ORS Public School Employees - Enrollment: When Coverage Begins

Enrollment: When Your Coverage Begins

Insurance coverage always begins on the first day of a month.

Your timelines and enrollment process will depend on whether you, your spouse, and eligible dependents are:

Enrolling at retirement.
Enrolling after retirement.
Changing plans.

Enrolling at retirement

Retiree coverage for yourself, your spouse, and dependents can begin on your retirement effective date or up to 90 days past your retirement date if you will have insurance coverage with your school employer after you retire. Make sure you determine the correct effective date and submit your application and proofs in a timely manner so you don't have a break in your coverage and you won't be duplicating coverage. Check with your school employer to find out when your present insurance plan(s) will terminate and review the timely application and proofs section. Determining the correct effective date is very important because we can't refund any premiums once they have been withheld from your pension.

Personal Healthcare Fund

If you have the Personal Healthcare Fund (PHF) you must enroll at retirement.

Timeline for your enrollment effective date at retirement

timeline

To ensure your coverage begins on your requested insurance enrollment date, follow these guidelines for submitting your insurance enrollment and required proofs.

Health Insurance and Prescription Drug Coverage: To ensure your health and prescription drug insurance enrollment begins on your requested insurance enrollment date, follow these guidelines for submitting your insurance enrollment and required proofs.

Non-Medicare: If your request and all required proofs are received the month prior to your retirement effective date, your insurance coverage can begin as of your retirement effective date. If your request and all required proofs are received in the month of your retirement effective date, your coverage can begin the first of the following month. If your request and all required proofs are received more than 30 days after your retirement effective date your coverage will begin the first of the sixth month after your request and all required proofs have been received.
Medicare: If your request and all required proofs are received more than one month prior to your retirement effective date, your insurance can begin as of your retirement effective date. If your request and all required proofs are received in the month prior to your retirement effective date, your coverage will begin the first of the second month. If your request and all required proofs are received within 30 days of your retirement, your coverage will begin the first of the second month. If your request and all required proofs are received more than 30 days from your retirement effective date, your coverage will begin the first of the sixth month after the request and proofs have been received.

Dental and Vision Coverage

For all applicants, your dental and vision insurance coverage can begin the first of the month after we receive your completed application and proofs.

If you have a retroactive retirement date

Insurance enrollments are not retroactive. Coverage can begin no earlier than the first day of the month after the enrollment request and required proofs are received for non-Medicare enrollees, and will begin no earlier than the first of the second month if the enrollee is on Medicare. This applies even if your retirement effective date is retroactive.

For disability retirees

If you are a disability pension recipient, insurance coverage will begin (after you apply) on your retirement effective date or the first of the month following approval of your disability, whichever is later.

Enrolling after retirement

If you have the premium subsidy benefit and are enrolling yourself, your spouse, or dependents in insurance after retirement, your coverage will begin on the first day of the sixth month after ORS receives all required forms and proofs (unless you have a qualifying event). For example, if we receive your Insurance Enrollment/Change Request (R0452C) form with proofs on Feb. 10, your coverage would begin Aug. 1 (see timeline below).

Do you have premium subsidy or do you have Personal Healthcare Fund?

If you aren't sure whether you have the Personal Healthcare Fund or the premium subsidy, log in to miAccount and refer to your Account Summary.

Personal Healthcare Fund

If you have the Personal Healthcare Fund, you cannot enroll in any insurance plan after your retirement effective date.

Timeline for enrollment without a qualifying event

timeline

If you have a qualifying event

If you, a spouse, or an eligible dependent have a qualifying event (such as change in family status or involuntary loss of other group coverage), and you have the premium subsidy benefit, your coverage can begin as early as the first of the month after you apply and we receive the required proofs. Refer to the timely application and proofs section for more details on required time frames.

If you have the Personal Healthcare Fund, you cannot enroll in any insurance plan after your retirement effective date.

ORS must receive your completed application and proofs within 30 days of the qualifying event. If you do not meet this time frame, your insurance coverage will begin the first day of the sixth month from the date we received your completed application and proofs.

If ORS receives your completed application and proofs within 30 days of the qualifying event, and you meet other eligibility requirements, your start date depends on if you have Medicare, and when you submit your request and proofs.

Non-Medicare: For retirees who do not have Medicare, coverage can begin the first of the month after we receive your completed application and proofs. For example, if ORS receives your application and proofs July 10, your coverage will begin Aug. 1

Medicare: For retirees with Medicare, your coverage can begin the first of the second month after we receive your request and proof of the qualifying event. For example, if ORS receives your application and proofs of qualifying event July 10, your coverage will begin Sept. 1. Learn more about how Medicare works with your coverage.

Qualifying Event Examples

The following are considered qualifying events for the purpose of adding or removing a dependent. You will need to provide proof of the qualifying event. Photocopies of proofs are acceptable. See the Proofs Required for Insurance Coverage table below for more details.

Involuntary loss of coverage in another group plan. Provide a statement on letterhead from the terminating group insurance plan explaining who was covered, what type of coverage it was, why coverage is ending, and the date coverage ends.
Adoption. Acceptable proof is adoption papers. See Dependent Coverage for more information.
Birth. Acceptable proof is a birth certificate.
Divorce. For enrollment, provide a statement on letterhead from the terminating group insurance plan explaining who was covered, what type of coverage it was, why coverage is ending, and the date coverage ends. For disenrolling a former spouse, no proof is needed.
Marriage. Acceptable proof is a government-issued marriage certificate and spouse's birth certificate - both are needed.

If you're changing insurance coverage, ORS will adjust your premiums, if needed, the month your insurance becomes effective. We cannot refund premiums withheld before or in the month you report the change. If you are adding a spouse or dependent due to marriage, birth, or adoption, be sure to submit the request and proofs within 30 days of the event or their coverage will begin on the first day of the sixth month after ORS receives the required forms and proofs.

Non-Qualifying Events

The following examples are not considered qualifying events for the purpose of adding or removing a dependent:

Dropping other coverage because rates increase.
Receiving a stipend in lieu of coverage.
Termination of coverage for failure to pay your premiums.
Lapse of coverage due to late enrollment in Medicare.

Changing plans

If you are currently enrolled in any health insurance plan with the retirement system, you can change your enrollment to another plan regardless of your Medicare status. Your change in coverage will be the first day of the second month after your request and required proofs are received. For example, if ORS receives your change request and any required proofs on Jan. 10, your coverage with the new plan will begin on March 1.

Required Proofs for Enrollment

If you want to…
Enroll your spouse in insurance	If enrolled in Medicare or other insurance plan	Medicare information: Medicare number. Medicare effective dates. Insurance plan information, including: Policy number. Type of coverage (health, dental, vision, prescription drug). Who is enrolled.

Enroll your dependent in insurance (under age 19)	Must have:	Birth certificate for each dependent.
	If you are the adoptive parent	Sworn statement with the date of placement or a court order verifying placement is required.
	If enrolled in Medicare or other insurance plan	Medicare information: Medicare number. Medicare effective dates. Insurance plan information, including: Policy number. Type of coverage (health, dental, vision, prescription drug). Who is enrolled.

Enroll your dependent in insurance (age 19 or older)	Must have:	Birth certificate for each dependent. School records as proof of full-time attendance, which must include: Dependent's name. Dates enrolled. Name of institution. Number of credit hours, or that student is deemed full time. IRS Form 1040 that identifies the child as your dependent or a letter from your tax preparer (on letterhead) declaring your dependent is eligible but files their own taxes.
	If you are the legal guardian	Court orders to prove guardianship.
	If you are the adoptive parent	Sworn statement with the date of placement or a court order verifying placement is required.
	If enrolled in Medicare or other insurance plan	Medicare information: Medicare number. Medicare effective dates. Insurance plan information, including: Policy number. Type of coverage (health, dental, vision, prescription drug). Who is enrolled.

Enroll your disabled dependent in insurance	Must have:	Birth certificate for each dependent. Current letter from the attending physician detailing the disability, stating the child is Totally and permanently disabled, and Incapable of self-sustaining employment. IRS Form 1040 that identifies the child as your dependent.
	If you are the legal guardian	Court orders to prove guardianship.
	If you are the adoptive parent	Sworn statement with the date of placement or a court order verifying placement is required.
	If enrolled in Medicare or other insurance plan	Medicare information: Medicare number. Medicare effective dates. Insurance plan information, including: Policy number. Type of coverage (health, dental, vision, prescription drug). Who is enrolled.

Prove your involuntary loss of coverage, verifying your qualifying event	Must have:	Statement on letterhead from the terminating group insurance plan explaining Who was covered. What type of coverage it was. Why coverage is ending. Date the coverage ends.

Enroll your dependent parent(s) or parent(s)-in-law in insurance	Must have:	Birth certificate for each dependent. Proof of residency, in the parent or parent-in-laws name. (Only one of the following is required) 1099/1098 tax form for previous year, or Current voter registration card, or State driver's license, or State-issued ID.