Q&A: Eligibility

Active Employees

Q: How do I know if I am eligible for benefits or not?

A: Benefits eligibility is defined in the Collective Bargaining Agreement or Statement of Understanding for each employee group.  These agreements can be viewed by clicking the appropriate link below:

Administrative   Classified   Licensed (not subs)   Licensed Substitutes

 

Dependents

Q: Can I still cover my dependents until age 26?   

A: Yes.  The age limit has not changed. 

Q: Is OEBB's definition of dependent different than what we were used to with Regence?   

A: It is slightly more specific, yes.  Biological, step and adopted children under age 19 are eligible for coverage under OEBB benefit plans. Eligible employees also may obtain coverage for dependent children that are legal wards of the court or that they, their spouses, or domestic partners are required to support.
 
Dependent children age 19 to 25 are eligible for coverage if they are:

  • Attending school full time, excluding foreign students; or
  • Living in the home of the eligible employee more than six months of the calendar year, and the eligible employee provides over half the yearly support; or
  • Incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability.

Dependent children age 26 or older are eligible for benefit coverage if they are incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability and were covered under a district plan prior to reaching the age of 26.  

Dependent children of all ages must be unmarried and not have a domestic partner to participate in OEBB-sponsored benefit plans.
 
A complete version of OEBB’s eligibility rules are at www.oregon.gov/das/oebb.

Q: How do I get ODS to certify my incapacitated/disabled dependent so they will continue to cover them past age 26?   
A: If a member has a child who has sustained a disability rendering him/her physically or mentally incapable of self-support, that child may be eligible for coverage even though he or she is over 26 years old. To be eligible, the child must be unmarried and principally dependent on the member for support. The incapacity must have arisen before the child's 26th birthday. The member must provide ODS with a written physician’s statement that confirms that these conditions existed continuously prior to the child’s 26th birthday. Documentation of the child’s medical condition must be reviewed and approved by the ODS medical consultant. Periodic review by the medical consultant will also be required on an ongoing basis. Dependents on full-time duty in the active military service of the United States are not eligible. This includes members of the Reserve Components serving on active duty or full-time training duty. Disabled children who live in group homes or other facilities, who are still dependent on their parents for support, would continue to be eligible for benefits past age 26 if they meet the disability criteria. ODS will continue to provide coverage as long as the dependent meets the appropriate criteria.

 

Documentation can be submitted by mail or fax to:

 

ODS Health Plans

PO Box 40384

ATTN: Healthcare Services

Portland, OR 97240

 

Fax: (503) 243-5105

 

 

Retirees

For eligibility questions related to retirees, please see the FAQ page "Retiree Coverage"

 

 



Last updated on June 5, 2009 - 5:04pm