Individual Medical Insurance Regulations in Oregon

In Oregon, individual medical insurance policies are subject to medical underwriting because they are not required to be sold on a guarantee issue basis. Medical underwriting gives the health insurance company a chance to review the applicant's health history. They can agree to offer full coverage through the medical insurance plan or they can deny coverage after reviewing the applicant's health history. Under Oregon law, Individual health plans are unique and each plan's benefits are at the carrier's discretion. Insurance companies do not have to make standardized policies available. All of these terms are located in the health plan description. Oregon law also allows health insurance companies to look back at pre-existing health conditions and add an exclusionary period on an applicant's health coverage. This pertains to applicants who are unable to show credit for prior coverage. Under state law, elimination riders are not allowed and insurance companies must make guaranteed issue coverage available to applicants that possess 6 months of prior creditable coverage.

Oregon (OR) Small Group Medical Insurance Regulations

Any company in Oregon that employs 2 -25 employees must abide by state small business medical insurance law and businesses with 2-50 employees must follow federal law. Small group health insurance is given on a guarantee issue basis under Oregon law. The guarantee issue basis prevents a group from being denied health insurance coverage because of the health of an individual employee or the health of the group overall. To join the employer's group plan, employees may have to go through a waiting period before they are eligible to become a member. After the employee has completed the waiting period they are then eligible to begin receiving health benefits. For applicants who have not had prior creditable coverage, health insurance companies can add a 6 month look back plus an exclusionary period of 12 months. This gives the insurance company a chance to review pre-existing conditions. In addition, the 12 month exclusionary period allows the insurance company to withhold coverage for the treatment of the pre-existing condition. The applicant's age, family and location are considered when determining modified community rates and group rates. These rates have a rate adjustment factor of 1.43. An employee must work at least 17 hours per week for more than half the calendar year in order to qualify for health coverage.

Oregon Continuation Coverage and COBRA

All companies must offer their employees an additional 6 months of continuation coverage if the company is grouped in the category of a small business in order to obtain health insurance coverage. This requirement is mandated under Oregon state mini-COBRA laws. In addition, if an employee is to be eligible to receive a continuation of benefits under these laws, then he or she must have had insurance under the employer's group health plan for at least 3 months before the employee's date of termination. The employee can continue to receive benefits under the group health plan at their own expense once continuation of coverage begins. Within 10 days of the date of termination, the applicant must make a written request in order to receive continuation of coverage. Any company that employs more than 19 people must abide by federal COBRA laws. Once a person uses up their coverage with COBRA, the law in Oregon enforces the individual health insurance company to take responsibility when offering guaranteed issue coverage to the person, as long as they have had prior coverage for at least 6 months.