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Initial Enrollment
Benefits Enrollment Forms Are Available ...
Full-time and part-time members: Submit completed form to District HR/Benefits.
Substitute teachers: Submit form to the Trust Office.
If you are eligible, you may enroll yourself and your eligible dependents within 60 days of notification of eligibility.
If You Decline Initial Enrollment
If you don't enroll within 60 days of notification of eligibility, you generally won't have another chance to enroll until the next annual open enrollment period. However, there are two situations in which you may enroll before the next open enrollment.
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If other coverage ends — If you decline initial enrollment for yourself and/or your eligible dependents because you have other health insurance coverage, you may enroll yourself and/or your dependents if your or your dependents' other coverage (or the employer's contribution towards it) ends. To enroll, you must complete and submit a Benefits Enrollment Form to District HR/Benefits within a reasonable period of time after the other coverage ends.
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If you acquire a new dependent — If you decline initial enrollment for yourself and/or your eligible dependents and later acquire one or more new dependents as a result of marriage, domestic partnership, birth, adoption or placement for adoption, you may enroll your new dependent(s) and yourself, if you are not already enrolled. To do so, you must submit a Benefits Enrollment Form to District HR/Benefits within a reasonable period of time after the Dependent is eligible for coverage. In this case, coverage for new dependents (and you, if you are newly enrolling yourself) begins as follows:
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Newborn infants are automatically covered for 31 days from the date of birth, except for employees who have selected Providence. To continue coverage beyond this period, you must submit a Benefits Enrollment Form to District HR/Benefits. To have coverage from birth for a newborn under an option provided by Providence, you must submit a Benefits Enrollment Form within 31 days of birth. In addition, an employee must submit a copy of the birth certificate to the Trust office within 62 days of the birth (31 days after the Benefits Enrollment Form).
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Adopted children are automatically covered for 31 days from the date of placement for adoption. To continue coverage beyond this period, you must submit a Benefits Enrollment Form and a copy of the adoption papers to District HR/Benefits.
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Eligible dependents acquired through marriage or domestic partnership (and you, if you are newly enrolling yourself) are covered starting the first day of the month after enrollment, provided you submit a Benefits Enrollment Form (and if applicable, an Affidavit of Domestic Partnership) to District HR/Benefits by the payroll cutoff date in the month of enrollment. To find out the cutoff date, contact District HR/Benefits at (503) 916-3544. If you miss the payroll cutoff date in the month of enrollment, coverage will begin the first day of the second following month.
Enrollment for Newborn and Adopted Children
Newborn infants are automatically covered for 31 days from the date of birth except with Providence. Adopted children are automatically covered for 31 days from the date of placement for adoption. To continue coverage beyond this time period, you must submit a Benefits Enrollment Form. In the case of adoption, you must also provide a copy of the adoption papers.
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