72nd OREGON LEGISLATIVE ASSEMBLY--2003 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 2027
A-Engrossed
House Bill 2537
Ordered by the Senate August 5
Including Senate Amendments dated August 5
Sponsored by Representative VERGER; Representatives ANDERSON,
KRUSE, MONNES ANDERSON
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.
{ - Modifies requirements for benefit levels of basic health
benefit plans for small employers. - }
{ + Permits Insurance Pool Governing Board to contract for
and offer health benefit plans for certain small employers that
are not eligible for subsidies under Family Health Insurance
Assistance Program. Requires board to report to Seventy-fourth
Legislative Assembly. Sunsets certain provisions of Act on
January 2, 2008.
Declares emergency, effective on passage. + }
A BILL FOR AN ACT
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.
(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 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.
(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 { - 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 - } .
(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 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. + }
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