71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 1921
House Bill 2432
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of Representative Bill Witt)
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Allows continuation of group dental coverage for individuals
who are otherwise eligible for continuation of group health
insurance benefits because of termination of employment or
membership.
A BILL FOR AN ACT
Relating to continuation of dental coverage under group policy;
creating new provisions; and amending ORS 743.610.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 743.610 is amended to read:
743.610. (1) A group health insurance policy providing coverage
for hospital or medical expenses { + or dental benefits + },
other than coverage limited to expenses from accidents or
specific diseases, shall contain a provision that certificate
holders whose coverage under the policy otherwise would terminate
because of termination of employment or membership may continue
coverage under the policy for themselves and their eligible
dependents as provided in this section.
(2) Continuation of coverage shall be available only to a
certificate holder who has been insured continuously under the
policy or similar predecessor policy during the three-month
period ending on the date of the termination of employment or
membership.
(3) Continuation of coverage shall not be available to a
certificate holder who is eligible for:
(a) Federal Medicare coverage; or
(b) Coverage for hospital or medical expenses { + or dental
benefits + } under any other program which was not covering the
certificate holder immediately before the certificate holder's
termination of employment or membership.
(4) The continued coverage need not include benefits for
{ - dental, - } vision care or prescription drug expense, or
any other benefits under the policy additional to hospital and
medical expense benefits { + and dental benefits + }.
(5) A certificate holder who has terminated employment or
membership and who wishes to continue coverage must request
continuation in writing not later than 10 days after the later of
the date on which employment or membership terminated and the
date on which the employer or group policyholder gave the
certificate holder notice of the right to continue coverage.
However, a certificate holder may not make a request for
continuation more than 31 days after the date of termination of
employment or membership.
(6) A certificate holder who requests continuation of coverage
must pay the premium on a monthly basis and in advance, as
provided in this subsection. The certificate holder shall pay the
premium to the insurer or to the employer or policyholder,
whichever the group policy provides. The required premium payment
may not exceed the group premium rate, for the insurance being
continued under the group policy, as of the date the premium
payment is due. The certificate holder must pay the first premium
not later than 31 days after the date on which the certificate
holder's coverage under the policy otherwise would end.
(7) Continuation of coverage as provided under this section
shall end upon the earliest of the following dates:
(a) Six months after the date on which the certificate holder's
coverage under the policy otherwise would have ended because of
termination of employment or membership.
(b) The end of the period for which the certificate holder last
made timely premium payment, if the certificate holder fails to
make timely payment of a required premium payment.
(c) The premium payment due date coinciding with or next
following the date the certificate holder becomes eligible for
federal Medicare coverage.
(d) The date on which the policy is terminated or the
certificate holder's employer terminates participation under the
policy. However, if the employer replaces the coverage which is
terminating for the certificate holder with similar coverage
under another group policy:
(A) The certificate holder may obtain coverage under the
replacement group policy for the balance of the period that the
certificate holder would have remained covered under the replaced
group policy under this section;
(B) The minimum level of benefits to be provided the
certificate holder by the replacement group policy shall be the
applicable level of benefits of the replaced policy reduced by
any benefits still payable under that policy; and
(C) The replaced policy shall continue to provide benefits to
the certificate holder to the extent of that policy's accrued
liabilities and extensions of benefits as if the replacement had
not occurred.
(8) The group health insurance policy also shall contain a
provision that:
(a) The surviving spouse of a certificate holder, if any, who
is not eligible for continuation of coverage under ORS 743.600
may continue coverage under the policy, at the death of the
certificate holder, with respect to the spouse and any dependent
children whose coverage under the policy otherwise would
terminate because of the death, in the same manner that a
certificate holder may exercise the right under this section.
(b) The spouse of a certificate holder, if any, who is not
eligible for continuation of coverage under ORS 743.600 may
continue coverage under the policy, upon dissolution of marriage
with the certificate holder, with respect to the spouse and any
children whose coverage under the policy otherwise would
terminate because of the dissolution of marriage, in the same
manner that a certificate holder may exercise the right under
this section.
(c) A spouse who requests continuation of coverage under this
subsection must pay the premium for the spouse and any dependent
children, on a monthly basis and in advance, as provided in this
paragraph. The spouse shall pay the premium to the insurer or to
the employer or policyholder, whichever the group policy
provides. The required premium payment under this subsection may
not exceed the group premium rate, for the insurance being
continued under the group policy, as of the date the premium
payment is due.
(9) A certificate holder who has terminated employment by
reason of layoff shall not be subject upon any rehire that occurs
within six months of the time of the layoff to any waiting period
prerequisite to coverage under the employer's group health
insurance policy if the certificate holder was eligible for
coverage at the time of the termination and regardless of whether
the certificate holder continued coverage during the layoff.
(10) This section applies only to employers who are not
required to make available continuation of health insurance
benefits under Titles X and XXII of the Consolidated Omnibus
Reconciliation Act of 1985, as amended, P.L. 99-272, April 7,
1986.
SECTION 2. { + The amendments to ORS 743.610 by section 1 of
this 2001 Act apply to certificate holders whose coverage under
the policy terminates because of termination of employment or
membership on or after the effective date of this 2001 Act. + }
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