Or. Admin. Code § 101-020-0015 - Opting Out of Medical Insurance Coverage
(1) A benefit eligible employee can Opt Out
of medical coverage and receive cash in lieu of medical insurance coverage.
PEBB determines the amount of cash paid to an employee who Opts Out of medical
coverage. Opt Out cash is included in employee income and is subject to
taxes.
(2) Opting Out of medical
coverage is an enrollment choice, it is not an enrollment in a PEBB medical
plan.
(3) PEBB can require eligible
employees who enroll in Opt Out to also enroll in other core benefits, such as
dental, vision, and employee basic life coverage. Opt out enrolled employees
who enroll for a core benefit plan are responsible to pay any premium share
required.
(4) Eligible employees
choosing to enroll in medical Opt Out must have minimum essential medical
coverage for themselves and all other individuals for whom the employee can
reasonably expect to claim a personal tax exemption deduction for. The
alternative medical coverage must be a group sponsored medical plan. The
employee must attest to the coverage at enrollment and annually
thereafter.
(5) The agency or PEBB
will cancel an employee's Opt Out enrollment when the attestation is not
completed during initial enrolment or annually during the open enrollment
period. If the Opt Out election is cancelled:
(a) The agency will enroll a new benefit
eligible employee in the Employee Only tier of a PEBB medical plan that
provides statewide coverage. All other employee plan elections will take effect
as enrolled.
(b) When the Opt Out
enrollment is to replace an enrolled employee's PEBB medical plan, the employee
and any eligible dependents will reinstate to the previous medical plan. All
other employee plan elections will take effect as enrolled.
(6) An employee is not eligible
for Opt Out if their alternative group medical coverage is one of the following
Medicaid, Veterans' Administration Health Benefit Programs, Student Health
Insurance, or individual market coverage.
(7) An employee enrolled in Opt Out will not
receive money in lieu of a PEBB medical plan enrollment when he or she is in a
leave without pay status, regardless if the leave is a protected leave; e.g.,
FMLA, CBIW, Military Duty, etc., or other administratively approved
leave.
(8) Employees enrolled in
Opt Out experiencing a federal HIPAA Special Enrollment Right event are
eligible for a qualified midyear change medical plan enrollment, for example, a
loss of group medical coverage, or a change in family status such as a birth,
adoption, etc.
(9) A PEBB retiree
enrolled in the PEBB retiree or COBRA plan receiving a premium subsidy, such as
an early retirement premium subsidy, returning as an active benefit eligible
employee, and choosing to continue coverage under the retiree or COBRA plan is
not eligible to enroll for Opt Out as an active employee.
(10) Opt Out cash will not be paid if the
agency or PEBB has knowledge or reason to know that the employee or any other
member of the employee's expected tax family does not have or will not have the
required alternative coverage.
Notes
Stat. Auth.: ORS 243.061 - 243.302
Stats. Implemented: ORS 243.061 - 243.302
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