PHIP enrollment opportunities, as defined in OAR 459-035-0070, are the only times you can enroll in PHIP: Eligible retirees and their spouses or dependents who do not choose to enroll in a PHIP health plan during one of these enrollment opportunities will not be able to enroll in PHIP coverage. For dependents to enroll in PHIP the retiree must be eligible to enroll in PHIP, and at some point, enroll with the dependent.
Dependents may enroll when the retiree experiences an enrollment opportunity and enrolls in PHIP coverage. Enrollment Request Forms can be submitted as early as 90 days prior to the event date for any these enrollment opportunities.
During peak enrollment times (i.e., plan change, peak retirement periods, end of month), processing delays may occur. Changes to the original requested effective date will not be allowed once the requested effective date has passed.
Enrollment opportunities are:
New Oregon PERS retirement
Initial Medicare eligibility
Loss of employer-sponsored coverage
Death notification of a PERS Retiree or spouse
Dependent enrollment
Dental enrollment
New Oregon PERS retirees can enroll within 90 days of their PERS effective retirement date. Coverage will begin either on the PERS effective retirement date if the completed Enrollment Request Form is received prior to that date, or the first of the month after the completed Enrollment Request Form is received by PHIP, whichever is later. Any Enrollment Request Form received after 90 days of the PERS effective retirement date is considered outside of the enrollment opportunity and will be ineligible.
If PERS retirement is due to disability you can enroll within 90 days from the date of your PERS disability approval letter. If you are receiving an OPSRP Disability Benefit you will not be eligible for PHIP.
Some employers allow employer-sponsored coverage to go beyond the retirement date, so you will want to verify the end date of your employer-sponsored coverage to determine your effective date with PHIP to prevent overlapping coverage.
PERS retirees can enroll within 90 days of their initial Medicare eligibility, if enrolled in both Medicare Part A and Part B. Enrollment in a PHIP medical plan includes enrollment in the PHIP Medicare Part D prescription drug plan.
Eligibility for Medicare begins the first of the month of your 65th birthday or, if receiving Social Security due to disability, on the 25th month of receiving Social Security benefits. You must be enrolled in both Medicare Part A and Part B to be covered by PHIP once you are eligible for Medicare.
PHIP coverage will begin on the date your Medicare coverage becomes effective — as long as we receive your completed Enrollment Request Form before the date of your initial Medicare eligibility. If you apply after the date of your initial Medicare eligibility, PHIP coverage will begin the first day of the month after we receive your completed application. Any Enrollment Request Forms received after 90 days of initial Medicare eligibility is considered outside of the enrollment opportunity and will be ineligible.
If you continue to work after your PERS retirement and have employer-sponsored group health coverage (your own or with your spouse) you may enroll in PHIP at any time as long as you have been covered under another employer-sponsored group health plan for 24 consecutive months immediately before you enroll in PHIP.
Employer-sponsored group coverage includes:
COBRA coverage is secondary to Medicare, except when the Medicare beneficiary has end-stage renal disease (ESRD); and COBRA coverage is primary to Medicare during the 30-month ESRD coordination period.
To enroll, submit your completed PHIP Enrollment Request Form 30 days prior to your employer-sponsored group coverage ending. To avoid a gap in coverage, choose your PHIP effective date as the first of the month after your employer-sponsored group coverage ends. To make sure you select the correct PHIP effective date, verify the end date of your current health plan coverage with your employer.
PHIP allows up to 30 days to enroll after loss of employer-sponsored group coverage ends. However if your Enrollment Request Form is received after your group coverage ends (or is incomplete), your PHIP effective date will be the first of the month after we receive your completed Enrollment Request Form. Any application received after 30 days of loss of employer group coverage is considered outside of the enrollment opportunity and will be ineligible.
If you work past age 65 or are covered by employer-sponsored group coverage past age 65 this would be your enrollment opportunity to enroll in PHIP coverage.
For the purposes of PHIP, healthcare coverage under worker’s compensation, Medicare or any other government entitlement program (including foreign healthcare) does not qualify as employer-sponsored group health coverage.
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 contact PHIP member services and mail a photocopy of the death certificate to PHIP and separately to the PERS Pension office.
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 would like to end your coverage, please send PHIP a Disenrollment Form.
Enrollment upon death of the PERS retiree:
If the surviving spouse is not enrolled at the time of the PERS retiree’s death, the spouse may enroll within 90 days of the date of death, or by meeting other enrollment opportunities. However, if the spouse remarries, coverage cannot be extended to the new spouse.
Once disenrollment or termination occurs, you cannot re-enroll in PHIP unless you have a new enrollment opportunity.
You may enroll an eligible spouse or dependent during any enrollment
opportunity available to retirees.
A Medicare eligible spouse can enroll in a PHIP Medicare health plan before the PERS retiree within 90 days from their initial Medicare eligibility in Part A and Part B. This is also contingent on the PERS retiree enrolling in PHIP upon their final enrollment opportunity. If the PERS retiree does not enroll in PHIP during their final enrollment opportunity, the spouse will no longer be eligible for PHIP coverage.
You must enroll your new spouse or dependent within 30 days of the family status change (e.g., birth, marriage). If your spouse has a different last name, PHIP will require a copy of the marriage certificate.
To add a new spouse and/or dependent, please complete and submit a PHIP Enrollment Request Form.
Coverage will begin the first of the month after we receive the completed PHIP Enrollment Request Form including additional documentation (e.g., birth certificate, marriage certificate).
To enroll in a PHIP dental plan, you must enroll in a PHIP medical plan during the same enrollment opportunities as the PHIP medical plan. Dependents’ dental coverage must be with the same contracted dental
plan as the retiree. However, the retiree can choose dental and medical plans from different Contracted Health Plans (CHP).
For Kaiser Permanente dental, you must live in the Kaiser Permanente dental plan service area.