Oregon Health Authority
Oregon Educators Benefit Board - Chapter 111
Division 40
ENROLLMENT
111-040-0011
Returning to Benefit Eligible Status
(1) A former Eligible Employee returning to benefit-eligible status with the same Entity following an unpaid leave of absence, or termination of employment, or returning from a strike, lock-out, layoff, within six months of the date eligibility was lost will have their benefit plans and coverages reinstated.
(a) All coverages and plans previously enrolled in will be effective the first of the month following the date eligibility is regained, unless otherwise stipulated in a collective bargaining agreement or documented Entity policy in effect on or before May 1, 2013.
(b) The 12-month late enrollment waiting period for dental and/or vision coverage will only apply if it was in effect at the time coverage was initially lost.
(c) Plan changes or changes to covered dependents may only be made if:
(A) A Qualified Status Change occurred during the period of ineligibility, consistent with OAR 111-040-0040, and requested within 31 days of returning to benefit-eligible status, or
(B) Benefits are being reinstated in a new plan year from which benefits were initially lost.
(2) If reinstatement occurs within the same plan year, medical, dental and vision coverage will be reinstated at the same level as was in effect immediately prior to the loss of eligibility. (i.e., dental incentive levels, amounts applied toward deductibles, annual maximum out-of-pockets and benefit maximums, and benefits beyond routine and basic dental and vision), if applicable.
(3) The Uniformed Services Employment and Reemployment Rights Act (USERRA). USERRA gives an employee and previously covered dependents the right to reinstate coverage upon returning to employment with the Entity in a benefit eligible position with no waiting period.
Statutory/Other Authority: ORS 243.860 – 243.886
Statutes/Other Implemented: ORS 243.864(1)(a)
History:
OEBB 2-2014, f. & cert. ef. 3-7-14
OEBB 23-2013(Temp), f. & cert. ef. 12-27-13 thru 6-25-14
OEBB 3-2013, f. & cert. ef. 4-26-13