA) and ORS 743.600 to 743.602. PERS-sponsored health insurance plans shall provide for continuation of coverage to the extent required by COBRA and ORS 743.600 to 743.602. Nothing in this rule is intended to expand any person's continuation coverage rights under those provisions or any other applicable provision of law.

(2) Any person who is on continuation of coverage under COBRA and/or ORS 743.600 to 743.602 shall pay the entire premium for that coverage and shall not be entitled to any contributions from the RHIA or RHIPA. Premium payment shall be made only by check or money order, and the check or money order must be physically received by the Third Party Administrator on or before the due date. Subject to the grace periods required by COBRA, failure to make the premium payment by the due date shall result in termination of a person continuation coverage.

Stat. Auth.: ORS 238.410 & 238.650
Stats. Implemented: 238.410
Hist.: PERS 4-1996, f. & cert. ef. 6-11-96; PERS 21-2005, f. & cert. ef. 11-1-05

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