Disenrollment

You may terminate your PHIP coverage any time you choose.

Per Oregon Administrative Rule (OAR) 459-035-0080 (2) Coverage shall cease for an eligible person on the earliest of the following dates:

 (a) The end of the month in which a signed notification is received by PERS from the covered person to terminate coverage.

Death Notification of PERS Retiree or Spouse

If you are the PERS retiree:
If your spouse passes away, your PHIP coverage will continue as usual. To end your spouse’s coverage, please notify both PHIP and the PERS Pension office. You will need to mail a copy of your spouse’s death certificate to PHIP. 

If you are the surviving spouse or dependent child of a PERS retiree:
If the PERS retiree passes away, your PHIP coverage will continue automatically. You will need to mail a copy of the retiree’s death certificate to PHIP and also separately to the PERS Pension office. If you do not want your coverage to continue, please send PHIP a Disenrollment Form.

If coverage was paid via pension deduction, your account will change to self-pay, and you will receive an invoice. If you are eligible for a PERS survivor benefit you can submit a PHIP Payment Option Form, selecting the pension deduction as your payment method. 

If the surviving spouse or dependent is not enrolled at the time of the PERS retiree’s death, the spouse or dependent may enroll within 90 calendar days of the death or by meeting another enrollment opportunity. However, in the event of remarriage, coverage cannot be extended to the new spouse.

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Voluntary Disenrollment

If you would like to end your PHIP coverage, you will need to complete and send a PHIP Disenrollment Form. This is legally required by PHIP and Medicare. This change will be effective on the first of the month after we receive your PHIP Disenrollment Form, unless you request a later date. If your spouse and/or dependent child (over 18) are part of your plan, they will also need to sign the form.

If anyone in your family stops their dental coverage, the whole family will lose their dental coverage.

Once you end your coverage from PHIP, you may not re-enroll unless you experience a new enrollment opportunity.

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Involuntary Termination

PHIP may be required to end your coverage if you:

Lose your Medicare Part A, B and/or D

In order to be eligible for PHIP, you must be enrolled in and maintain Medicare Part A and Part B. Part B premiums must be paid to Medicare. If you drop or lose your Part A or Part B coverage through Medicare, you will no longer be eligible for coverage through PHIP.

Fail to pay your monthly premium

Your premium payment is due on the first of each month. If your payment is not received by then, your account will be considered delinquent. If you do not pay your premium, your health plan coverage will be terminated. If your coverage is terminated, you may have to pay for all claims, unless they are covered under Original Medicare. 

Sign up for another non-PHIP Medicare Advantage or Medicare Part D Prescription Drug Plan

You can only be enrolled in one Medicare Advantage and Medicare Part D prescription drug plan at a time. Enrolling in another Medicare Advantage or Medicare Part D plan outside of PHIP will disenroll you completely from PHIP, including your optional dental coverage. 

Lose your retirement status

If you are no longer an eligible retiree under PERS as defined under ORS 238.305(3), 238.315, or 238A.195, or payment(s) under ORS 238A.400, or a person who is receiving retirement pay or pension calculated under ORS 1.314 to 1.380 (1989 Edition), you are no longer eligible for the PHIP. 

Your coverage will be terminated the end of the month in which you are no longer an eligible retiree. 

Once your coverage is terminated for any reason, you may not re-enroll unless you experience a new enrollment opportunity.

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COBRA  Continuation of Coverage

If you experience one of these qualifying events you or your dependent may be eligible for continuation of coverage through COBRA. In accordance with federal  and state of Oregon guidelines, PHIP provides opportunities for the continuation of coverage through COBRA following specific qualifying events. If you experience one of the qualifying events listed below, please contact PHIP for additional information. A qualifying event will occur if eligibility for coverage is
lost because of:

• Cancellation of PERS retirement status.
• The divorce or legal separation of a retiree’s covered spouse; PHIP must be notified within 60 days from the signed Dissolution of Marriage document.
• A spouse or dependent child no longer meeting eligibility requirements (e.g., a child reaches the maximum age limit, or a spouse loses coverage because the retiree does not enroll in PHIP upon the last enrollment opportunity)

Once COBRA has been secured, timely payment of premiums is essential.

Timely COBRA Premium Payments

Once you elect COBRA coverage you have 45 days to pay the initial premium. After that, premiums are due the first day of each month. If your initial payment is not (postmarked or received) by the due date, your coverage will be terminated and cannot be reinstated. You have a 30-day grace period for monthly payments, after which your policy will be cancelled and cannot be reinstated. The initial premium must be paid within 45 days of the date COBRA is elected. Thereafter,  premiums are due the first day of each month for that month’s coverage. If payment is not postmarked on or before the 45th day (for the initial premium) or the 30th day following the monthly due date, coverage will be terminated and cannot be reinstated.

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