Oregon Individual Health Insurance
Health insurance is necessary for your peace of mind. A proper health insurance policy allows your family to take care of basic medical needs without financial worry. If you are without group health insurance coverage, purchasing an Oregon individual health insurance plan is a great option. If you are considering this route, you may have a lot of questions about the laws in Oregon regarding individual health insurance policies. The information below will seek to help you learn more about private insurance policies, the Oregon laws surrounding them, and any rights that you may have.
Eligibility: How Am I Evaluated?
Typically, an insurer is allowed to evaluate an applicant any way that they choose. This includes evaluating an applicant’s health status and the flexibility to deny coverage based on that status. Applications are reviewed based on each company’s policy. For the most part, an applicant can be turned down for any reason, including health status. The determination is based on the discretion of the insurer and is not regulated by Oregon law.
To comply with HIPPA Group-to-Individual Portability Coverage regulations, residents are offered guaranteed coverage into the Oregon Medical Insurance Pool (OMIP), the state’s high-risk health insurance, for individuals leaving a group health plan who haven't been able to obtain other private insurance.
Oregon Guaranteed Benefits & Pre-Existing Conditions
There are some benefits that each insurance plan is required to cover in Oregon; for example, your plan must cover mammograms, diabetes care, screening for prostate, colorectal and cervical cancer and medical care for pregnant women. Beyond those benefits, your insurer can pick and choose what is covered under each plan. In addition, Oregon health insurers are mandates to provide equal coverage for mental health conditions and physical health conditions.
In Oregon, there are two ways that an insurer can choose from to help protect themselves from pre-existing conditions. The first is by attaching a 24-month exclusionary period to conditions that they determine are pre-existing. They can use a 6-month look back window to make this determination. Secondly, they may require new applicants to wait a full 90-days before using their new policy at all. If they choose this second route, then an exclusionary period exclusively for pre-existing conditions does not apply.
Oregon Individual Health Insurance Premiums
Oregon individual health insurance premiums are determined based on the individual factors of each applicant. For example, your age, family size, and what plan you choose can all be factored into your rate. The only restriction on premium rates in Oregon is that your health status cannot be taken into consideration when calculating your rate. So, as long as you are not receiving a higher rate than other customers due to your health status, your insurer may charge whatever they want for a policy. Additionally, you are guaranteed the ability to renew your Oregon individual health insurance policy regardless of your health status at the end of your plan's term. Your insurer cannot deny your renewal because of your health. This regulation helps to protect those who may find themselves in declining health from being left without insurance protection.
Health insurance can save you a lot of money, and therefore, you must contact a qualified broker or agent to understand the coverage details and costs of owning a health insurance policy, suitable for you and your family.