Skip to main content

Oregon State Flag An official website of the State of Oregon »

Oregon Health Authority logo

Dependent Eligibility

Definitions

Who Can You Cover?

When you enroll in benefits through OEBB, you can only cover people who meet OEBB’s rules. Read the definitions below to make sure each dependent you enroll is eligible.

Who Counts as a Dependent?

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:

  1. Your biological child
  2. Your spouse’s or domestic partner’s biological child
  3. Your legally adopted child or a child placed for adoption
  4. A child placed in your custody by the court (must provide legal documents)
  5. Your stepchild
Special cases:
  • You can only cover a grandchild if you are their legal guardian or adoptive parent
  • OEBB no longer accepts affidavits or notarized letters to prove child eligibility—you must provide legal documentation (e.g., court order)

Covering a Disabled Dependent Child

  • You must act before they turn 26
If your child has a qualifying disability and you want to continue their coverage, you must apply before the child reaches age 26. Coverage does not continue automatically, even if the carrier (Moda, Kaiser, etc.) knows about the disability.
Who Qualifies?

All the following must be true:

  1. Your child can’t support them self due to a developmental disability, physical disability, or mental illness
  2. A medical provider confirmed the disability before your child turned 26
  3. Your child had continuous health coverage (no breaks), and

One of these applies:

  1. You claim your child on your federal tax return
  2. You have legal guardianship ordered by a court
  3. Your child files their own tax return and earns less than 150% of the federal poverty level (FPL)

Note:

  • You may owe extra taxes (called “imputed income”) for covering someone who isn’t a tax dependent.

What You Need to Do

  1. Contact OEBB up to 60 days before your child turns 26:
  2. Submit the required paperwork to OEBB
  3. Provide a birth certificate and proof of guardianship or tax status
  4. Send your documents (copies only, not originals) to OEBB
  5. Ask your doctor to submit proof of disability to your carrier
  6. Use your carrier’s Disabled Dependent form, which you can request from your carrier or from OEBB
  7. Get approval from the carrier
    • They will review and may recheck eligibility in the future.

Once your child is enrolled as a Disabled Dependent, you must continue covering the child for them to stay eligible. If you drop the child from your OEBB coverage for any reason, you cannot re-enroll them in the future.

Need help?

Call OEBB Member Services at:

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 can cover a domestic partner if one of these is true:

  1. Registered Partnership (same sex)
  2. You and your partner are:
    • Unmarried
    • Same sex
    • Registered under Oregon’s “Declaration of Domestic Partnership”
    • Unregistered Partnership (same or opposite sex)
  3. You and your partner must also:
    • 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.)
  4. You must both complete and submit an Affidavit of Domestic Partnership to your employer within five business days of enrolling.
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

Special Rules for Retirees

If you're a retiree with an OEBB medical or vision plan and you become eligible for Medicare (except for 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.
  • Not reporting on time may count as fraud and lead to retroactive termination of your benefits.

Retiree’s 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.