Dependent Health Insurance

• Your spouse, as long as he or she is not also enrolled separately as an eligible state employee or retiree.
• Your unmarried children by birth, legal adoption, or legal guardianship who are in your custody and dependent on you for support.

In the case of legal adoption, a child is eligible for coverage as of the date of placement. Placement occurs when you become legally obligated for the total or partial support of the child in anticipation of adoption.

In the case of legal guardianship, eligibility for coverage ceases when the child reaches age 18 or upon your death, whichever occurs first.

Continuing coverage after age 19

Coverage for your eligible children ceases the end of the month in which they turn age 19. However, if your coverage is still active, your dependent by birth or legal adoption can remain eligible through the month in which the child turns age 25 or graduates, whichever comes first, if he or she is an unmarried student who regularly attends school and is dependent on you for financial support.

If your enrolled dependent is an incapacitated child, coverage will continue as long as he or she became incapacitated before age 19, continues to be incapacitated, and your coverage does not terminate for any other reason. Incapacitated children are those who are unable to earn a living because of a mental or physical impairment and must depend on their parents for support and maintenance. You must furnish proof of incapacitation and proof of dependency before the end of the month in which the child turns age 19.

You may be asked to provide tax returns as proof of dependency and school records as proof of school attendance.

Note: Recent national health care legislation extends coverage to adult children through age 26 for active employee plans, but this does not apply to retiree health plans.

Reporting changes for your dependents

It is your responsibility to notify ORS of any change in your status or that of your family that would result in ineligibility, or of coverage under any other group insurance including Medicare. We will adjust your premium deductions if necessary, but we cannot refund premiums that were withheld before the month in which you report the change.

To report changes, log into miAccount, navigate to the Insurance Coverage section, make your changes, and mail us the required proofs if necessary. You can also use the Insurance Enrollment/Change Request (R0452H).

You can also use miAccount to add or change the name of someone on your health, dental, or vision insurance contract. If you're adding a spouse or dependent due to marriage, birth, or adoption, be sure send a copy of the marriage, birth, or adoption certificate within 30 days of the event so the 6-month waiting period can be waived. If we do not receive the proofs on time, you will be subject to a 6-month waiting period from the time we receive all proofs.

Do not mail in original documents, as they will not be returned.

COBRA protects your dependents after eligibility stops

If one of your dependents loses insurance eligibility, he or she may be able to pay for continued coverage for a limited time. A federal law known as the Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows your spouse or child the option of paying for continued health insurance coverage for up to 36 months after a qualifying event that results in loss of eligibility. The retiree or affected family member must notify us within 30 days of the date of the qualifying event and request an Application for Continuation of Insurances (CS-1767). Your health insurance carrier may also offer a conversion policy for your dependents. Contact the insurance carrier for more information.