OAR 459-035-0020: Eligibility, General

This rule describes the eligibility requirements for a person to be eligible to participate in a PERS-sponsored health insurance plan. An “eligible person” includes a retiree, a spouse, a dependent, a dependent domestic partner, and a surviving spouse or dependent. Each category of “eligible person” is defined as follows: (1) A retiree as defined in OAR 459-035-0001(14). (2) The spouse of a retiree. (3) A dependent means a dependent child as defined in OAR 459-035-0001(1) who satisfies one of the following requirements: (a) The child is less than 26 years of age; or (b) The child is 26 years of age or more and has either been continuously dependent upon the retiree since childhood due to disability or physical handicap, or has been covered under a health care insurance plan as the retiree’s dependent for at least 24 consecutive months immediately before enrollment in a PERS-sponsored health insurance plan. In either case, the following additional requirements must also be satisfied: (A) The child is not able to achieve self-support through his or her work due to a developmental disability, mental or physical handicap as verified by a physician and accepted by the carrier; and (B) The incapacity is continuous and began before the date the child would otherwise have ceased to be an eligible dependent. (4) A dependent domestic partner as defined in OAR 459-035-0001(2). (5) A surviving spouse or dependent means a person who is the surviving spouse or dependent of: (a) A deceased retiree; or (b) A deceased PERS member who was not retired but who was eligible to retire at the time of death; or (c) A deceased retiree who was receiving a retirement payment or benefit, or a pension calculated under ORS 1.314 to 1.380 (1989 Edition), provided that the person was covered under a PERS-sponsored health insurance plan at the time of the retiree’s death. (6) In no event shall an eligible person as defined in this rule be entitled to coverage under more than one PERS-sponsored medical, dental, or long term care insurance plan. (7) In no event shall an eligible person as defined in this rule be entitled to participate as a retiree and as a spouse, dependent, or dependent domestic partner.