DEFINITIONS
101-010-0005
Definitions
Unless the context indicates otherwise, as used in OAR chapter 101, divisions 1 through 60, the following definitions will apply:
(1) "Actively at work" for medical and dental insurance coverage means an active eligible employee at work, in paid regular status and scheduled for work during the month of requested insurance coverage, or using accrued leave on the effective date of coverage. Reference optional insurance polices or certificates for plan specific “actively at work” criteria.
(2) “Active Participation” in reference to a Flexible Spending Account (FSA) means an eligible employee currently enrolled and who contributes each month to the account.
(3) "Affidavit of Dependency" means a notarized document that attests a dependent child meets the criteria in section OAR (101-015-0011).
(4) "Affidavit of Domestic Partnership" means a notarized document that attests the eligible employee and one other individual meet the criteria in OAR 101-015-0025(2).
(5) "Benefit amount" means the amount of money paid by a PEBB participating organization on behalf of active eligible employees for the purchase of benefit plans.
(6) "CBIW" means Continuation of Benefits for Injured Workers.
(7) “Certificate of Registered Domestic Partnership” means the certificate issued by an Oregon county clerk to two individuals of the same sex after they file a Declaration of Domestic Partnership with the county clerk.
(8) “COBRA” means the federal Consolidated Omnibus Reconciliation Act.
(9) “Dependent Care Flexible Spending Account (FSA)” means the dependent care assistance program.
(10) "Dependent child" is defined by OAR 101-015-0011
(11) "Domestic partner" means an eligible employee's partner in a registered domestic partnership under Chapter 99 Oregon Laws 2007 or unmarried partner of the same or opposite sex that meets the requirements as outlined in OAR 101-015-0025(2).
(12) "Eligible employee" means and includes:
(a) "Active eligible employee" means an employee of a PEBB participating organization, including state officials, in exempt, unclassified, classified and management service positions who are expected to work at least 90 days; and who work at least half-time or are in a position classified as job share.
(b) "Retired eligible employee" means a previously active eligible employee, who meets retiree eligibility as defined in OAR 101-050-0005. A retired eligible employee is eligible only for those benefit plans established in division 50 of this chapter.
(c) "Other eligible employees" means individuals of self-pay groups as established by ORS 243.140 and 243.200. This group is eligible only for medical or dental benefits as approved by PEBB.
(13) "Family member" means a spouse or dependent child.
(14) "FMLA" means the federal Family Medical Leave Act.
(15) "FTE" means full time equivalent job position.
(16) "Half-time" means an eligible employee who works less than full time but at least:
(a) Eighty paid regular hours per month; or
(b) Eighty paid regular hours per month or .5 FTE for OUS employees; or
(c) Eighty paid regular hours per month and is in a .5 FTE position for the Oregon Judicial Department; or
(d) As defined by collective bargaining.
(17) “Health Flexible Spending Account (FSA)” means the health flexible spending arrangement.
(18) "Imputed value" means a dollar amount established yearly for an insurance premium at fair market value. The IRS views the imputed value as taxable income. The imputed value dollar amount is added to the eligible employee's taxable wages.
(19) "Ineligible individual" means an individual who does not meet the definition of an eligible employee, spouse, domestic partner, or dependent child.
(20) "Job share" means two eligible employees sharing one full time equivalent position. Each eligible employee's percentage of the total position determines the benefit amount the employee receives. The monthly benefit percentage amount remains the same regardless of individual hours worked per month. Job share employees may not donate their portion of the benefit amount to the job share co-worker.
Example 1: John and Jill share one full time equivalent position. When they were hired into the position in July, John's percentage of the total position was 40 percent; Jill's percentage was 60 percent. John worked 70 percent of the available hours in September. John's benefit amount percentage for September remains at 40 percent. Jill's benefit amount percentage remains at 60 percent.
(21) "OFLA" means the Oregon Family Leave Act.
(22) “OSPS” means the Oregon State Payroll System.
(23) “OUS” means the Oregon University System.
(24) "Open enrollment period" means an annual period chosen by PEBB when both active and other eligible employees and COBRA participants can make benefit plan changes or elections for the next plan year.
(25) “Optional insurances” means, but is not limited to:
(a) Dependent life insurance;
(b) Employee, spouse, or domestic partner life insurance;
(c) Accidental Death & Dismemberment (AD&D) insurance;
(d) Short Term Disability insurance;
(e) Long Term Disability insurance;
(f) Flexible Spending Accounts (Health and Dependent Care); and
(g) Long Term Care insurance.
(26) "Paid regular" means in current payroll status, and receiving payment for work time including vacation, sick, holiday or personal leave and compensatory time.
(27) "Pebb.benefits" means the electronic benefit management system sponsored by PEBB. The system allows electronic enrollment and termination of the eligible individual's benefit plans, personal information updates, and the transmittal of data to plans, payroll centers, and third party administrators.
(28) "PEBB participating organization" means a state agency, board, commission, university, or other entity that receives approval to participate in PEBB benefit plans.
(29) "Plan change period" means a period chosen by PEBB when retirees can make limited benefit plan changes.
(30) "Plan year" means a period of twelve consecutive months.
(31) "Qualified status change" (QSC) means a change in family or work status that allows limited mid-year changes to benefit plans consistent with the individual event.
(32) "Reinstate” means to reactivate previous benefits and enrollments, if available, to an eligible employee returning to eligible status within a specific time frame. Reinstated enrollment does not include FSA or Long Term Care.
(32) "Spouse" means a person of the opposite sex who is a husband or wife. A relationship recognized as a marriage in another state between two opposite sex partners will be recognized in Oregon even though such a relationship would not be a marriage if the same facts had been relied upon to create a marriage in Oregon. The definition of spouse does not include a former spouse and a former spouse does not qualify as a dependent.
Stat.
Auth.: ORS 243.061 - 243.302
Stats.
Implemented: ORS 243.061 - 302, 659A.060 - 069, 743.600 - 602, 743.707
Hist.:
PEBB 1-1999, f. 12-8-99, cert. ef. 1-1-00; PEBB 1-2000, f. 11-15-00, cert. ef. 1-1-01;
PEBB 1-2001, f. & cert. ef. 9-6-01; PEBB 1-2002, f. 7-30-02, cert. ef. 8-1-02;
PEBB 1-2003, f. & cert. ef. 12-4-03; PEBB 1-2004, f. & cert. ef. 7-2-04;
PEBB 3-2004, f. & cert. ef. 10-7-04; PEBB 3-2005, f. 8-31-05, cert. ef. 9-1-05;
PEBB 2-2006(Temp), f. & cert. ef. 12-14-06 thru 6-12-07; PEBB 1-2007(Temp),
f. & cert. ef. 6-11-07 thru 12-8-07; PEBB 2-2007, f. 9-28-07, cert. ef. 10-1-07;
PEBB 1-2008(Temp), f. & cert. ef. 2-4-08 thru 8-1-08; PEBB 2-2008, f. &
cert. ef. 8-1-08; PEBB 3-2009, f. 9-29-09 cert. ef. 10-1-09
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