Coverage in group health benefit plans
- • consideration of prospective enrollee health status restricted
- • effect of discontinuing offer of plans
- • exceptions
- • coverage by multiple employer welfare arrangements
(1) Except in the case of a late enrollee and as otherwise provided in this section, a carrier offering a group health benefit plan to a group of two or more prospective certificate holders shall not decline to offer coverage to any eligible prospective enrollee and shall not impose different terms or conditions on the coverage, premiums or contributions of any enrollee in the group that are based on the actual or expected health status of the enrollee.
(2) A carrier that elects to discontinue offering all of its group health benefit plans under ORS 743B.105 (Requirements for group health benefit plans other than small employer plans) (5)(e), elects to discontinue renewing all such plans or elects to discontinue offering and renewing all such plans is prohibited from offering health benefit plans in the group market in this state for a period of five years from:
(a) The date of notice to the Director of the Department of Consumer and Business Services pursuant to ORS 743B.105 (Requirements for group health benefit plans other than small employer plans) (5)(e); or
(b) If notice is not provided under paragraph (a) of this subsection, the date on which the director provides notice to the carrier that the director has determined that the carrier has effectively discontinued offering group health benefit plans in this state.
(3) The Department of Consumer and Business Services may, in accordance with ORS 743B.129 (Shortening period of exclusion following discontinued offering), shorten the period of prohibition described in subsection (2) of this section if necessary to ensure, in all geographic areas of this state, that:
(a) A competitive health insurance market exists;
(b) Group purchasers have a reasonable number of health insurance options available to them; and
(c) Consumers who purchase insurance are protected.
(4) Subsection (1) of this section applies only to group health benefit plans that are not small employer health benefit plans.
(5) Nothing in this section shall prohibit an employer from providing different group health benefit plans to various categories of employees as defined by the employer nor prohibit an employer from providing health benefit plans through different carriers so long as the employer’s categories of employees are established in a manner that does not relate to the actual or expected health status of the employees or their dependents.
(6) A multiple employer welfare arrangement, professional or trade association, or other similar arrangement established or maintained to provide benefits to a particular trade, business, profession or industry or their subsidiaries, shall not issue coverage to a group or individual that is not in the same trade, business, profession or industry or their subsidiaries as that covered by the arrangement. The arrangement shall accept all groups and individuals in the same trade, business, profession or industry or their subsidiaries that apply for coverage under the arrangement and that meet the requirements for membership in the arrangement. For purposes of this subsection, the requirements for membership in an arrangement shall not include any requirements that relate to the actual or expected health status of the prospective enrollee. [Formerly 743.752; 2017 c.206 §5]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent. Currency Information