OAR 471-070-2270: Equivalent Plans: Proration of Benefit Amounts for Simultaneous Coverage

(1) An employee is considered to have simultaneous coverage when the employee is covered by more than one employer’s equivalent plan at the same time or is covered by the state plan established in ORS 657B.340 and at least one employer with an equivalent plan, at the same time. An employee does not have simultaneous coverage if they work for multiple employers covered by the state plan. (2) An employee with simultaneous coverage at the start of a leave event shall apply separately under all plans they are covered under and from which they are taking leave by following the respective application guidelines for each plan. An equivalent plan employer may ask an employee whether the employee has additional Paid Family and Medical Leave Insurance (PFMLI) coverage but may not require that the employee provide details on the other employers or the plans. The employer, employee, or administrator may request information from the department as described in OAR 471-070-2260. (3) Each equivalent plan is required to pay benefit amounts that are equal to or greater than the benefits offered under the state plan as described in OAR 471-070-2260 and ORS 657B.050 and applicable administrative rules. Upon request, the department may provide information to equivalent plan employers or administrators regarding prorated benefit amounts, if the department is aware of simultaneous coverage. Each respective plan benefit amount shall be prorated by the average number of work days worked per work week by the claimant for each respective plan rounded to the nearest whole cent. When rounding, any number with the last figure five or greater is rounded up, while numbers less than five are rounded down. (a) The state plan shall pay benefits based on the prorated weekly benefit amount and shall further prorate the weekly benefit amount as described in OAR 471-070-1440 for leave taken in work day increments. (b) The equivalent plan shall pay benefits equal to or greater than the prorated weekly benefit amount and may further prorate the weekly benefit amount when leave is taken in work day increments based on the number of work days of leave taken in the work week. Example 1: Alondra is employed by two employers. One employer is a state plan employer and the other is an equivalent plan employer. Alondra works five days per work week for the state plan employer and three days per work week for the equivalent plan employer. Alondra is unable to work for both employers due to the need to provide care for a seriously ill parent for the next five weeks. Alondra must apply for benefits separately for the state plan and the equivalent plan. Alondra’s weekly benefit amount is $1,040. Alondra will receive two separate benefit payments each week. The state plan will pay the prorated weekly benefit in the amount of $650 [($1,040 weekly benefit amount divided by 8 total days worked at both jobs) x 5 days worked for the state plan employer]. The equivalent plan employer will pay at least the prorated weekly benefit in the amount of $390 [($1,040 weekly benefit amount divided by 8 total days worked at both jobs) x 3 days worked for the equivalent plan employer]. Example 2: Same typical work schedule and weekly benefit amount as in example 1; however, Alondra is unable to work for the state plan employer one day per work week and is unable to work for the equivalent plan employer one day per work week (for a total of two days of leave each week) to provide care for a seriously ill parent for the next five weeks. Alondra must apply for benefits separately for the state plan and the equivalent plan. Alondra’s weekly benefit amount is still the same at $1,040 (the state plan prorated weekly benefit amount is $650 and the equivalent plan prorated weekly benefit amount is at least $390). Because the leave is taken in work day increments and not an entire work week, once the prorated weekly benefit amount is determined, the state plan will further prorate the state’s weekly benefit amount by the number of work days on leave. The state plan will pay weekly benefits in the amount of $130 [($650 state plan portion of the weekly benefit amount divided by 5 work days) x 1 day on leave in the work week)]. The equivalent plan employer may choose to further prorate the weekly benefit amount by the number of work days on leave [($390 equivalent plan portion of the weekly benefit amount divided by 3 work days) x 1 day on leave in the work week) for a minimum weekly benefit amount of $130]. (4) The department shall calculate prorated benefit amounts when: (a) The department receives an application for an employee that provides current employment information from a state plan employer(s) and one or more equivalent plan employer(s). The department shall verify coverage under the equivalent plan as described in OAR 471-070-2230 to determine a prorated benefit amount for benefits offered under the state plan. (b) The department receives a request from an equivalent plan employer or administrator for an employee’s benefit information in accordance with OAR 471-070-2260. The department shall verify whether the employee has coverage under more than one equivalent plan and, if covered, include the prorated benefit amounts to the employer. The department will provide prorated benefit amounts to any other equivalent plan employer or administrator that covers the employee also. (5) Should the department receive information about changes in simultaneous coverage after information is provided to an equivalent plan employer or administrator in accordance with OAR 471-070-2260 and under this rule, the department shall calculate or re-calculate the proration, as applicable, and notify all employers, administrators, or employees of the change. Any overpayments made by the Paid Leave Oregon program shall be recovered in accordance with OAR 471-070-1510.