75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
Enrolled
House Bill 2433
Sponsored by COMMITTEE ON CONSUMER PROTECTION
CHAPTER ................
AN ACT
Relating to health insurance; creating new provisions; amending
ORS 743.610; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2009 Act is added to and made
a part of the Insurance Code. + }
SECTION 2. { + (1) Notwithstanding the limitations of ORS
743.610, the Director of the Department of Consumer and Business
Services by rule may extend the period of time during which
coverage is available to a certificate holder and may open a new
period of time during which a certificate holder may request
continuation of health benefit coverage under the state
continuation of benefits program described in ORS 743.610 if:
(a) The establishment of the extension and new request period
is in response to and consistent with federal legislation
relating to the continuation of health benefit coverage; and
(b) The director finds that the rule is necessary to take
advantage of a benefit provided to insurers, employers or
employees by the federal legislation relating to the continuation
of health benefit coverage.
(2) The rules adopted by the director under subsection (1) of
this section may include but need not be limited to:
(a) Changes to the maximum period of coverage;
(b) Adoption of notice requirements for insurers, plan
administrators, employers, group policyholders and certificate
holders;
(c) Criteria to determine if a certificate holder is eligible
for a benefit;
(d) Procedures to allow an additional opportunity to request
continuation coverage under ORS 743.610 (5) to a certificate
holder whose employment was involuntarily terminated between
September 1, 2008, and the effective date of this 2009 Act;
(e) Any necessary extension of the time by which the
certificate holder must pay the first premium as required under
ORS 743.610; and
(f) Any necessary extension of the time by which the
certificate holder must request or elect continuation
coverage. + }
SECTION 3. ORS 743.610 is amended to read:
743.610. (1) A group health insurance policy providing coverage
for hospital or medical expenses, other than coverage limited to
expenses from accidents or specific diseases, { - shall - }
{ + must + } contain a provision that certificate holders whose
Enrolled House Bill 2433 (HB 2433-A) Page 1
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 - } { + is + }
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 - } { + is
not + } available to a certificate holder who is eligible for:
(a) Federal Medicare coverage; or
(b) Coverage for hospital or medical expenses 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.
(5) { + Except as provided by rule by the Director of the
Department of Consumer and Business Services under section 2 of
this 2009 Act, + }a certificate holder who has terminated
employment or membership and who wishes to continue coverage must
request continuation in writing { + :
(a) + } 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 - } { + ; and
(b) + } { - May not make a request for continuation - }
{ + Not + } more than 31 days after the date of termination of
employment or membership.
(6) A certificate holder who requests continuation of coverage
{ - must - } { + shall + } 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.
{ + Except as otherwise provided by rule by the director under
section 2 of this 2009 Act, + } 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) { + Except as otherwise provided by rule by the director
under section 2 of this 2009 Act, + } continuation of coverage as
provided under this section { - shall end upon - } { + ends
on + } the earliest of the following dates:
(a) { - Six - } { + Nine + } 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.
Enrolled House Bill 2433 (HB 2433-A) Page 2
(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 replacement group policy must provide, at a minimum, + }
the applicable level of benefits of the replaced policy reduced
by any benefits still payable under that policy; and
(C) The replaced policy { - shall - } { + must + } 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 - }
{ + must + } 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 - } { + may not be + }
subject upon any rehire that occurs within { - six - }
{ + nine + } 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
Budget Reconciliation Act of 1985, as amended, P.L. 99-272, April
7, 1986.
SECTION 4. ORS 743.610, as amended by section 3 of this 2009
Act, is amended to read:
Enrolled House Bill 2433 (HB 2433-A) Page 3
743.610. (1) A group health insurance policy providing coverage
for hospital or medical expenses, other than coverage limited to
expenses from accidents or specific diseases, must 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 is 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 is not available to a certificate
holder who is eligible for:
(a) Federal Medicare coverage; or
(b) Coverage for hospital or medical expenses 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.
(5) { - Except as provided by rule by the Director of the
Department of Consumer and Business Services under section 2 of
this 2009 Act, - } A certificate holder who has terminated
employment or membership and who wishes to continue coverage must
request continuation in writing:
(a) 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; and
(b) Not more than 31 days after the date of termination of
employment or membership.
(6) A certificate holder who requests continuation of coverage
shall 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. { - Except as otherwise provided by rule by the
director under section 2 of this 2009 Act, - } 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) { - Except as otherwise provided by rule by the director
under section 2 of this 2009 Act, - } Continuation of coverage
as provided under this section ends on the earliest of the
following dates:
(a) Nine 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.
Enrolled House Bill 2433 (HB 2433-A) Page 4
(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 replacement group policy must provide, at a minimum,
the applicable level of benefits of the replaced policy reduced
by any benefits still payable under that policy; and
(C) The replaced policy must 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 must 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 may not be subject upon any rehire that occurs
within nine 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
Budget Reconciliation Act of 1985, as amended, P.L. 99-272, April
7, 1986.
SECTION 5. { + Section 2 of this 2009 Act is repealed on
January 2, 2012. + }
SECTION 6. { + The amendments to ORS 743.610 by section 4 of
this 2009 Act become operative on January 2, 2012. + }
SECTION 7. { + This 2009 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
Enrolled House Bill 2433 (HB 2433-A) Page 5
is declared to exist, and this 2009 Act takes effect on its
passage. + }
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Passed by House April 1, 2009
...........................................................
Chief Clerk of House
...........................................................
Speaker of House
Passed by Senate April 22, 2009
...........................................................
President of Senate
Enrolled House Bill 2433 (HB 2433-A) Page 6
Received by Governor:
......M.,............., 2009
Approved:
......M.,............., 2009
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 2009
...........................................................
Secretary of State
Enrolled House Bill 2433 (HB 2433-A) Page 7