Member FAQ

You’ve got questions. We have answers.

OEBB Enrollment

 

Yes, COBRA participants have the same rights as all active employees while they are enrolled in COBRA continuation coverage.

If you, or a dependent who is a qualified beneficiary, are determined by Social Security Administration (SSA) to have been disabled at any time during the first 60 days of COBRA coverage, you and your dependents will be eligible to extend coverage for 11 months. The law specifies that you must provide a copy of the disability determination (Notice of Award) before the end of the original 18-month period that applies to the qualifying event. This letter must include the actual date the SSA deems you disabled according to their rules. We must receive the Notice of Award within 60 days of the date of the letter.

 

No. You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

You have the right to continue both coverages if you had other group coverage before electing COBRA. However, if you obtain new coverage after electing COBRA and notify us, your COBRA coverage will end as of the effective date of your new coverage. You must send us written notification of the new coverage, preferably before the effective date of the new coverage.

OEBB Benefits


If your former employer offers an insurance option other than an HMO, you can to switch to the other plan because of your move. If your former employer offers only an HMO to active employees and you now reside outside the HMO service area, you may still sign up for the HMO plan.

Yes. You have a 30-day grace period to pay your COBRA premiums. However, your insurance carrier may suspend claims payments if your premium is not paid by the first of the month.

Your COBRA insurance will end on the first day of the month you become entitled to Medicare. If you become entitled to Medicare before you turn 65 years old, you must notify us as soon as possible.

Yes. If your dependents are qualified beneficiaries, their COBRA coverage may be extended.

PEBB Enrollment

 

Yes. COBRA participants have the same rights as all active employees while they are enrolled in COBRA continuation coverage.

If you, or a dependent who is a qualified beneficiary, are determined by Social Security Administration (SSA) to have been disabled at any time during the first 60 days of COBRA coverage, you and your dependents will be eligible to extend coverage for 11 months.

The law specifies that you must provide a copy of the disability determination (Notice of Award) before the end of the original 18-month period that applies to the qualifying event. This letter must include the actual date the SSA deems you disabled according to their rules. We must receive the Notice of Award within 60 days of the date of the letter.

No. You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

PEBB Benefits

 

You have the right to continue both coverages if you had other group coverage before electing COBRA. However, if you obtain new coverage after electing COBRA and notify us, your COBRA coverage will end as of the effective date of your new coverage.

You must send us written notification of the new coverage, preferably before the effective date of the new coverage.

If your former employer offers an insurance option other than an HMO, you can switch to the other plan because of your move. If your former employer offers only an HMO to active employees and you now reside outside the HMO service area, you may still sign up for the HMO plan.

No. You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

Your COBRA insurance will end on the first day of the month you become entitled to Medicare. If you become entitled to Medicare before you turn 65 years old, you must notify us as soon as possible.

Yes. If your dependents are qualified beneficiaries, their COBRA coverage may be extended.

PEBB Retiree

 

No. Most retiree plans have specific rules about changing plans, adding or deleting plans, or adding dependents. You can only add dependents when you first enroll in the retirement plan or if you have a family status change, such as marriage or birth of a child. Please contact us regarding your specific situation.

Entitlement to Medicare occurs if you have Part A. Once you or one of your dependents become entitled to Medicare (age in at 65 or Disability Medicare), your retiree coverage will end. Dependents can stay on the early retiree plan until they become entitled to Medicare or otherwise lose eligibility. Call us right away if you or one of your dependents is about to have Medicare coverage.

Flexible Spending Accounts (FSA)

 

To see your balance, log in to your member portal. If you don’t have online account access, contact our Customer Service team at 888-398-8057 from Monday - Friday, 7:30 a.m. - 5:30 p.m.

IRS Code 213(d) requires all claims be verified. This is to make sure you only get reimbursed for eligible expenses. To find out what expenses are eligible, log in to your member portal.

You have 45 days to submit documentation before your FSA card is deactivated. Once we receive acceptable documentation, your card will be reactivated.

No. Your card may only be used for current plan year expenses.

You can only use your FSA for eligible expenses during the specific plan year. A LOMN must be valid for the current plan year to comply with IRS rules.

No. Benefit cards are not issued for dependent care accounts.

It's easy. First, log in to your member portal. Then click on the “Forgot Password” link. Or contact our BenefitHelp Solutions Consumer Services team at 855-378-0197, Monday - Friday, 7 a.m. to 7 p.m., Central Standard Time.

Forms can be downloaded in the "Resources" section of the BenefitHelp Solutions site.

If you need to change your healthcare or dependent care election, you must have experienced an IRS Qualified Life Event. Qualified Life Events include certain changes in family or work status. Please contact your employer for more information.

Examples of Qualified Life Event Changes include:

  • Marriage
  • Divorce
  • Birth or adoption of child
  • Death
  • Change in employment status for you, your spouse or tax dependent
  • Change in dependent care provider
  • Increase or decrease in dependent care provider charges 

Please refer to your Summary Plan Description for more details.

Health Reimbursement Accounts (HRA)

 
Our claims processors make decisions about whether a service qualifies for reimbursement and if we need additional documents to reimburse your claim. Please review the eligible expenses list for more information.

Log in to your member portal and file a claim. If the dates of service, member and amount are all eligible, we review the service description. Some services or supplies are always eligible for reimbursement. Others are potentially eligible and we will need additional documents to establish medical necessity. Other services are never eligible, even if prescribed by your healthcare provider.

Your employer keeps unused funds unless they’re paid from a trust.

Dependent Care Account (DCA)

 

For dependent status, a child must be younger than the taxpayer and unmarried.

If parents do not file a joint federal income tax return, the child can only be claimed by one parent: the custodial parent.

How to determine the custodial parent:*

  1. Who child resides with for more than half of the year
  2. Who the child resided with for the greater number of nights during the calendar year
  3. If the child resides with both parents for the same amount of time, the parent with the higher adjusted gross income may claim the child as a dependent

*Exception: If it is stated in a divorce decree that the non-custodial parent can claim the child as a dependent, then the decree must be upheld, and the above does not apply. They will need to attach a signed declaration from the custodial parent when filing their taxes.

Non-custodial parent: A non-custodial parent may claim a child as a qualifying child if:

  1. The parents of the child provide more than half the child support for the calendar year
  2. The child is in the custody of one or both parents for half the calendar year
  3. The parents are divorced, legally separated, or have lived apart at all times for the last six months
  4. The custodial parent does not claim the child as a dependent

Yes. You must complete the Reimbursement Request Form and attach a receipt of payment that shows the dates of service.

Yes: As long as the family member is not a dependent of the member. The definition of a dependent is either a minor child, or an adult living in the member’s household receiving 50 percent of support from the member.

According to the IRS, a 5-year-old child in school is considered to be in a kindergarten-level class. Thus, costs for instructional education are not reimbursable. If a 5-year-old child or younger does not receive instructional education for a full day, but instead receives daycare services for a portion of that day, the provider must itemize a receipt with the hours of education and the hours of daycare services. The cost of daycare is reimbursable under your FSA. The cost of educational instruction is not reimbursable.

If you have set aside money through salary reduction, and you do not use it by the end of the plan year, you will lose it. The IRS requires that all funds that have been deducted from your paychecks and placed in the Dependent Care Account must be used during the plan year. It is important to deduct from your salary only the amount that you’re sure you’ll spend.

No. Contributions allocated to one benefit account can only be used to pay a claim from that benefit program. For example, your contributions to your Dependent Care Account cannot be used to pay a medical care expense claim.

Yes. You can, as long as any of the following qualifying events happen:

  • A change in the cost of dependent care.
  • Employment status
    • Any employment status change for the employee, spouse or dependent
    • Termination or commencement of employment, strike or lockout
    • Return from unpaid leave of absence
    • Change in worksite
  • Dependent eligibility
    • A change in dependent eligibility that causes the dependent to satisfy or cease to satisfy requirements due to: age, marriage, or any similar circumstances
  • A change in family status caused by:
    • Change in number of dependents
    • Change in legal marital status
    • An unpaid leave of absence by you or your spouse

If you need to change your healthcare or dependent care election, you must have experienced an IRS Qualified Life Event. Qualified Life Events include certain changes in family or work status. Please contact your employer for more information.

Examples of Qualified Life Event Changes include:

  • Marriage
  • Divorce
  • Birth or adoption of child
  • Death
  • Change in employment status for you, your spouse or tax dependent
  • Change in dependent care provider
  • Increase or decrease in dependent care provider charges 

Please refer to your Summary Plan Description for more details.

COBRA

 

Yes. COBRA participants have the same rights as all active employees while they are enrolled in COBRA continuation coverage.

If you, or a dependent who is a qualified beneficiary, are determined by Social Security Administration (SSA) to have been disabled at any time during the first 60 days of COBRA coverage, you and your dependents will be eligible to extend coverage for 11 months.

The law specifies that you must provide a copy of the disability determination (Notice of Award) before the end of the original 18-month period that applies to the qualifying event. This letter must include the actual date the SSA deems you disabled according to their rules. We must receive the Notice of Award within 60 days of the date of the letter.

However, some employers have elected to extend the 60-day time period for submitting a disability extension. COBRA premiums during an 11-month disability extension are increased to 150 percent of the regular premium rate.

Contact us if you have questions.

No. You have 45 days from signing up to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

You have the right to continue both, if you had other group coverage before electing COBRA. However, if you obtain new coverage after electing COBRA, your COBRA coverage will end as of the effective date of your new coverage. A written notification of the new coverage must be submitted to us, preferably before the effective date of your new coverage.

If your former employer offers an insurance option other than an HMO, you can switch to the other plan because of your move. If your former employer offers only an HMO to active employees and you now reside outside the HMO service area, you may still sign up for the HMO plan.

Yes. You have a 30-day grace period to pay your COBRA premiums. However, your insurance carrier may not pay claims if your premium is not paid by the first of the month.

Your COBRA insurance will end on the first day of the month that you become entitled to Medicare. If you become entitled to Medicare prior to turning 65 years old, you must contact us as soon as possible. This is to ensure timely transition to your other coverage options and correct payment to your providers.

Yes. If your dependents are qualified beneficiaries, they may continue COBRA coverage. The length of continued coverage may vary: Contact us for more information.

Qualified beneficiaries who are entitled to elect COBRA may do so even if they have other group health plan coverage, or are entitled to Medicare benefits on or before the date they elect COBRA. Medicare becomes the primary payer for an age-based or disability-based Medicare beneficiary who also has COBRA coverage.

If Medicare entitlement is based on End-Stage Renal Disease (ESRD), then Medicare is the secondary payer for the first 30 months of the Medicare entitlement.

Retiree

 

It is federal law that you be offered COBRA when you retire. Under the federal COBRA guidelines, loss of coverage due to retirement is a qualifying event.

If you or any dependents are on Medicare prior to the qualifying event, you might want to take the COBRA coverage. You cannot be on the retiree plan if you are entitled to Medicare — unless your retiree plan has over-65 coverage.

Yes: As long as you maintain continuous coverage and were covered under a public employer retiree plan. In some plans, if you do not choose the retiree plan from the original loss of coverage date, you may be opting out of your retiree coverage and may not pick it up later. Please contact us if you have questions.

No. You can only add dependents when you initially enroll in the retirement plan — or if there is a family status change, such as marriage or birth of a child.

If you receive a PERS pension check and your premium amount is less than the amount of the check, you can have your premium deducted from your pension check. If you do not receive a PERS pension check or do not want to have your premium deducted from your pension check, you can pay your premium via Electronic Funds Transfer (EFT) or by sending a check directly to BenefitHelp Solutions.

Yes. Your spouse can stay on the early retiree plan until they become entitled to Medicare or otherwise lose eligibility.

Yes. Once it has been identified that your automatic payment was not processed, we will send you a bill.

No. Most retiree plans have specific rules about changing, adding or deleting plans.

Yes, BenefitHelp Solutions will send you a confirmation letter anytime there is a change that affects your premiums.

Yes. We need your current mailing address so we can send you important information about your medical coverage. You can change your address on our website, calling our office or sending a written change of address.

No. Once you or one of your dependents are covered by Medicare (at age 65 or Disability Medicare), your retiree coverage ends. Call us if you or one of your dependents has or is about to have Medicare coverage.

Yes. According to federal law, your dependent will be offered COBRA at the time of their loss of coverage. Under federal COBRA guidelines, loss of coverage due to loss of dependent eligibility is a qualifying event.

No. Entitlement to Medicare occurs if you have only Part A.

Benefits Card

 

The Benefits Card provides direct access to FSA funds, allowing you to pay for eligible healthcare expenses at qualified locations wherever VisaTM is accepted. The amount of the transaction will be automatically deducted from your spending account.

The main advantage of using the card is that you do not have to pay for eligible IRS expenses out of your own pocket, submit a claim form and wait to be reimbursed for the expense. The money is deducted directly from your FSA at the time of purchase.

You can request a Benefits Card during Open Enrollment. They cannot be requested at any other time. If you have a card, you may request a second card for a family member.

Using the benefits card does not eliminate the IRS requirement of submitting supporting documentation for FSA expenses. After using the card for a purchase, you may get a letter from us requesting more information.

Sometimes, things like co-payments charged together, such as $10 and $20, for a total of $30, cannot be matched by our system, and you will receive a letter requesting documentation. Or the merchant code for your provider or place of purchase may not be recognized.

Supporting documentation will need to include the name of the provider, date of service, type of service performed and amount of the service. For example: an itemized statement or receipt from your provider, or an Explanation of Benefits from your insurance company for healthcare expenses. The receipt that you signed for the purchase, balance forward statements or balance due statements are not acceptable forms of documentation: This information usually does not list the type of service performed or the name of the product.

If you do not submit your documentation to us, we will send you a second request. After that, if you still do not send it in, you will receive a final notice. After that, your benefits card will be deactivated until we receive the requested documentation.

As of January 1, 2011 most OTC medicines and drugs need a prescription to be eligible for reimbursement under an FSA. If you have a valid prescription and purchase the item at a grocery a store you will need to pay out of your pocket and submit a claim form along with a copy or your receipt and prescription for reimbursement. If you purchase the medicine at a pharmacy, you may use your benefits card and the transaction will be automatically approved.

The benefits card should only be used to pay for services that happened in the current plan year.

The service must have happened on or before the payment date and  within the current plan year. Contact us at 503-219-3679 or 888-398-8057 with questions.

You will receive a letter from us for the transaction that asks for supporting documentation. If the transaction was for an expense that isn’t eligible, you will need to refund your account.

The does not work for daycare expenses. To use your FSA plan for daycare expenses, you will need to pay for the expense at the daycare provider and then submit a request for reimbursement with a claim form to BenefitHelp Solutions. You can find claim forms on our website under FSA members or you can get one from your Human Resources department.

You will need to notify your employer of your name change and submit a written request for your name change to us. Your card will be deactivated and cannot be used until your new card is received.

You can: Just loginto your member portal. The first time you log on, you will be asked to set up a sign-on and password.

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