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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) Refer to OAR 101-20-0002(7)(d)for
employee premium payment requirements.
(4) 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.
(5) 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.
(6) A previously benefit
eligible employee returning to paid regular status 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.
(7) A COBRA qualifying event
occurs at the end of the CBIW continuation period, or when the current benefit eligible
stability period ends the allowable benefit period, if the employee has not returned
to paid regular status.
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; PEBB 3-2014(Temp), f. & cert. ef. 11-12-14 thru 5-10-15; PEBB
1-2015, f. & cert. ef. 5-12-15
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) Refer to OAR 101-20-0002((7)(d)for
employee premium payment requirements.
(4) An eligible employee
on FMLA leave during open enrollment must make open enrollment benefit elections.
(5) 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 the employee pre-paid
the contributions to the 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.
(6) 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).
(7) A COBRA qualifying event
occurs when (i) the employee does not return to work, is not in paid regular status
the first day after the qualified FMLA leave ends, and is not in a current stability
period, or (ii) when the employee is in a current benefit eligible stability period
and is approved to continue the leave without pay after the qualified the FMLA ends,
or (iii) 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; PEBB 3-2014(Temp),
f. & cert. ef. 11-12-14 thru 5-10-15; PEBB 1-2015, f. & cert. ef. 5-12-15
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
(1) A permanent, temporary or impermanent
benefit eligible employee who qualifies for OFLA leave will continue benefits as
outlined in OAR 101-020-0005 according to the their benefit eligible current stability
status at the time the leave starts.
(2) When benefits continue
during OFLA because of the employee’s current benefit eligible stability status,
refer to OAR 101-20-0002(7)(d) for employee premium payment requirements.
(3) If active employee’s
PEBB insurance coverage ends, the employee will receive a COBRA election notice.
See OAR 101-030-0005.
(4) See OAR 101-020-0045
Returning to Work.
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; PEBB 3-2014(Temp),
f. & cert. ef. 11-12-14 thru 5-10-15; PEBB 1-2015, f. & cert. ef. 5-12-15
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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