Employee must select one option from the medical choices available.
Medical Plan Choices:
- Kaiser Permanente HMO plan
- Kaiser Maintenance Plan HMO plan (available ONLY to part-time employees)
- Moda Performance PPO Plan - Moda Plus Network
- Moda Preferred PPO Plan - Moda Plus Network
- Moda Major Medical PPO Plan - Moda Plus Network
Prescription drug coverage is included with all medical plan options except Opt-Out.
Vision coverage is included with Performance PPO, Preferred PPO and Kaiser Permanente plans only.
Dental Plan Choices:
- Kaiser Permanente Dental
- Delta Dental Plan
- Willamette Dental Group Plan
- Decline Dental Coverage (there is no refund associated with this choice)
ENROLLMENT PERIOD: Newly hired employees must submit a completed Benefit Enrollment form during the 31 days immediately following their hire date.
DEFAULT ENROLLMENT: If you do not submit a Benefit enrollment form during this new hire enrollment period, at the end of the 31-day period you will be enrolled in the following plan:
- Full-time employees - Moda Major Medical PPO Plan and the ODS Dental Plan with employee-only coverage;
- Part-time employees – Moda Major Medical PPO Plan with employee-only coverage.
There will be no opportunity to change this default enrollment until the next annual open enrollment period or recognized family status change.
EMPLOYEES WHO CAN ENROLL: Permanent full-time and part-time employees and their eligible dependents are eligible for County-sponsored health plan coverage. Part-time employees are those employees working .5 FTE to .79 FTE or 20 to 31.9 hours per week. All employees are subject to premium sharing for elected coverage. The amount of your premium sharing is based on the plan choice you make and the number of family members you elect to enroll. Please review the enclosed rate sheets for premium sharing information on each plan offered.
ELIGIBLE DEPENDENTS INCLUDE:
- Your legal spouse or domestic partner: To enroll a spouse or domestic partner, an employee must also complete an Affidavit of Marriage/Domestic Partnership form. County benefit plans are structured under IRS regulations. Enrollment of a Domestic Partner creates a tax event for the employee that reduces take-home pay.
- Children who are under age 26 and are the employee's biological child, step-child, adopted child*, child in employee's custody pending adoption*, a child for whom employee is required by court order to provide coverage, child for which the employee is a court appointed legal guardian* (up to the age of majority, or age specified by the court), or biological/adopted child of domestic partner. *Copies of legal documents/adoption/placement for adoption must accompany enrollment form.
IMPUTED INCOME TAX FOR NON-IRS ELIGIBLE DEPENDENTS: The County allows coverage of a broader range of family members than the IRS recognizes as tax eligible dependents. If you enroll a non-IRS eligible dependent (such as a domestic partner or child of a domestic partner), you will be required to pay tax on the value of that non-IRS eligible dependent’s coverage. This is referred to as an imputed income tax. If you have questions about the amount of additional tax you would pay for the coverage of a non-IRS eligible dependent, please contact the Employee Benefits Office for an estimate.
You may receive an incentive payment in lieu of County medical coverage. To elect this option, you must complete the Opt-Out Affidavit.
- Full-time employees receive a $250.00 monthly refund as a gross monthly payment in the 1st through the 15th paycheck.
This payment is made to the employee on the second paycheck of each month, is subject to taxes and taxed at the supplemental rate. There is no refund for opting-out of dental coverage. Opt-Out refunds are not paid during any period the employee is in an unpaid status. Employees may Opt-Out of medical coverage but still enroll in dental coverage
How To Sign Up
New employees must complete a Medical & Dental Enrollment Form to enroll in their medical and/or dental plan. The completed form(s) must be received in the Employee Benefits Office within 31 days of hire date. Failure to submit an enrollment form during this period will result in Default Enrollment for the employee.
COVERAGE BEGIN DATE: Medical and Dental Plan coverage begins on the first of the month following the receipt of your completed enrollment form by the Employee Benefits Office**.
(**Exception: If the first day of the month is a working day, and is also a new hire’s initial working day, and the completed benefit enrollment form is received by the EBO on or before that date, coverage becomes effective immediately.)
ENROLLMENT CONFIRMATION PACKET: After a new hire has submitted their benefit enrollment forms and the forms have been processed, the Employee Benefits Office will provide Benefit Enrollment Confirmation and important plan documents, benefit booklets, and instructions. Employees who have not received this confirmation within 30 days of submitting their enrollment forms should contact the Employee Benefits Office immediately.
No changes to medical and dental coverage are allowed during a plan year unless you experience a designated qualifying event – known as Family Status Change Events. These events are explained later in this booklet.
Employees are responsible to report subsequent eligibility changes for their enrolled family members due to additions to the family (by marriage, birth, etc.) and to remove dependents that are no longer eligible for coverage by completing and submitting a Benefit Change form. When requesting coverage cancellation of a spouse or domestic partner due to a divorce or end of a domestic partnership, a Termination of Marriage/Domestic Partnership Affidavit form must also be completed, in addition to a Benefit Change form. When you have such an event, regardless of when you report the eligibility change, the former spouse’s coverage is terminated retroactive to the end of the month in which the divorce was final; the former domestic partner’s coverage is terminated retroactive to the end of the month in which the partnership dissolved. Failure to report these changes may result in the employee being billed for benefits used by the former spouse/partner after the date of divorce/dissolution.
The County allows employees a 90-day period to report the addition of a new dependent, or the cancellation of coverage for ineligible dependents. However, we encourage employees to provide this notification as soon as possible.
- Failure to request enrollment of a new dependent during this 90-day period will mean you cannot enroll the dependent until the next annual open enrollment.
- Failure to report an ineligible dependent within 90 days of the eligibility loss event may result in the County recovering the cost of claims paid on behalf of that dependent during the period of ineligibility. The termination of coverage will be based on the date of the event causing coverage loss – not the date the event is reported.
IMPORTANT NOTE: Federal COBRA (the opportunity to continue coverage for a former de-pendent by paying the entire premium) regulations require an employee to report a depend-ent’s loss of eligibility within 60 days of the eligibility loss event. Failure to report eligibility loss during this 60-day period causes a forfeiture of the terminated dependent’s COBRA rights.