Dependent Eligibility

Eligible Dependent Definitions

When you enroll in benefits through OEBB, you can only cover people who meet OEBB’s rules. The Dependent Eligibility Verification (DEV) audits ensure those rules are followed. Read the definitions below to make sure each dependent you enroll is eligible.

Dependent Types

Child

You can cover a child who is 25 or younger on the first day of the month if they meet one of these criteria:

• Your biological child
• Your spouse’s or domestic partner’s biological child
• Your legally adopted child or a child placed for adoption
• A child placed in your custody by the court (you must provide legal documentation)
• Your stepchild

Grandchild

You can only cover a grandchild if you are their legal guardian or adoptive parent.

• You must provide legal documentation (e.g., court order)

Disabled Dependent Child

If your child has a qualifying disability and you want to continue their coverage, you must apply before the child reaches age 26.

What should you do?

• Contact OEBB up to 60 days before your child turns 26.
• Coverage does not continue automatically, even if the carrier (Moda, Kaiser) knows about the disability.
  

To meet eligibility requirements, all the following must be true:

• Your child can’t support themselves due to a developmental disability, physical disability, or mental illness.
• A medical provider confirmed the disability before your child turned 26.
• Your child has had continuous health coverage (no breaks).

AND one of these applies:

• You claim your child on your federal tax return
• You have legal guardianship ordered by a court
• Your child files their own tax return and earns less than 150% of the Federal Poverty Level (FPL)

Ask your doctor to send proof of disability to your medical carrier (Moda, Kaiser)

• Use your medical carrier’s Disabled Dependent form, which you can request from your carrier or OEBB to get approval from the carrier.

After your child is enrolled as a Disabled Dependent, you must continue coverage for the child to stay eligible. If you stop OEBB coverage for any reason other than you losing , you cannot re-enroll the Disabled Dependent child in the future. If you become eligible for OEBB benefits again and want to cover your Disabled Dependent child, you must show that you continued coverage for the child during the gap that you lost eligibility (no breaks in coverage for the child).

Important: You may owe extra taxes (called “ imputed income”) for covering someone who isn’t a tax dependent. A tax dependent is a qualifying dependent who relies on you for financial support and is claimed on your tax return.

What you need to do now?

Send copies of the required paperwork:

1. A copy of their birth certificate AND
2. Proof of guardianship or tax status (copies only, not originals) to OEBB by:
• Mail: Attn: OEBB Dependent Eligibility Review Team, 500 Summer Street NE E-88, Salem, OR 97301-1063
• Fax: 503-378-6875, or
• Secure email:
• Go to https://secureemail.dhsoha.state.or.us/encrypt to send a secure email.
• First, enter your own email address to create an account.
• Then, enter oebb.dependenteligibility@odhsoha.oregon.gov as the recipient.
• If taking a photo of your documents with your smartphone, please upload the file no smaller than medium
• Please do not CC or BCC any other recipients. This voids the secure send feature, and only these recipients will receive the email.
• If you're a DHS/OHA employee, you can send a secure email by adding #secure# to your Subject line.
  

Spouse

• You can cover your spouse if you're legally married under the laws of Oregon or another state or country.
• You cannot cover a former spouse.

Domestic Partner

You may cover a Domestic Partner if one of these is true:

1. Registered Partnership
• Unmarried
• Registered under Oregon’s Certificate of Domestic Partnership
2. Unregistered Partnership -- You and your partner must:

• Be at least 18 years old
• Be responsible for each other’s well-being
• Be each other’s only domestic partner
• Not be married or have had another partner in the past 6 months
• Not be related in a way that would prevent marriage in Oregon
• Have lived together for at least 6 months in a shared home
• Share financial responsibilities for basic living costs (food, rent, utilities, etc.)
• If you were able to answer yes to all the Unregistered Partnership requirements:
• Complete and send OEBB's Affidavit of Domestic Partnership to your employer within five business days of enrolling them in benefits.

Important:

• If your Domestic Partnership ends, you must tell your employer within 31 days.
• You may have to pay imputed income taxes for covering a domestic partner.
• Some districts or unions may have their own rules if set before Jan. 31, 2008.
  

Retirees

If you're a retiree with an OEBB medical or vision plan and you become eligible for Medicare (except for End-stage Renal Disease (ESRD)-related eligibility), your OEBB coverage must end on the last day of the month before your Medicare starts.

• You must report your Medicare coverage to OEBB and your former employer within 31 days.

Important:

Not reporting this information with 31 days may count as fraud and lead to retroactive termination of your benefits.

Dependents

If your covered dependents also become eligible for Medicare, their OEBB medical or vision coverage must end unless:

• Your district or union contract (as of Feb. 1, 2010) allows them to stay on until you (the retiree) become eligible for Medicare.
• You’re enrolled in a Kaiser Permanente medical plan—in that case, coverage must end for Medicare-eligible dependents.