What happens to your benefits when you go on leave without pay or have a reduction in hours

We want to provide you with important information on your benefits if you should go on leave without pay or have a reduction in hours. If you have questions, please call (541) 346-2956 or e-mail the Benefits Department. The following outline defines eligibility requirements for PEBB Benefits and summarizes coverage termination, your rights for continuation of coverage, returning to benefit eligible status and your responsibilities.

IMPORTANT: Contact the Benefits Office immediately to complete forms to reinstate your benefits if you return to work or have an increase in your hours.

• Insurances
• Continuation of Coverage Options
• Dependent Care Flexible Spending Account
• Returning to Benefit Eligible Status

1. Insurances

Employees are eligible for the next month's PEBB insurance benefits based on working or "paid regular hours" of at least "half time" in the current month (or in the current pay period if paid mid-month to mid-month). PEBB eligibility rules define "paid regular hours" as paid work time (including vacation, sick, personal leave and compensatory time). "Half time" means no less than 80 hours per month for represented employees or working at least half the working days in the month for academic employees. Your insurances will stop at the end of the month in which you go a leave without pay or have a reduction in hours if you work less then 50% of the month.

You will need to contact the Benefits Office for the exact date your insurance will end.

Continuation of Coverage Options

Most PEBB insurance benefits can be continued without an interruption in coverage. You must follow specific enrollment and self-payment of premium procedures. Timely premium payment is required to ensure continuation of coverage.

Your right for continuation of coverage applies only to the PEBB group insurance benefits in effect at the time of your employment status change. Continuation rights and responsibilities vary depending on the type of insurance you wish to continue.

a. Medical-Dental Insurance

Group medical coverage may be continued under the COBRA and portability options. Dental coverage may be continued only under the COBRA option. You must complete enrollment forms for the COBRA or portability options and premium payments must be made for continuation coverage to be effective.

COBRA Option

Employees who lose eligibility for group medical and/or dental coverage, due to a reduction in hours or an unpaid leave of absence, experience a qualifying event. Under federal law, Consolidated Omnibus Budget Reconciliation Act (COBRA), a covered employee and/or their covered dependents on a plan immediately prior to a qualifying event may continue group medical and/or dental coverage, at their own expense beyond the date active group coverage ends. You will be required to pay the premiums plus an additional 2% administrative fee during the months you are eligible for the continued coverage. BenefitHelp Solutions administers the COBRA plans for PEBB.

BenefitHelp Solutions will be notified about your termination date. BenefitHelp Solutions will send you a COBRA Continuation of Coverage Notice describing your COBRA election rights and responsibilities. COBRA rates are based on the active employee group rates plus an additional 2% administrative fee. If you decide to continue your insurance on the COBRA program, follow the instructions on the PEBB COBRA Continuation Election Form and return it to the address shown on the form within the designated 60 days for electing coverage. If you have questions after receiving the notice, BenefitHelp Solutions may be contacted at 1-800-822-3173.

2008 COBRA Rates

2009 COBRA Rates

Portability Option (medical only)

If you have been covered by your medical plan for at least 180 days, another option is to convert your current group medical insurance to a portability plan offered by your insurance company. You can choose this option before, during or after your COBRA continuation coverage ends. Call your insurance company for information about the portability plans and costs. To enroll, you must make application directly to your medical insurance carrier within 63 days of the date your group coverage ends. If you have any questions, you may contact Cindi Peterson at 346-2956.

Regence BlueCross BlueShield of Oregon portability plans

b. Life, Disability, AD&D and Long Term Care Insurance

You may self-pay for continuation of other PEBB sponsored benefit plans. The Benefits office will send you a notice. Your leave without pay or reduction in hours employment status is classified as either "medical" or "non-medical" for purposes of determining continuation privileges. The following chart indicates which coverage can or cannot be self-paid for a period of up to 12 months.

Continuation of Coverage Options

* If the reduction in hours is due to lack of work at the Agency's request and lasts less than 90 days, you may self pay coverage for up to 3 months.

** Faculty members on an approved temporary leave of absence for the purpose of conducting special research may self-pay during the first 15 months of leave.

2. Dependent Care and Health Care Flexible Spending Accounts

You may not continue participation in the dependent care or health care program. An employee must be working in order to participate in the program. You are not eligible to request reimbursement for dependent care or health care expenses when you are not at work.

3. Returning to Benefit Eligible Status

Returning to benefit eligible status after LWOP or reduction of hours means that after returning to work you are required to meet "half time" eligibility in the month they return to work to have coverage effective first of the following month.

Return to work in the same plan year

Contact the UO Benefits office to reinstate medical, dental, life and disability coverage in effect before you lost benefit eligibility. Dependent care flexible spending account deposits are reinstated if you did not revoke your participation in the program. Unum Long Term Care (LTC) insurance deductions are only reinstated if premiums are self-paid.

Return to work in a subsequent plan year

Contact the UO Benefits office to reinstate all medical, dental, life and disability coverage in effect before you lost benefit eligibility. If you were previously enrolled in a medical, dental, life and disability plan and it is no longer available, you will be required to submit the appropriate update or open enrollment form to have that type of coverage reinstated. You must re-enroll in the dependent care flexible spending account program to reinstate participation. Unum LTC insurance deductions are only reinstated if premiums are self-paid.

When you return to work in a subsequent plan year, you have the right to participate in a missed open enrollment period. Your agency must receive completed open enrollment forms within 60 days of your return to work from unpaid leave. For employees who regain eligibility for benefits following a reduction in hours, your agency must receive completed open enrollment forms within 60 days of your meeting the eligibility requirements. Open enrollment elections become effective the first of the month following receipt of your completed forms by the agency.

Special Notes -- Return to Benefit Eligible Status

• Qualified Family Status Change: If you experience a qualified family status change event during the time you are ineligible for active group benefits, you may request to change your benefits if your request is because of and corresponds with the change in status that affects eligibility for coverage. Your agency must receive completed update forms requesting a change within 60 days of the qualified family status change event or your return to work from unpaid leave. For employees who regain eligibility for benefits following a reduction in hours, your agency must receive completed update forms within 60 days of your meeting "half-time" eligibility requirements. Requests for changes become effective the first of the month following receipt of the completed update form by the agency. Qualified family status change
• Medical Insurance: The PEBB medical plans do not contain pre-existing condition clauses. Any portion of your deductible already met, if applicable, will be applied toward the annual amount within the same plan year.
• Dental Plans: On the ODS Preferred and Traditional dental plans, there is a 12-month waiting period when individuals are not enrolled at the time they are initially eligible or if there is a break in coverage greater than 12 months. During the waiting period, dental coverage is limited to preventive services and relief of pain. For orthodontic benefits, there is a 24-month waiting period.
• Disability Insurance: If you return within 90 days of the date of ineligibility and are still within the waiting period under the disability coverage, you will receive credit for the period of ineligibility. You will not be subject to new pre-existing condition limitations or exclusions and credit will be given for time served.
• Disability Insurance: If you return beyond 90 days of the date of ineligibility, pre-existing condition limitations will apply to all disability options unless you are returning from a medical leave of absence and were eligible for benefits under the short or long term disability plans during the leave.

Employee Responsibility

The information provided in this notice summarizes your eligibility for PEBB sponsored benefits plans. It is your responsibility to comply with the continuation of coverage requirements and the procedures to reinstate active group coverage. Any error or omission in this notice is unintentional. For detailed information, please refer to your individual insurance carrier member handbook or certificate, the PEBB Eligibility Handbook, and the PEBB Benefits Handbook. This information may also be accessed on-line at http://pebb.das.state.or.us. If there is a discrepancy between this notice and state and federal law or the plan document, the law or document will prevail.