Return to Benefit Eligible Status

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.

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 theUO Benefits Office at 541-346-3085 or e-mail email 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 at 541-346-3085 or e-mail email 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.
  • 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.

 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://www.oregon.gov/oha/pebb/pages/index.aspx. If there is a discrepancy between this notice and state and federal law or the plan document, the law or document will prevail.