Public Employees Retirement System

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.

(b) The end of the month for which the last premium is paid.

(c) The end of the month in which a person ceases to be an eligible person, subject to any continuation of coverage rights under state or federal law

If your coverage has been involuntarily terminated due to late payment, loss of PERS retirement status, loss of Medicare Parts A and/or B you may lose all rights to be enrolled in PHIP.

Termination due to death

Please notify PHIP customer service in a timely manner, upon the death of a PHIP member. If a refund is due to the estate for premiums paid after the death, PHIP will automatically request one.

As a PERS retiree, upon the death of your spouse, your PHIP coverage will continue as usual.

As a surviving spouse or dependent of a deceased PERS retiree, your PHIP coverage will also continue as usual. If coverage was paid via pension deduction, the surviving spouse/dependent account will be changed to self-pay. If you are eligible for a PERS survivor benefit you can submit a PHIP Payment Options 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

To disenroll, please submit a PHIP Disenrollment Form.

PHIP and Medicare guidelines require a written request for voluntary disenrollment from PHIP. Disenrollment will occur the first of the month following reciept of your completed PHIP Disenrollment Form, unless a later date is request.

Both the member and spouse must sign the written request for disenrollment. If one member of your family wishes to terminate their dental coverage, the whole family will be disenrolled from dental.

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

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Involuntary Termination

Loss of Medicare Parts A, B and/or D

In order to be eligible for PHIP, you must be enrolled in and maintain Parts A and B of Medicare. 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.

Termination due to late premium payment

Premium payments are due on or before the first of each month, with no grace period. If payment is not received by the first day of the month, the account is considered delinquent. If you do not pay your premium upon notification, your health plan coverage will be canceled. If your coverage is terminated due to a delinquent payment, you may be responsible for all claims incurred on or after that termination date. Once you terminate your coverage from PHIP, you may not re-enroll unless you experience a new enrollment opportunity.

Enrollment in 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 will disenroll you completely from PHIP, including your optional dental coverage. Once disenrollment has occurred, you may not re-enroll in PHIP, unless you experience a new enrollment opportunity.

Loss of retirement status

If you are a Tier One/Tier Two retired member, you may be employed by an Oregon public employer and continue to receive retirement benefits as long as the period or periods of employment with one or more participating public employers do not total 1,040 hours or more in a calendar year. Please note that hours are counted in the year in which you performed the service, not in the year in which the hours were reported. Hours of employment are hours worked on or after your effective retirement date for which you receive wages, salary, paid leave, or other compensation.

If you return to employment with a public employer in the state of Oregon after retirement, Oregon statutes impose certain limitations on that employment. It is your responsibility to be aware of these limitations and to track your hours to ensure compliance. If you decide to return to work with a public employer in the state of Oregon after retirement, you can control of the number of hours you work and accordingly, whether you comply with or violate the limitation. It is your responsibility to remain in compliance with the limitations applicable to you if you do not want your retirement benefits to stop.

If your retirement benefits stop, you are no longer considered an eligible retiree under PHIP statutes and your PHIP coverage will be terminated the end of the month in which you are no longer an eligible retiree.

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COBRA eligibility

COBRA is offered only in specific scenarios if you’re terminated from PHIP. COBRA qualifying events under PHIP would be due to loss of PERS retirement status, a dependent turning 26, and in the case of divorce. You have 60 days from loss of coverage or the date of the COBRA notice, whichever is later, to elect COBRA. If you are eligible for COBRA and have not received your COBRA notification letter, please contact PHIP customer service.

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Loss of eligibility

If you are disenrolled by PHIP, you may lose all eligibility in PHIP. Typically, you may not re-enroll in PHIP unless you experience a new enrollment opportunity.