OAR 471-070-2220: Equivalent Plans: Plan Requirements

In order for an equivalent plan to be approved by the department, the plan must at a minimum: (1) Cover all Oregon employees who have been continuously employed with the employer for at least 30 calendar days, regardless of hours worked, including full-time, part-time, temporary workers hired by the employer, and replacement employees hired to temporarily replace eligible employees during Paid Leave Oregon leave. Any employees who were eligible for benefits under their previous Oregon employer’s equivalent plan, who begin working for a new employer with an approved equivalent plan, must be automatically covered for benefits under the equivalent plan offered by the new employer as described in ORS 657B.250; (2) Provide family leave as described in ORS 657B.010(18) and applicable administrative rules; (3) Provide medical leave as described in ORS 657B.010(20) and applicable administrative rules; (4) Provide safe leave as described in ORS 657B.010(22) and applicable administrative rules; (5) Allow eligible employees to take family leave, medical leave, or safe leave in a benefit year for periods of time equal to or longer than the duration of leave provided under ORS 657B.020; (6) Provide eligible employees weekly benefit amounts equal to or greater than benefits provided under ORS 657B.050; (7) Allow family leave, medical leave, or safe leave to be taken in increments or nonconsecutive periods as provided under ORS 657B.090; (8) Impose no additional conditions or restrictions on the use of family leave, medical leave, or safe leave beyond those explicitly authorized by ORS chapter 657B and applicable administrative rules; (9) Provide that the employee contributions withheld by an equivalent plan shall not be greater than the employee contributions that would be charged to employees under ORS 657B.150 and determined annually under OAR 471-070-3010; (10) Ensure employee contributions that are received or retained under an equivalent plan are used solely for equivalent plan expenses, are not considered part of an employer’s assets for any purpose, and are held separately from all other employer funds; (11) Meet all equivalent plan requirements provided in ORS 657B.210 and applicable administrative rules; (12) Provide for decisions on benefit claims, to be in writing, either in hard copy or electronically if the employee has opted for electronic notification. Decisions on benefit claim approvals must include the amount of leave approved, the weekly benefit amount, and a statement indicating how the employee may contact the department to request the eligible employee’s average weekly wage amount if the employee believes the benefit amount may be incorrect. Denial decisions must include the reason(s) for denial of benefits along with an explanation of an employee’s right to appeal the decision and instructions on how to submit an appeal. (13) Provide an appeal process to review benefit decisions when requested by an employee that also requires the employer or administrator to issue a written decision. The employee must have at least 60 calendar days from the date of the written denial to request an appeal with the employer or administrator, if applicable, or as soon as practicable if there is good cause for the delay beyond the 60 calendar days as described in OAR 471-070-2400(8). The employee, and the employer, or administrator have 20 calendar days from the date the appeal is received, or as soon as practicable if there is good cause as described in OAR 471-070-2400(8), to resolve the appeal and for the employer or administrator to issue a written appeal determination letter along with an explanation of the department’s dispute resolution process as described in OAR 471-070-2400 if an appeal is denied; (14) Provide that the equivalent plan employer or administrator must make all reasonable efforts to make a decision on whether to allow the claim and issue the first payment of any benefits to an employee within two weeks after receiving the claim or the start of leave, whichever is later. Subsequent benefit payments must be provided weekly by a fully insured equivalent plan and benefit payments may be paid according to the existing paycheck schedule for employees under an employer administered equivalent plan; and (15) Ensure a written notice poster for the equivalent plan as described in OAR 471-070-2330, will be given to all employees, at the time of hire and each time the policy or procedure changes, in the language that the employer typically uses to communicate with the employee.