Chapter 742 Oregon Laws 2003

AN ACT

HB 2537

Relating to health benefit coverage; creating new provisions; amending ORS 735.700, 735.702 and 735.710; and declaring an emergency.

Be It Enacted by the People of the State of Oregon:

SECTION 1. ORS 735.700 is amended to read:

735.700. As used in ORS 735.700 to 735.740, unless the context requires otherwise:

(1) “Board” means the Insurance Pool Governing Board established under ORS 735.704.

(2) “Carrier” means an insurance company or health care service contractor holding a valid certificate of authority from the Director of the Department of Consumer and Business Services, or two or more companies or contractors acting together pursuant to a joint venture, partnership or other joint means of operation.

(3) “Class of employee” means an employee classed as either management or nonmanagement employee.

(4) “Eligible employee” means an employee of an employer who is employed by the employer for an average of at least 17.5 hours per week, [who elects to participate in one of the group benefit plans provided through board action, and] sole proprietors, business partners, and limited partners. The term does not include individuals:

(a) Engaged as independent contractors.

(b) Whose periods of employment are on an intermittent or irregular basis.

[(c) Who have been employed by the employer for fewer than 90 days.]

(5) “Family member” means an eligible employee’s spouse,[and] any unmarried child or stepchild within age limits and other conditions imposed by the board with regard to unmarried children or stepchildren, or any other dependents eligible under the terms of the health benefit plan selected by the employee’s employer.

(6) “Health benefit plan” means a contract for group medical, surgical, hospital or any other remedial care recognized by state law and related services and supplies.

(7) “Premium” means the monthly or other periodic charge for a health benefit plan.

SECTION 2. ORS 735.702 is amended to read:

735.702. [It is the intent of the Legislative Assembly by enactment of ORS 735.700 to 735.740] To increase access to health insurance and health care [by providing], the Insurance Pool Governing Board shall provide:

(1) Information about health benefit plans and the premiums charged for those plans to self-employed individuals and small employers in Oregon;

(2) Direct assistance to health insurance agents and health insurance consumers regarding health benefit plans;

(3) A central source for information about resources for health care and health insurance; and

(4) Health benefit plans for small employers [that have not provided a group health benefit plan for eligible employees for a period of at least one year].

SECTION 2a. Section 2b of this 2003 Act is added to and made a part of ORS 735.700 to 735.740.

SECTION 2b. Health benefit plans for small employers offered by the Insurance Pool Governing Board under ORS 735.710 (8) that are not eligible for a subsidy under ORS 735.724 may be offered only to small employers that did not provide a health benefit plan for eligible employees on July 1, 2003, and to small employers that begin business operations on or after the effective date of this 2003 Act.

SECTION 3. ORS 735.710 is amended to read:

735.710. (1) In carrying out its duties under ORS 735.700 to 735.740, the Insurance Pool Governing Board [shall] may:

(a) Enter into contracts for administration of ORS 735.700 to 735.740 including collection of premiums and paying carriers.

(b) Retain consultants and employ staff.

(c) Enter into contracts with carriers or health care providers for health benefit plans[, including contracts where final payment may be reduced if usage is below a level fixed in the contract].

(d) Set premium rates for eligible employees and small employers.

(e) Perform other duties to provide low-cost health benefit plans of types likely to be purchased by small employers.

(f) Establish contributions to be paid by small employers toward the premiums incurred on behalf of covered eligible employees.

(2) Notwithstanding any other health benefit plan contracted for and offered by the board, the board shall contract for a health benefit plan or plans best designed to meet the needs and provide for the welfare of eligible employees and small employers.

(3) The board may approve more than one carrier for each type of plan contracted for and offered, but the number of carriers shall be held to a number consistent with adequate service to eligible employees and family members.

(4) Where appropriate for a contracted and offered health benefit plan, the board shall provide options under which an eligible employee may arrange coverage for family members of the employee.

(5) In developing any health benefit plan, the board may provide an option of additional coverage for eligible employees and family members at an additional cost or premium.

(6) Transfer of enrollment from one health benefit plan to another shall be open to all eligible employees and family members under rules adopted by the board.

(7) If the board requests less health care service or benefit than is otherwise required by state law, a carrier is not required to offer such service or benefit.

(8) The board may contract for and offer health benefit plans for small employers [contracted for and offered by the board must] that provide a sufficient level of benefits to be eligible for a subsidy under ORS 735.724 as well as health benefit plans for small employers that are not eligible for a subsidy under ORS 735.724.

(9) The board may employ whatever means are reasonably necessary to carry out the purposes of ORS 735.700 to 735.740. Such authority includes but is not limited to authority to seek clarification, amendment, modification, suspension or termination of any agreement or contract which in the board’s judgment requires such action.

SECTION 4. Section 5 of this 2003 Act is added to and made a part of ORS 735.700 to 735.740.

SECTION 5. (1) The Insurance Pool Governing Board shall submit to the Director of the Department of Consumer and Business Services any information requested by the director for the purpose of assessing the impact of the amendments to ORS 735.700, 735.702 and 735.710 by sections 1, 2 and 3 of this 2003 Act.

(2) The board shall report the results of the assessment conducted under subsection (1) of this section to the Seventy-fourth Legislative Assembly. The report shall include, but not be limited to:

(a) The demographics of small employers obtaining health benefit plans from the board;

(b) The carriers with whom the board has contracts to offer health benefit plans for small employers; and

(c) The premiums charged for health benefit plans for small employers.

SECTION 6. ORS 735.700, as amended by section 1 of this 2003 Act, is amended to read:

735.700. As used in ORS 735.700 to 735.740, unless the context requires otherwise:

(1) “Board” means the Insurance Pool Governing Board established under ORS 735.704.

(3) “Class of employee” means an employee classed as either management or nonmanagement employee.

(4) “Eligible employee” means an employee of an employer who is employed by the employer for an average of at least 17.5 hours per week[,] who elects to participate in one of the group benefit plans provided through board action, and sole proprietors, business partners, and limited partners. The term does not include individuals:

(a) Engaged as independent contractors.

(b) Whose periods of employment are on an intermittent or irregular basis.

(c) Who have been employed by the employer for fewer than 90 days.

(5) “Family member” means an eligible employee’s spouse[,] and any unmarried child or stepchild within age limits and other conditions imposed by the board with regard to unmarried children or stepchildren[, or any other dependents eligible under the terms of the health benefit plan selected by the employee’s employer].

(6) “Health benefit plan” means a contract for group medical, surgical, hospital or any other remedial care recognized by state law and related services and supplies.

(7) “Premium” means the monthly or other periodic charge for a health benefit plan.

SECTION 7. ORS 735.702, as amended by section 2 of this 2003 Act, is amended to read:

735.702. To increase access to health insurance and health care, the Insurance Pool Governing Board shall provide:

(1) Information about health benefit plans and the premiums charged for those plans to self-employed individuals and small employers in Oregon;

(2) Direct assistance to health insurance agents and health insurance consumers regarding health benefit plans;

(3) A central source for information about resources for health care and health insurance; and

(4) Health benefit plans for small employers that have not provided a group health benefit plan for eligible employees for a period of at least one year.

SECTION 8. ORS 735.710, as amended by section 3 of this 2003 Act, is amended to read:

735.710. (1) In carrying out its duties under ORS 735.700 to 735.740, the Insurance Pool Governing Board [may] shall:

(a) Enter into contracts for administration of ORS 735.700 to 735.740 including collection of premiums and paying carriers.

(b) Retain consultants and employ staff.

(c) Enter into contracts with carriers or health care providers for health benefit plans, including contracts where final payment may be reduced if usage is below a level fixed in the contract.

(d) Set premium rates for eligible employees and small employers.

(e) Perform other duties to provide low-cost health benefit plans of types likely to be purchased by small employers.

(f) Establish contributions to be paid by small employers toward the premiums incurred on behalf of covered eligible employees.

(4) Where appropriate for a contracted and offered health benefit plan, the board shall provide options under which an eligible employee may arrange coverage for family members of the employee.

(5) In developing any health benefit plan, the board may provide an option of additional coverage for eligible employees and family members at an additional cost or premium.

(6) Transfer of enrollment from one health benefit plan to another shall be open to all eligible employees and family members under rules adopted by the board.

(7) If the board requests less health care service or benefit than is otherwise required by state law, a carrier is not required to offer such service or benefit.

(8) [The board may contract for and offer] Health benefit plans for small employers [that] contracted for and offered by the board must provide a sufficient level of benefits to be eligible for a subsidy under ORS 735.724 [as well as health benefit plans for small employers that are not eligible for a subsidy under ORS 735.724].

SECTION 9. The amendments to ORS 735.700, 735.702 and 735.710 by sections 6, 7 and 8 of this 2003 Act become operative on January 2, 2008.

SECTION 10. Sections 2b and 5 of this 2003 Act are repealed on January 2, 2008.

SECTION 11. Section 12 of this 2003 Act is added to and made a part of ORS 735.700 to 735.740.

SECTION 12. The Insurance Pool Governing Board may renew health benefit plans for small employers offered by the board on or after the effective date of this 2003 Act that are not eligible for a subsidy under ORS 735.724.

SECTION 13. This 2003 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2003 Act takes effect on its passage.

Approved by the Governor September 2, 2003

Filed in the office of Secretary of State September 2, 2003

Effective date September 2, 2003

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