Oregon Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Oregon Medical Insurance Pool / OMIP
Insurance Regulation Establishing Risk Pool
OMIP was established in 1989 by the Oregon Legislature
Amends the Original Legislation
Oregon Medical Insurance Pool (OMIP)
Oregon Medical Insurance Pool, established by the Oregon Legislature, provides health coverage to Oregon residents who are unable to obtain medical insurance because of health conditions.
OMIP also provides a way to continue insurance coverage for those who exhaust COBRA benefits and have no other options.
Funding
OMIP is funded partially by the premiums that are made by plan members. Deficits, caused by operating costs and claims payments, are funded by assessments to insurance companies and reinsurance companies operating in the State of Oregon. Oregon also offers a low-income premium subsidy program.
Plans Offered
There are four medical insurance plans available through the OMIP program; all four plans are PPO plans: Medical Plan 500, Medical & Portability Plan 750, Medical Plan 1000 and Medical and Portability Plan 1500.
Plan Benefits
The Medical Plan 500 has an annual deductible of $500.00. For most in-patient covered medical service expenses, there is a 20% coinsurance. For most out-patient services, the coinsurance is 20%. The maximum out-of-pocket limit is $1,000.00 after deductible. The Medical and Portability Plan 750 has an annual deductible of $750.00. For most in-patient covered medical service expenses, there is a 20% coinsurance. For most out-patient services, the coinsurance is 40%. The maximum out-of pocket limit is $3,000.00 after deductible.
The Medical Plan 1000 has an annual deductible of $1000.00. For most in-patient covered medical service expenses, there is a 20% coinsurance. For most out-patient services, the coinsurance is 40%. The maximum out-of-pocket limit is $4,000.00 after deductible.
The Medical and Portability Plan 1500 has an annual deductible of $1,500.00. For most in-patient covered medical service expenses, there is 30% coinsurance. For most out-patient services, the coinsurance is 50%. The maximum out-of-pocket limit is $6,000.00 after deductible.
Maximum Benefit Limits
Each of the OMIP PPO health plans offers a lifetime maximum benefit of $2,000,000.00.
Eligibility
You must be a resident of Oregon and meet one of the eligibility categories, each with their own requirement
Medical Eligibility Requirements
- Within the last six months you must have received a declination of individual health insurance coverage due to health reasons
- You have recently been diagnosed with one or more of the medical conditions listed in Section C of the OMIP application
- You were offered individual health insurance coverage through a private health insurance company that included a restrictive waiver that substantially reduced the coverage by excluding coverage for a specific medical condition
- You were offered individual health insurance coverage but were limited by the choice of plans the carrier was willing to offer due to a specific medical condition
Portability Eligibility Requirements
- You were offered and have exhausted your COBRA coverage
- No COBRA or continuation coverage was offered to you through your previous health insurance plan
- You were covered under a portability plan, but your previous insurance company ceased operations in the State of Oregon
- You have been continuously covered for 18 months without a gap in coverage of more than 63 days, and your most recent coverage was through a group health plan
Enrollment Periods
For applications submitted under the Medical Eligibility category, coverage will begin on the first day of the month following your application submittal and approval date. For those applying under the Portability Eligibility category, your coverage can be made effective on the day following the termination date of your previous coverage.
Premium Payments
Premiums for OMIP are based on your plan selection, your age and your eligibility category. When a family is applying for coverage, the rates are based and determined by the oldest family member applying for the plan. The rate for the oldest member applying will apply to all other members on the plan.
Premium Calculations
OMIP premiums are calculated by comparing the rates of similar health insurance plans offered at standard risk rates and may not exceed 125% of these standard rates. HIPAA rates may not be more than 100% of the HIPAA rates charged by private health insurance companies offering HIPAA eligible plans in Oregon.
Pre-Existing Condition Waiting Periods
OMIP has a 6 month exclusionary period if you are applying for coverage through the Medically Eligible category. Persons qualifying for coverage under the Portability category will have a waiver of the pre-existing medical condition exclusionary period.
Oregon Medical Insurance Pool Contact Information
Oregon Medical Insurance Pool
C/O Regence Blue Cross Blue Shield of Oregon MS 5K
P.O. Box 1271
Portland, OR 97207-1271
Phone: 800-848-7280, 503-225-5474
OMIP Website
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