[OEBB_alltopic] OEBB Members - Dependent Eligibility

[OEBB information]

Dear OEBB Member:

In OEBB's continuing efforts to provide quality, low-cost benefits for
Oregon's educational employees and their families, we plan to perform a
dependent eligibility verification review in early 2012.  In the midst
of busy lives, sometimes circumstances change causing a dependent to
lose eligibility but removing them from insurance coverage may be
overlooked. Covering ineligible dependents on a benefits program
increases costs for everyone.  For OEBB, covering ineligible dependents
on our plans mean all employees pay more through higher premiums and
out-of-pocket costs and all educational entities pay more through higher
contributions.

We will be providing additional information about the review process
along with your open enrollment materials in early August 2011.
However, in preparation for the upcoming open enrollment period and
subsequent review, we ask that you take a moment at this time to review
the dependent eligibility requirements at the end of this letter to
ensure all of the dependents included on your plan(s) meet one of these
definitions.

If you find that one or more of your covered dependents don't meet the
definition of an eligible dependent under the OEBB benefits program, you
must remove the dependent(s) from your OEBB plans prior to or during the
2011 Open Enrollment period (beginning August 15, 2011) to avoid the
possibility of having coverage for the ineligible dependent terminated
retroactive to the date eligibility was initially lost. 

You can view your current dependent information by logging into
MyOEBB.org and viewing your Benefits Summary.

Thank you for your cooperation in this effort to help control costs for
all OEBB members. If you have any questions about the process, please
contact OEBB Member Services by phone at 888-469-6322 (888-4My-OEBB) or
by email at oebb.benefits at state.or.us.

Sincerely,

 

Joan Kapowich, OEBB Administrator

 

 

DEPENDENT ELIGIBILITY REQUIREMENTS

 

"Child" means and includes the following: 

 

(a) An eligible employee's, spouse's, or domestic partner's biological
son, daughter, stepson, or stepdaughter; adopted child, child placed for
adoption, or legally placed child, who is 25 or younger on the first day
of the month. An eligible employee must provide the required custody or
legal documents to their Educational Entity showing proof of adoption,
legal guardianship or other court order if enrolling a child for whom
the employee, spouse, or domestic partner is not the biological parent.

 

(b) A person who is incapable of self-sustaining employment because of a
developmental disability, mental illness, or physical disability. There
is no age limit for a dependent child who is incapable of
self-sustaining employment because of a developmental disability, mental
illness, or physical disability. When the dependent child is 26 years of
age or older all the following requirements must be met: 

 

     i.        The disability must have existed before attaining age 26.


 

    ii.        (B) The employee must provide evidence to the Educational
Entity or OEBB that (1) the person had health plan coverage, group or
individual, prior to attaining age 26, and (2) health plan coverage
continued without a gap until the OEBB health plan effective date. 

 

   iii.        (C) The person's attending physician must submit
documentation of the disability to the eligible employee's OEBB health
insurance plan for review and approval. If the person receives health
plan approval, the health plan may review the person's health status at
any time to determine continued OEBB coverage eligibility. 

 

  iv.        (D) The person must not have terminated from OEBB health
plan coverage after attaining the age of 26. 

 

(c) Eligibility for coverage under this rule includes people who may not
be dependents under federal or state tax law and may require an
Educational Entity to adjust an Eligible Employee's income based on the
imputed value of the benefit.

 

"Spouse" means a person of the opposite sex who is a husband or wife.
Except as provided in Oregon Constitution Article XV, Section 5a, a
relationship recognized as a marriage in another state will be
recognized in Oregon even though such a relationship would not be a
marriage if the same facts had been relied upon to create a marriage in
Oregon. The definition of spouse does not include a former spouse and a
former spouse does not qualify as a dependent.

 

"Domestic partner," unless otherwise defined by a collective bargaining
agreement or documented district policy in effect on January 31, 2008,
means and includes the following: 

 

(a) An unmarried individual of the same sex who has entered into a
"Declaration of Domestic Partnership" with the eligible employee that is
recognized under Oregon law; or 

 

(b) An unmarried individual of the same or opposite sex who has entered
into a partnership that meets the following criteria: 

 

     i.        Both are at least 18 years of age; 

 

    ii.        Are responsible for each other's welfare and are each
other's sole domestic partners; 

 

   iii.        Are not married to anyone and have not had a spouse or
another domestic partner within the prior six months. If previously
married, the six-month period starts on the final date of divorce; 

 

  iv.        Share a close personal relationship and are not related by
blood closer than would bar marriage in the State of Oregon;

 

   v.        Have jointly shared the same regular and permanent
residence for at least six months immediately preceding the date the
Affidavit of Domestic Partnership is signed and submitted to the
Educational Entity; and 

 

  vi.        Are jointly financially responsible for basic living
expenses defined as the cost of food, shelter and any other expenses of
maintaining a household. Financial information must be provided if
requested.

 

vii.        The eligible employee and domestic partner must jointly
complete and submit to the Educational Entity an Affidavit of Domestic
Partnership form, within five business days of the electronic enrollment
date or the date the Educational Entity received the enrollment/change
form. If the affidavit is not received, coverage will terminate for the
domestic partner retroactive to the effective date. 

 

(c) The domestic partner must notify the Educational Entity within 31
days of meeting all criteria as defined in 111-010-0015 (15)(b) or
obtaining the "Declaration of Domestic Partnership" which is recognized
under Oregon law. 

 

(d) Educational Entities' must calculate and apply applicable imputed
value tax for domestic partners covered under OEBB benefit plans.

 

RETIREES

 

"Retirees" enrolled in OEBB retiree insurance plan that becomes eligible
for Medicare coverage may not continue on an OEBB medical or vision
plan, unless they are eligible for Medicare as a result of end-stage
renal disease. OEBB benefits end the last day of the month prior to the
Medicare effective date. The retiree is responsible for reporting to
their Educational Entity and to OEBB when the retiree is covered by
Medicare within 31 days after the Medicare coverage effective date.
Failure to report within this timeframe may be considered intentional
misrepresentation by OEBB and OEBB may retroactively terminate OEBB
coverage back to the last day of the month prior to the Medicare
effective date.

 

Eligible dependents of "Retirees" who were covered on an OEBB medical
plan at the time of retirement who are eligible for Medicare, or who
become eligible for Medicare, may not continue coverage on an OEBB
medical or vision plan unless it is stated in a collective bargaining
agreement or documented district policy in effect on or before February
1, 2010, that they may continue on OEBB medical plans until the retiree
becomes eligible for Medicare with the following exception: OEBB
coverage must end for Medicare-eligible dependents of a retiree enrolled
on a Kaiser Permanente medical plan.

 

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