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 link below: http://www.4j.lane.edu/hr/employeerelations/laboragreements/
Dependents
Q: Can I cover my dependents until age 26?
A: Yes. The age limit has not changed.
Q: What is OEBB’s definition of a dependent child?
“Child” means and includes the following:
(a) An eligible employee’s, spouse’s, or domestic partner’s biological son or daughter; adopted child; child placed for adoption; or legally placed child, who is 25 or younger on the first day of the month. An eligible employee must provide the required custody or legal documents to their Educational Entity showing proof of adoption, legal guardianship or other court order if enrolling a child for whom the employee, spouse, or domestic partner is not the biological parent. Grandchildren are only eligible when the eligible employee is the legal guardian or adoptive parent of the grandchild.
(b) A person who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. There is no age limit for a dependent child who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. When the dependent child is 26 years of age or older all the following requirements must be met:
A complete version of OEBB’s eligibility rules are at www.oregon.gov/das/oebb.
Q: What is the process to notify our insurance carrier that my child/dependent is disabled and request that they be allowed to remain covered beyond the age of 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 complete the Disabled Dependent Certification form which requires documentation from the childs attending physician. Documentation of the child’s medical condition must be reviewed and approved by the insurance carrier. 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.
Documentation can be submitted by mail or fax to:
ODS Health Plans
ATTN: Billing and Eligibility
601 S.W. Second Ave
Portland, OR 97204
Fax: (503) 243-5105
Retirees
For eligibility questions related to retirees, please see the FAQ page “Retiree Coverage”.
