Oregon Health Authority
Public Employees' Benefit Board - Chapter 101
Division 20
ENROLLMENT RULES
101-020-0045
Returning to Work
(1) Refer to the following rules for an employee returning to paid regular status from the following leave status:
(a) Continuation of Benefits for Injured Workers (CBIW). See OAR 101-030-0010.
(b) Federal Family Medical Leave Act (FMLA). See OAR 101-030-0015.
(c) Oregon Family Leave Act (OFLA). See OAR 101-030-0015.
(d) Active Military Duty Leave (USERRA). See OAR 101-030-0022.
(2) A benefit eligible employee who is not in a current benefit eligible stability period and is returning to paid regular status must work at least half-time in the month of return to be eligible for core benefits and optional plan coverage the following month if returning from:
(a) A leave without pay that is not listed in subsection (1) of this rule and has a break in active employee coverage; or
(b) A reduction in hours below benefit eligibility criteria, unless the employee is a benefit eligible employee in a job share position.
(3) Any benefit eligible employee returning to paid regular status within 30 days without a break in core coverage from either a leave not listed in (1) of this rule or from an employment termination will have all available previous coverage reinstated. The employee cannot make benefit plan changes. A benefit eligible employee who:
(a) Is not in a current benefit eligible stability period, must work at least half-time in the month of return for benefits to be active the following month.
(b) Is in a current benefit eligible stability period will receive benefits in the month following the return to work regardless of the number of paid regular status hours in the month of return.
Example 1: Gary is employed by an agency and receives PEBB benefits. On May 20 Gary begins a leave without pay that does not provide for continued benefits throughout the leave. Gary worked more than 80 hours in May, and the agency correctly schedules his benefit coverage end date as June 30. Gary returns to paid regular status June 5, within 30 days of the leave start and with no break in core coverage. If Gary is in a current benefit eligible stability period, his return to paid regular status will reinstate his coverage for July 1. If he is not in a current benefit eligible stability period, he must work 80 hours in June for his coverage to continue in July. Gary cannot make any election changes to his enrollments.
Example 2: Mark terminates employment at his agency on May 31. At the time of his termination he is in a current benefit stability period. . Mark had 80 paid hours in the month of May; therefore, his agency ends his coverage on June 30. Mark is rehired by an agency as a temporary employee, his hire date is July 1. This is less than 30 days; however, a break in coverage occurred on June 30. Even if Mark is in a current benefit eligible stability period his benefits will not be reinstated until August 1.
(4) A temporary or impermanent position benefit eligible employee who is in a current benefit eligible stability period and has no hours of service for either 13 weeks, or a period lasting at least four weeks and longer than the employee’s prior employment, is considered a new employee upon return to regular pay status. Benefits are not reinstated.
(5) A permanent previously benefit eligible employee returning to a permanent benefit eligible position within 12 months of the prior core benefit termination date is not required to work at least half-time in the month of return to be eligible for benefits the following month. The agency will reinstate the previous plan enrollments, if available, effective the first of the month following the employee’s return to work. The reinstatement excludes Health and Dependent Care Flexible Spending Accounts, Commuter Accounts, and Long Term Care. The employee may make midyear plan changes to their enrollments within 30 days of the return to work date. This rule applies regardless of the employee’s current stability period status.
(6) A permanent benefit eligible employee who terminates employment for at least 13 weeks, and later returns to work must start a new initial measurement period.
(a) When returning to a permanent position benefits are reinstated according to (5) or (6) of this rule.
(b) When returning as a temporary worker the employee is not reinstated to benefits and will enroll for benefits according to temporary employee benefit policy.
(7) Any previously active benefit eligible employee returning to paid regular status in a benefit eligible position after a termination of core benefits of 12 months or longer must enroll as a newly eligible employee.
Statutory/Other Authority: ORS 243.061 - 302
Statutes/Other Implemented: ORS 243.061 - 302 & 659A.060-069
History:
PEBB 2-2017, f. & cert. ef. 8-17-17
PEBB 1-2015, f. & cert. ef. 5-12-15
PEBB 3-2014(Temp), f. & cert. ef. 11-12-14 thru 5-10-15
PEBB 7-2010, f. 12-10-10, cert. ef. 1-1-11
PEBB 3-2009, f. 9-29-09 cert. ef. 10-1-09
PEBB 2-2008, f. & cert. ef. 8-1-08
PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07
PEBB 3-2005, f. 8-31-05, cert. ef. 9-1-05
PEBB 3-2004, f. & cert. ef. 10-7-04
PEBB 1-2004, f. & cert. ef. 7-2-04
PEBB 1-2002, f. 7-30-02, cert. ef. 8-1-02
PEBB 1-2001, f. & cert. ef. 9-6-01
PEBB 1-2000, f. 11-15-00, cert. ef. 1-1-01
PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00