Or. Admin. Code § 459-035-0070

Current through Register Vol. 63, No. 12, December 1, 2024

Section 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 the PERS Health Insurance Program Enrollment Request Form, and submit the form with all required supporting documents to the Third Party Administrator prior to the requested effective date of enrollment. The PERS Health Insurance Program Enrollment Request Form must:

(A) Indicate which plan is desired;

(B) List individually all dependents, including the spouse, that are to be enrolled; and

(C) Have signatures of all members, dependents over the age of 18, and spouses that are to be enrolled.

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

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

(B) Within 90 days of the date of submitting a service retirement application under OAR 459-015-0025(4)(c);

(C) Within 90 days of the date of the Disability Approval Letter generated under OAR 459-015-0025(5)(a);

(D) 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;

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

(F) Within 90 days of the date of the Notice of Award letter issued by the Social Security Administration; or

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

(c) Except as provided in subsections (f) and (g) of this section, an eligible spouse, dependent domestic partner, or dependent must be enrolled at the same time as the eligible retiree. An eligible spouse, dependent domestic partner or dependent enrolling in Parts A and B of Medicare must be enrolled in the Medicare Companion Plan offered by the same carrier that covers 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.

(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;

(D) Within 90 days of the date of the Notice of Award letter issued by the Social Security Administration; or

(E) 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; and

(B) 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. Enrollment in a PERS-sponsored dental insurance plan must be made under the enrollment conditions for the PERS-sponsored health insurance that are described in section (1) of this rule.

(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.

Or. Admin. Code § 459-035-0070

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; PERS 4-2015, f. & cert. ef. 3/30/2015; PERS 8-2018, amend filed 08/03/2018, effective 8/3/2018

Statutory/Other Authority: 238.650 & ORS 238.410

Statutes/Other Implemented: ORS 238.410, 238.415 & 238.420