COBRA Law Summaries
Oregon, COBRA Law Summaries
Oregon's health care continuation law is codified in the Oregon Revised Statutes at Title 56, Chapter 743, Sections 743.600 through 743.622.
DEFINITIONS
The term “employees” includes the officers, managers and employees of subsidiary or affiliated corporations, the individual proprietors, partners and employees of individuals and firms, if the business of the employer and such individual or firm is under common control though stock ownership, contract or otherwise. The term employees also includes retired employees (Sec. 743.522).
“Group policy” means that form of health insurance covering groups of persons with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or more dependents of such groups of persons (Sec. 743.522).
EXCEPTIONS
Oregon's health care continuation law does not apply to employers maintaining group medical plans subject to federal COBRA law. However, group health policies must contain a provision providing continuation coverage for surviving and divorced spouses aged 55 or older, regardless of the applicability of COBRA to the employer with 20 or more employees maintaining the plan (Sec. 743.600 and Sec. 743.610, as amended by H. 2433, L. 2009).
PROCEDURES
An employer must offer continuation coverage to employees and their eligible dependents, as long as the employee was continuously covered under the group policy for three months prior to the date employment ended. Spouses and their dependents are also eligible on the death of a covered employee or on divorce from the employee. Continuation coverage is not available to a person eligible for Medicare, or for coverage under any other group plan which was not covering the person immediately prior to the termination of employment (Sec. 743.610, as amended by H. 2433, L. 2009).
A covered employee must elect continuation coverage in writing 10 days after the date of (Sec. 743.610, as amended by H. 2433, L. 2009):
the date employment ends or
the date on which the employer gave the employee notice of the right to continue coverage.
Except as provided by rule by the Director of the Department of Consumer and Business Services under Sec. 2, H. 2433, L. 2009 (see below), a certificate holder who has terminated employment and who wishes to continue coverage must request continuation in writing as described just above and not more than 31 days after the date of termination of employment (Sec. 753.610, as amended by H. 2433, L. 2009).
WHAT THE EMPLOYER MUST DO
Oregon's health care continuation law requires an employer to offer continuation coverage to employees and their eligible dependents (Sec. 743.610, as amended by H. 2433, L. 2009).
Eligibility requirements.- Employees and eligible dependents are eligible for continuation coverage, as long as the employee was continuously covered under the group policy for three months prior to the date employment ended. Spouses and their dependents are also eligible on the death of a covered employee or on divorce from the employee. Continuation coverage is not available to a person eligible for Medicare or for coverage under any other group plan which was not covering the person immediately prior to the termination of employment (Sec. 743.610, as amended by H. 2433, L. 2009).
Conversion to individual policy.- Generally, conversion coverage is available for group certificate holders whose coverage under the group policy terminates for any reason. Coverage is not available to those who were not entitled to, or failed to request, continuation coverage under the group policy, or to those whose group coverage terminated for failure to pay premiums. In addition, the insurer need not provide coverage to those individuals eligible for Medicare or for similar benefits under another individual policy (Sec. 743.611).
Deadlines.- The certificate holder must submit a written application and the first premium payment for the coverage no later than 31 days after the date the group coverage terminates (Sec. 743.611).
Premiums.- The insurer must determine the premium in accordance with the insurer's table of premium rates applicable to the age and class of risk of the person to be covered, and the type and amount of insurance provided (Sec. 743.611).
Termination of coverage.- The insurer may refuse to renew a policy if:
the certificate holder is eligible for other benefits that, together with the converted policy, would result in overinsurance;
the certificate holder makes a material misrepresentation in applying for benefits; or
the certificate holder is eligible for Medicare
(Sec. 743.611).
Duration of coverage.- Except as otherwise provided by rule by the director under Sec. 2, H. 2433, L. 2009 (see below), continuation of coverage ends on the earliest of the following dates (Sec. 743.610, as amended by H. 2433, L. 2009):
nine months after the date on which the certificate holder's coverage under the policy otherwise would have ended because of termination of employment.
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.
the premium payment due date coinciding with or next following the date the certificate holder becomes eligible for federal Medicare coverage.
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.
Premiums: Continuation coverage.- The required premium for continuation coverage 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 Sec. 2, H. 2433, L. 2009 (see below), 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 (Sec. 743.610, as amended by H. 2433, L. 2009).
Premiums: Conversion coverage.- The insurer must determine the premium in accordance with the insurer's table of premium rates applicable to the age and class of risk of the person to be covered, and the type and amount of insurance provided (Sec. 743.611).
Termination of coverage: Continuation coverage.- Continuation of coverage is not available to a certificate holder who is eligible for federal Medicare coverage, or 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 (Sec. 743.611 and Sec. 743.610, as amended by H. 2433, L. 2009).
Extension of coverage.- 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 (Sec. 2, H. 2433, L. 2009, effective until January 2, 2012):
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
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.
DEADLINES
Continuation coverage.- Except as provided by rule by the Director of the Department of Consumer and Business Services under Sec. 2, H. 2433, L. 2009 (see above), a certificate holder who has terminated employment and who wishes to continue coverage must request continuation in writing (Sec. 743.610, as amended by H. 2433, L. 2009):
Not later than 10 days after the later of the date on which employment terminated and the date on which the employer or group policyholder gave the certificate holder notice of the right to continue coverage; and
not more than 31 days after the date of termination of employment.
Conversion coverage.- The certificate holder must submit a written application and the first premium payment for the coverage no later than 31 days after the date the group coverage terminates (Sec. 743.611).
Premiums.- The insurer must determine the premium in accordance with the insurer's table of premium rates applicable to the age and class of risk of the person to be covered, and the type and amount of insurance provided (Sec. 743.611).
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