Or. Admin. Code § 459-035-0001

Current through Register Vol. 63, No. 10, October 1, 2024

Section 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.

Or. Admin. Code § 459-035-0001

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

Stat. Auth.: ORS 238.410, 238.650 & 238A.450

Stats. Implemented: ORS 238.410, 238.415, 238.420 & 238A.050