PHIP reviews eligibility when we receive your enrollment forms as defined in OAR 459-035-0070. An eligible person includes an eligible PERS retiree, spouse, dependent domestic partner, dependent or surviving spouse or dependent :
- A PERS retiree, who is receiving a PERS retirement allowance or benefit or who received an optional lump sum payment.
- OPSRP disability benefit recipients are not eligible for PHIP until they are an eligible retiree under ORS 238.305, 238.315, 238.195, or 238A.400.
- An eligible spouse is the spouse of an eligible retiree. A marriage
certificate is required if the spouse has a different last name than the retiree.
- An IRS-eligible dependent domestic partner, defined by IRS Code 26
USC 105(b), refers to a person who has had a relationship with and
resides with a PERS retiree for at least 12 months immediately before
PHIP enrollment. Also, the PERS retiree must be providing more than
one-half of the financial support for the dependent domestic partner and must have claimed them on their most recent federal tax return. You will need to provide an Affidavit of Domestic Partnership and a copy of your most recent federal tax return.
- A dependent child who is less than 26 years of age and meets one of the following definitions:
- A natural child
- A legally adopted child or a child placed in the home pending adoption
- A step-child who resides in the household of the eligible retiree
- A grandchild, provided at the time of birth at least one of the grandchild’s parents was covered under a PHIP plan as a dependent child and resided in the household of an eligible retired member.
- An dependent child may also be someone who is age 26 or older and has either been continuously dependent upon the retiree since childhood because of a disability or physical handicap, or has been covered under a healthcare insurance plan as the retiree’s dependent for at least 24 consecutive months immediately before enrollment in a PHIP plan. In either case, the following additional requirements must be satisfied:
- The child is not able to achieve self-support through work because of a developmental disability, mental retardation or a physical handicap as verified by a physician and accepted by the health plan.
- The incapacity is continuous and began before the date the child
would otherwise have ceased to be an eligible dependent.
- An eligible surviving spouse or dependent of an eligible PERS retiree:
- The surviving spouse or dependent of a deceased
retired PERS member or
- The surviving spouse or dependent of a deceased PERS member who was not retired but was eligible to retire at the time of death.
- In the event the non-PERS surviving spouse remarries, coverage cannot be extended to the new spouse.
In no event shall an eligible person as defined in this rule be entitled to coverage as both a retiree and as a spouse or dependent.