Chapter 305 Oregon Laws 2005

AN ACT

SB 130

Relating to adverse underwriting decisions; creating new provisions; and amending ORS 735.615.

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

SECTION 1. ORS 735.615 is amended to read:

735.615. (1) Except as provided in subsection (3) of this section, any individual person who is a resident of this state, as defined by the Oregon Medical Insurance Pool Board, shall be eligible for pool coverage if:

(a) An insurer, or an insurance company with a certificate of authority in any other state, has made within a time frame established by the board an adverse underwriting decision, as defined in ORS 746.600 (1)(a)(A), (B), (D), (E) or (F), on individual medical insurance for health reasons while the person was a resident;

(b) The person has a history of any medical or health conditions on the list adopted by the board under subsection (2) of this section; or

(2) The board may adopt a list of medical or health conditions for which a person is eligible for pool coverage without applying for individual medical insurance pursuant to this section.

(3) A person is not eligible for coverage under ORS 735.600 to 735.650 if:

(a) Except as provided in ORS 735.625 (3)(b), the person is eligible [for health care benefits under ORS chapter 414] to receive health services as defined in ORS 414.705 that meet or exceed those adopted by the board or is eligible for Medicare;

(b) The person has terminated coverage in the pool within the last 12 months and the termination was for a reason other than becoming eligible [for health care benefits under ORS chapter 414] to receive health services as defined in ORS 414.705;

(d) The person is an inmate of or a patient in a public institution named in ORS 179.321;

(e) The person has, on the date of issue of coverage by the board, coverage under health insurance or a self-insurance arrangement which is substantially equivalent to coverage under ORS 735.625; or

(f) The person has the premiums paid or reimbursed by a public entity or a health care provider for the sole purpose of reducing the financial loss or obligation of the payer.

(4) A person applying for coverage shall establish initial eligibility by such evidence as the plan of operation shall require.

(5)(a) Notwithstanding ORS 735.625 (4)(c) and subsection (3)(a) of this section, if a person becomes eligible for Medicare after being enrolled in the pool for a period of time as determined by the board by rule, that person may continue coverage within the pool as secondary coverage to Medicare.

(b) The board may adopt rules concerning the terms and conditions for the coverage provided under paragraph (a) of this subsection.

SECTION 2. The amendments to ORS 735.615 by section 1 of this 2005 Act apply to adverse underwriting decisions made on or after the effective date of this 2005 Act.

SECTION 3. ORS 735.615, as amended by section 1 of this 2005 Act, is amended to read:

(a) An insurer, or an insurance company with a certificate of authority in any other state, has made within a time frame established by the board an adverse underwriting decision, as defined in ORS 746.600 (1)(a)(A), (B)[,] or (D)[, (E) or (F)], on individual medical insurance for health reasons while the person was a resident;

(b) The person has a history of any medical or health conditions on the list adopted by the board under subsection (2) of this section; or

(2) The board may adopt a list of medical or health conditions for which a person is eligible for pool coverage without applying for individual medical insurance pursuant to this section.

(3) A person is not eligible for coverage under ORS 735.600 to 735.650 if:

(a) Except as provided in ORS 735.625 (3)(b), the person is eligible to receive health services as defined in ORS 414.705 that meet or exceed those adopted by the board or is eligible for Medicare;

(b) The person has terminated coverage in the pool within the last 12 months and the termination was for a reason other than becoming eligible to receive health services as defined in ORS 414.705;

(d) The person is an inmate of or a patient in a public institution named in ORS 179.321;

(e) The person has, on the date of issue of coverage by the board, coverage under health insurance or a self-insurance arrangement which is substantially equivalent to coverage under ORS 735.625; or

(f) The person has the premiums paid or reimbursed by a public entity or a health care provider for the sole purpose of reducing the financial loss or obligation of the payer.

(4) A person applying for coverage shall establish initial eligibility by such evidence as the plan of operation shall require.

(b) The board may adopt rules concerning the terms and conditions for the coverage provided under paragraph (a) of this subsection.

SECTION 4. The amendments to ORS 735.615 by section 3 of this 2005 Act become operative on January 2, 2008.

Approved by the Governor June 28, 2005

Filed in the office of Secretary of State June 28, 2005

Effective date January 1, 2006

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