(1) In addition to individuals otherwise qualified under ORS 735.615, the following individuals qualify for portability health insurance coverage under the Oregon Medical Insurance Pool if an application for coverage is made not later than the 63rd day after the date of first eligibility, as provided in subsection (2) of this section, and the individual is an Oregon resident at the time of such application:
(a) An individual who has left coverage that was continuously in effect for a period of 180 days or more under one or more group health benefit plans, if:
(A) The terminated coverage was in a plan issued or established in a state other than Oregon; and
(B) The individual was an Oregon resident for at least 180 consecutive days immediately prior to the termination of coverage;
(b) An eligible individual, as defined in ORS 743.760, who has left coverage under a group health benefit plan or a portability health benefit plan and whose carrier cannot offer a portability plan under ORS 743.760 (6) because of:
(A) A change in residence of the eligible individual within Oregon;
(B) A change in the geographic area served by the group carrier; or
(C) The carrier’s withdrawal from the group market in Oregon in accordance with ORS 743.737 and 743.754;
(c) An individual who has left coverage that was continuously in effect for a period of 180 days or more under one or more Oregon group health benefit plans and the terminated coverage was provided by:
(A) An employee welfare benefit plan that is exempt from state regulation under the federal Employee Retirement Income Security Act of 1974, as amended;
(B) A multiple employer welfare arrangement subject to ORS 750.301 to 750.341; or
(C) A public body of this state in accordance with ORS 731.036; and
(d) On or after January 1, 1998, an individual who meets the eligibility requirements of 42 U.S.C. 300gg-41, as amended and in effect on January 1, 1998, and does not otherwise qualify to obtain portability coverage from an Oregon group carrier in accordance with ORS 743.760.
(2) Eligibility for coverage pursuant to subsection (1) of this section is subject to the following provisions:
(a) An eligible individual does not include:
(A) An individual who remains eligible for the individual’s prior group coverage or would remain eligible for prior group coverage in a plan under the federal Employee Retirement Income Security Act of 1974, as amended, were it not for action by the plan sponsor relating to the actual or expected health condition of the individual;
(B) An individual who is covered under another health benefit plan at the time that portability coverage would commence;
(C) An individual who is eligible to enroll in another health benefit plan offered by the employer, other than as a late enrollee, at the time that portability coverage would commence; or
(D) An individual who is eligible for the federal Medicare program.
(b) If an eligible individual has left group coverage issued by an insurance company, a health care service contractor or a health maintenance organization, the date of first eligibility is the day following the termination date of the group coverage, including any period of continuation coverage that was elected by the individual under federal law or under ORS 743.600 or 743.610.
(c) If an eligible individual has left group coverage issued by an entity other than an insurance company, a health care service contractor or a health maintenance organization, the date of first eligibility is the day following the termination date of the group coverage, including the full extent of continuation coverage available to the individual under federal law and ORS 743.600 and 743.610.
(d) If an individual is eligible for coverage pursuant to subsection (1)(b) of this section, the date of first eligibility is the day following the loss of the group or portability coverage.
(3) Coverage under the Oregon Medical Insurance Pool pursuant to subsection (1) of this section shall be offered according to the following provisions:
(a) Coverage is subject to ORS 743.760 (2) and (8);
(b) Coverage may not be subject to a preexisting conditions provision, exclusion period, waiting period, residency period or other similar limitation on coverage; and
(c) The individual shall be required to pay a premium rate not more than the applicable portability risk rate determined by the Oregon Medical Insurance Pool Board pursuant to ORS 735.625. [Formerly 743.763; 1999 c.987 §1; 2001 c.356 §2]
Section: Previous 735.495 735.600 735.605 735.610 735.612 735.614 735.615 735.616 735.620 735.625 735.630 735.635 735.640 735.645 735.650 NextLast modified: August 7, 2008