Oregon Administrative Rules › Chapter 471 - EMPLOYMENT DEPARTMENT › Division 70 - Paid Family Medical Leave Insurance › Section 471-070-2220 - Equivalent Plans: Plan Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
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 PFMLI 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(17)
			 and applicable administrative rules;
(3) Provide medical leave as described in ORS
			 657B.010(19)
			 and applicable administrative rules;
(4) Provide safe leave as described in ORS
			 657B.010(21)
			 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(7). 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(7), 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 eligible
			 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.
Statutory/Other Authority: ORS
				  657B.340
Statutes/Other Implemented: ORS
				  657B.210