Oregon Administrative Rules › Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD › Division 15 - ELIGIBILITY › Section 101-015-0011 - Dependent Child

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 dependent child must meet the following eligibility conditions to receive PEBB
			 health plan coverage:
(a) The child is:
(A) An eligible employee's, spouse's, or
			 domestic partner's son, daughter, stepson, stepdaughter, adopted child;
			 or
(B) A Child by Affidavit which
			 includes but is not limited to a foster child, grandchild, child placed for
			 adoption, or court ordered placement of a child who lives in the household of
			 the eligible employee, and is the eligible employee's IRS dependent. The
			 employee must provide court ordered documentation of guardianship and the
			 notarized Affidavit of Child Dependency upon enrollment. The exception would be
			 newborns or adopted children who are automatically covered as an eligible PEBB
			 individual the first 31 days from birth or placement without documentation and
			 Affidavit in place. The Affidavit and documentation must be on file the first
			 of the month following the event date in order to meet eligibility and continue
			 coverage under the PEBB plans. Coverage ends the last day of the month in which
			 the court ordered guardianship ends or age 18, whichever comes first. An
			 eligible employee may not add a child by affidavit age 18 or older to PEBB
			 coverage unless they can provide court ordered documentation for responsibility
			 of the child beyond the age of 18; or,
(C) The biological child of an eligible
			 dependent child of an eligible employee, spouse, or domestic partner (a
			 grandchild by affidavit) and meets all the following criteria:
(i) The child's parent will not be older than
			 age 26, is unmarried and without a domestic partner. Both the child's parent
			 and the child live in the household of the eligible employee, and both the
			 child and grandchild are the eligible employee's IRS dependent and must claim
			 both child and grandchild on their most recent years tax return. The child's
			 parent has PEBB health coverage through the eligible employee. The grandchild
			 is automatically covered as an eligible PEBB individual the first 31 days from
			 birth without documentation and Affidavit in place. The Affidavit and any
			 appropriate documentation must be on file the first of the month following the
			 event date to meet eligibility and continue coverage under the PEBB rules. An
			 eligible employee may not add a grandchild age 18 or older to their PEBB
			 coverage unless they can provide court ordered documentation for responsibility
			 of the child beyond the age of 18.
(ii) Once the child no longer meets the
			 requirements of section (5) of this rule, the child and grandchild will no
			 longer be eligible.
(D)
			 Covered if the eligible employee loses their spouse or domestic partner by
			 death, the dependents (i.e. child of domestic partner, stepchild, grandchild)
			 may continue PEBB health plan coverage provided they are currently enrolled,
			 and eligibility is still being met. For biological, stepchildren or children of
			 domestic partners, coverage ends the last day of the month in which they turn
			 26. For Child by Affidavit of Dependency, coverage ends the last day of the
			 month in which the court ordered guardianship ends or age 18. For Grandchild by
			 Affidavit, eligibility ends when the grandchild no longer meets the definition
			 of Grandchild by Affidavit.