This section explains how to use your FlexAbility benefit plans. This is a general introduction to information that applies to all the benefit plans. More detailed information for each plan can be found in the section of FlexAbility On-Line that explains that benefit.

Enrolling in Your Benefits

When you become a benefit-eligible employee, you will be given enrollment instructions so that you can enroll yourself and your dependents in the FlexAbility plan. Enrolling is a way to let your employer know which options you wish to take advantage of. Your coverages usually become effective (benefits are payable) on the first day of the month after you have satisfied your waiting periods. If there is no waiting period for the type of benefit, then the benefits become available on the first day of the month following your benefit-eligible date (click here for "Waiting Periods").

In order to be eligible for FlexAbility, you must be a benefit-eligible employee. A benefit eligible employee is one who meets the eligibility criteria established by the employer. For specific details, click here for "Eligibility" criteria.

New enrollment

Your first opportunity to enroll in FlexAbility benefits is 30 days from your date of hire or the date you become a benefit eligible employee. Keep in mind that you must complete your online enrollment within this 30 day period.

If you do not complete your online enrollment within the 30 days, you will be enrolled in the "default coverage" provided by your region (see "Default Coverage").

Your next opportunity to make changes to your coverage is the next open enrollment period or when you have a change in family or job status (click here for "Open Enrollment" and "Keeping Family Status Changes Current"). If you elect to waive the medical insurance at the time of new enrollment, your next opportunity to enroll is open enrollment, or if family status change occurs, unless you qualify for special enrollment. See below for more information.

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Special Enrollment
If you have declined enrollment for yourself, or your eligible family dependents, (including your spouse) because of other health insurance coverage or any other health coverage, you may in the future, enroll yourself or your eligible family dependents under the terms of this plan, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

A. Loss of Other Coverage
For the first special enrollment period to apply, the person must meet each of the following conditions:

• The person was covered under a group health plan or had other health coverage at the time coverage under the plan was first offered to the person.
• The person stated in writing that coverage under such group health plan or health insurance coverage was the reason for declining enrollment.
• If coverage was under a COBRA Continuation of Coverage provision, and that Continuation of Coverage was exhausted. ("Exhausted" does not include termination of such coverage because the person failed to pay timely premium, or if coverage terminated for cause.)
• If coverage was not under a COBRA Continuation of Coverage provision, that coverage was terminated as a result of loss of eligibility for the coverage including legal separation, divorce, death, termination of employment, or reduction in the number of hours employment, or the current former employer contributions towards such coverage were terminated. (Coverage is not "terminated" within the meaning of this condition if it is terminated for cause or due to the person’s failure to pay premiums in a timely manner.)
• The person requests enrollment under the plan no later than 30 days after the date the prior coverage ended. The coverage under this plan will become effective on the first day of the calendar month following our receipt of the enrollment request.

B. Adoption, Birth or Marriage
If you are covered under the plan (or have met any waiting periods and are eligible to enroll, but did not enroll during a previous enrollment period) and a person becomes your eligible dependent through marriage, birth, adoption or placement for adoption, the plan will provide for a special enrollment period described below during which that dependent (and you if not otherwise enrolled) may be enrolled, and in the case of birth or adoption of a child, your spouse may also be enrolled as your dependent if he or she is otherwise eligible for coverage.

The special enrollment period shall be a period of 30 days and begin on the date of the marriage, birth, or adoption or placement for adoption.

If you request to enroll during the special enrollment period, the coverage shall be effective:

• In the case of marriage, on the first day of the first calendar month following our receipt of the enrollment request.
• In the case of dependent birth, on the date of such birth.
• In the case of dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption.

Confirmation statements

After you complete you online enrollment, at your request, your local Human Resources department will send you a confirmation statement which confirms your benefit elections. If the confirmation statement is not correct, you will have five working days to make corrections to the statement and return it to your Human Resources department. After that period, no changes are allowed until the next open enrollment period or until you have a qualifying family status change.

Default coverage

Default coverage (the coverage you are given if you don't complete the online enrollment) vary slightly depending on the region. Please click on your region below to see the default coverage which pertains to you.

• Employees Paid from System Office

• Peace Harbor Hospital

• St. John Medical Center

• St. Joseph Hospital

• Ketchikan General Hospital

• PeaceHealth - Oregon Region

• Oregon Medical Labs

Default coverage (the coverage you are given if you don't complete the online enrollment) vary slightly depending on the region. Please click on your region below to see the default coverage which pertains to you.

• All employers include at least these four coverage in their default coverage.
• Core Employee Life
• Core Employee Accidental Death & Dismemberment (AD&D)
• Core Long-Term Disability (LTD)
• Medical coverage for the employee only

Enrollment periods

Coverage for you and your eligible dependents become effective on the first of the month following the waiting period established by your region for each benefit.

Example: You start work on August 15. Your waiting period for a particular coverage is 90 days. That coverage begins on December 1.

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Open enrollment

Every year during the Open Enrollment period, you have the opportunity to change your benefit options. Any changes or new benefit elections you make at this time must be entered on-line through the Benefits Enrollment module of the Employee Info Center located in the Human Resources Service Center on Crossroads. Here you will also find:

• A summary of your FlexAbility benefit plans.
• An update of benefit changes for the coming calendar year.
• A spending account worksheet for calculating routine child care and health care expenses.
• A summary of your current benefits.
• A way to make changes, such as adding a dependent or spouse to your benefit coverage.

Keep in mind when reviewing your enrollment information that any changes you make will take effect on January 1 of the following year and remain in effect until December 31.

Waiting periods

Waiting periods are established by your employer. Click on your location (below) to determine your eligibility period.

• Employees Paid from System Office

• Peace Harbor Hospital

• St. John Medical Center

• St. Joseph Hospital

• Ketchikan General Hospital

• PeaceHealth - Oregon Region

• Oregon Medical Labs

Making choices

Certain benefits allow you to choose from a number of options. Some benefits have core coverage which is provided to you at no cost and other benefits allow you to receive cash back in lieu of benefit coverage.

Categories of coverage

You can choose different coverage categories for different benefits -for example, you can cover both yourself and your family under a medical plan, and only yourself under the dental plan -but, if you choose to cover your family for any benefit, all family members must be covered under the same plan.

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Keeping Family Status Changes Current

Whenever a change occurs to you or your dependent family members that qualifies as a family status change, you may have the opportunity to make adjustments to your benefits. Be sure to contact your local Human Resources department within 30 days of the family status change. Any changes to your benefits must be consistent with your family status change. (Note: notification regarding the birth or adoption of a child varies, depending on location).

New spouse

When you marry, you have 30 days to add your new spouse to your FlexAbility plan. Coverage will usually be effective for your new spouse on the first of the month following the date of your marriage.

New children

Depending on your work location, your new baby, adopted child, or foster child is automatically covered by your medical plan for an initial period of time.

• If you work at System Office-Bellevue, Whatcom Region, Lower Columbia Region or Ketchikan General Hospital (SE Alaska Region), this coverage ends 21 days after the child's date of birth, adoption, or placement in your home.
• If you work at PeaceHealth Oregon Region, Peace Harbor Hospital or OML, this coverage ends 31 days after the child's date of birth, adoption, or placement in your home.

PLEASE NOTE: To continue coverage, you must complete a PeaceHealth Benefits form and return it to your local Human Resources department within 60 days of the child's birth, even if you are already enrolled in family coverage. If you do not meet this deadline, your next opportunity to enroll the child will be during Open Enrollment in October.

Special circumstances

If your other group health plan is canceled

If your spouse or child is covered by another group health plan, and they involuntarily lose coverage because the plan is canceled by the insurer or employer, you have 30 days after their loss of coverage to apply for FlexAbility dependent coverage. 

In order to enroll your dependent, you must provide:

• Proof of termination of other insurance.
• A completed and signed PeaceHealth Benefits form.

If your dependents lose their group coverage for some other reason -for example, a job change, job loss, or reduction in work hours -they may still be eligible for enrollment on your FlexAbility plan, if you change your election within 30 days of the qualifying event. They also may be eligible for continuation coverage under their former health plan.

This table shows the kinds of changes you can make to each plan in the event of a family status change.

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Make changes as needed to these plans:

Other circumstances, such as a change in your employment status, may require changes to your benefits. As with any change, you must Contact your local Human Resources department if you wish to apply for continuation coverage for yourself or your dependent. This table shows the kinds of changes you can make to each plan.

Make changes as needed to these plans.

* Status change is changing part-time to full-time, full-time to part-time, going on/returning from unpaid leave/Family Medical Leave. Please click on your location in the Eligibility section of this information to determine part-time and full-time classifications specific to your location.

** If you do not elect continuation coverage when going on an unpaid leave of absence, you may experience a waiting period upon your return to work, and exclusion of coverage for pre-existing conditions. Contact your local Human Resources Department for more information.

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Eligibility

Eligibility varies depending on your region and employment status.

For a more complete definition of "eligibility" in your Region, click below:

• Employees Paid from System Office

• Peace Harbor Hospital

• St. John Medical Center

• St. Joseph Hospital

• Ketchikan General Hospital

• PeaceHealth - Oregon Region

• Oregon Medical Labs

Dependent eligibility

Eligible dependents include:

• Your legal spouse
• Your unmarried dependent children up to age 23 if they meet the Internal Revenue Code's definition of a dependent.

“Children" refers to your natural children, adopted children, stepchildren, foster children, and children related to you by blood or marriage for whom you or your spouse have legal guardianship. Dependents in the military service are not eligible.

Internal Revenue Code’s definition of a dependent requires two additional tests.

• Income Test – the child’s gross income must be less than $2,900 unless he or she was either under age 19 at the end of the calendar year or under age 23 at the end of the calendar year and was a student.
• Support Test – you must have provided over half of the person’s total support during the calendar year. There are two exceptions to this test: one for children of divorced or separated parents and one for persons supported by two or more taxpayers.

Your children over the age of 23 may still be eligible for coverage if they are unmarried, disabled, and entitled to be claimed as a dependent on your federal tax return. They do not necessarily have to live with you to be eligible.

Adopted and foster children

A legally adopted or foster child is considered an eligible dependent as long as:

• The child has been physically placed with you for the purpose of adoption or foster care under the laws of the state in which you reside; and
• You have assumed financial responsibility for the medical expenses of the child; And you notify your local Human Resources department of the adopted/foster child being placed with you within 60 days from the date of placement.

Young adult dependent coverage

Your children over the age of 23 may still be eligible for coverage under your FlexAbility plan if they are unmarried, disabled, and entitled to be claimed as a dependent on your federal tax return. They do not necessarily have to live with you to be eligible.

Be sure to contact your local Human Resources department when your child reaches the limiting age (23) to talk about continued benefits and rate changes. You may be asked to complete a PeaceHealth Benefits form to terminate or extend coverage.

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Loss of eligibility

In most cases, you will continue to be covered until the end of the month in which you lose eligibility. Ask your employer for complete information.

Example: You quit your job to become a full-time student on September 12. You will be covered by your FlexAbility plan through September 30.

Even if you lose eligibility for your group plan, you may qualify for continuation coverage (click on "Health Benefit Protection").

If you have questions about your eligibility, please contact your local Human Resources department for more information.

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