(1) “Group health insurance” means that form of health insurance covering groups of persons described in this section, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or more dependents of such groups of persons, and issued upon one of the following bases:
(a) Under a policy issued to an employer or trustees of a fund established by an employer, who shall be deemed the policyholder, insuring employees of such employer for the benefit of persons other than the employer. As used in this paragraph, “employees” includes:
(A) The officers, managers and employees of the employer;
(B) The individual proprietor or partners if the employer is an individual proprietor or partnership;
(C) The officers, managers and employees of subsidiary or affiliated corporations;
(D) The individual proprietors, partners and employees of individuals and firms, if the business of the employer and such individual or firm is under common control through stock ownership, contract or otherwise;
(E) The trustees or their employees, or both, if their duties are principally connected with such trusteeship;
(F) The leased workers of a client employer; and
(G) Elected or appointed officials if a policy issued to insure employees of a public body provides that the term “employees” includes elected or appointed officials.
(b) Under a policy issued to an association, including a labor union, that has an active existence for at least one year, that has a constitution and bylaws and that has been organized and is maintained in good faith primarily for purposes other than that of obtaining insurance, which shall be deemed the policyholder, insuring members, employees or employees of members of the association for the benefit of persons other than the association or its officers or trustees.
(c) Under a policy issued to the trustees of a fund established by two or more employers in the same or related industry or by one or more labor unions or by one or more employers and one or more labor unions or by an association as described in paragraph (b) of this subsection, insuring employees of the employers or members of the unions or of such association, or employees of members of such association for the benefit of persons other than the employers or the unions or such association. As used in this paragraph, “employees” may include the officers, managers and employees of the employer, and the individual proprietor or partners if the employer is an individual proprietor or partnership. The policy may provide that the term “employees” includes the trustees or their employees, or both, if their duties are principally connected with such trusteeship.
(d) Under a policy issued to any person or organization to which a policy of group life insurance may be issued or delivered in this state, to insure any class or classes of individuals that could be insured under such group life policy.
(2) Group health insurance offered to a resident of this state under a group health insurance policy issued to a group other than one described in subsection (1) of this section may be delivered if:
(a) The Director of the Department of Consumer and Business Services finds that:
(A) The issuance of the policy is in the best interest of the public;
(B) The issuance of the policy would result in economies of acquisition or administration; and
(C) The benefits are reasonable in relation to the premiums charged; and
(b) The premium for the policy is paid either from funds of a policyholder, from funds contributed by a covered person or from both.
(3) As used in this section and ORS 743.533:
(a) “Client employer” means an employer to whom workers are provided under contract and for a fee on a leased basis by a worker leasing company licensed under ORS 656.850.
(b) “Employee” may include a retired employee.
(c) “Leased worker” means a worker provided by a worker leasing company licensed under ORS 656.850. [1967 c.359 §461; 1975 c.229 §1; 1989 c.784 §13; 2001 c.943 §4; 2005 c.22 §492]Section: Previous 743.489 743.492 743.495 743.498 743.516 743.519 743.520 743.522 743.523 743.524 743.525 743.526 743.527 743.528 743.529 Next
Last modified: August 7, 2008