Oregon (OR)
Individual Health Insurance Regulations

Learn more about Oregon Individual Health Insurance

In Oregon, individual health insurance policies are not required to be sold on a guarantee issue basis, so they are subject to medical underwriting. The underwriting process allows the health insurance carrier an opportunity to review the past and present health conditions of the applicant and offer full coverage under the terms of the health insurance plan or deny coverage based upon the applicant's health history and status. Oregon law does not mandate that insurance carriers offer standardized individual medical insurance policies. All individual health plans will offer a unique design and provide benefits offered at the carrier's discretion and as outlined in the health plan description. Health insurance carriers are permitted a look back and exclusionary period pertaining to the pre-existing conditions of applicants who are not able to provide credit for prior coverage. Elimination riders are not permitted under Oregon law. For persons that have had 6 months of prior creditable coverage, the insurance companies must offer guaranteed issue coverage.

Oregon (OR)
Small Group Health Insurance Regulations

Oregon small business health insurance regulations apply to a company who employs 2 -25 employees. Federal regulations apply to employers with 2-50 employees. Under Oregon law, small group health insurance is offered on a guarantee issue basis, which provides that no group can be turned away or denied health insurance coverage based on the overall health of the group or an individual employee. Guidelines to join the employer-sponsored medical plan may require that all employees fulfill a specified waiting period before becoming eligible to join, but must be offered health insurance coverage once the specified period has been satisfied. Health insurance carriers are permitted to exercise a 6 month look back, 12 month exclusionary period on all applicants who are not able to provide proof of prior creditable coverage. This provision provides the health insurance company an opportunity to gather medical history concerning pre-existing conditions and to impose a 12 month exclusionary period during which treatment of the pre-existing condition will not be covered under the terms of the health policy. Group rates are based on modified community rates which are determined by family makeup, age, and geographic location of employer with a rate adjustment factor of 1.43. To be eligible for coverage, an employee must work over 17 hours a week for more than half the calendar year.

Oregon COBRA and Continuation Coverage

Under Oregon state mini-COBRA laws, all companies classified as a small business for the purpose of receiving health insurance coverage must offer their employees an additional six months of continuation coverage. To be eligible to receive a continuation of benefits under the Oregon state mini-COBRA law, the employee must have been insured under the employer-sponsored group health plan for a minimum period of three months prior to the employee's date of termination. Upon their election of continuation of coverage, the employee, at their sole expense, may continue to receive benefits under the group health plan. A written request for continuation of coverage must be made by the applicant within 10 days of the date of termination of employment. Federal COBRA laws apply to companies that employee more than 19 people. For persons exhausting their COBRA coverage, Oregon law requires the individual health insurance carriers the responsibility of offering guaranteed issue coverage to all residents who have had 6 months of prior coverage.