Bill Text: OR SB90 | 2011 | Regular Session | Introduced
Bill Title: Relating to health insurance; declaring an emergency.
Sponsorship: Unknown
Status: (Failed) 2011-06-30 - In committee upon adjournment. [SB90 Detail]
Download: Oregon-2011-SB90-Introduced.html
76th OREGON LEGISLATIVE ASSEMBLY--2011 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 573
Senate Bill 90
Printed pursuant to Senate Interim Rule 213.28 by order of the
President of the Senate in conformance with presession filing
rules, indicating neither advocacy nor opposition on the part
of the President (at the request of Governor John A. Kitzhaber
for Department of Consumer and Business Services)
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 as
introduced.
Prohibits insurer from canceling, rescinding or refusing to
renew policy except for fraud or intentional misrepresentation of
material fact. Applies to policies issued or renewed on or after
September 23, 2010.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to health insurance; creating new provisions; amending
ORS 743.737, 743.754, 743.760, 743.766, 743.801, 750.055 and
750.333 and section 4, chapter 75, Oregon Laws 2010; and
declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2011 Act is added to and made
a part of the Insurance Code. + }
SECTION 2. { + (1) An insurer may not rescind a health benefit
plan or the coverage of any individual under a group or
individual health insurance policy unless:
(a)(A) The individual or a person seeking coverage on behalf of
the individual performs an act, practice or omission that
constitutes fraud; or
(B) The individual makes an intentional misrepresentation of a
material fact as prohibited by the terms of the plan or policy;
and
(b) The insurer provides at least 30 days' advance written
notice, in the form and manner prescribed by the Department of
Consumer and Business Services, to each plan enrollee or primary
subscriber who would be affected by the rescission of coverage.
(2) An insurer that rescinds a plan or policy must provide
notice of the rescission to the department in the form and manner
prescribed by the department no later than 30 days after the date
that the rescission takes effect.
(3) As used in this section, 'a person seeking coverage on
behalf of the individual' does not include an insurance producer
or an employee or authorized representative of an insurance
producer or carrier. + }
SECTION 3. ORS 743.737 is amended to read:
743.737. { - Health benefit plans covering small employers
shall be subject to the following provisions: - }
(1) A preexisting conditions provision in a small employer
health benefit plan shall apply only to a condition for which
medical advice, diagnosis, care or treatment was recommended or
received during the six-month period immediately preceding the
enrollment date of an enrollee or late enrollee. As used in this
section, the enrollment date of an enrollee shall be the earlier
of the effective date of coverage or the first day of any
required group eligibility waiting period and the enrollment date
of a late enrollee shall be the effective date of coverage.
(2) A preexisting conditions provision in a small employer
health benefit plan shall { - terminate its effect - } { +
expire + } as follows:
(a) For an enrollee, { - not later than the first of - }
{ + on the earlier of + } the following dates:
(A) Six months { - following - } { + after + } the
enrollee's effective date of coverage; or
(B) Ten months { - following - } { + after + } the start of
any required group eligibility waiting period.
(b) For a late enrollee, not later than 12 months
{ - following - } { + after + } the late enrollee's effective
date of coverage.
(3) In applying a preexisting conditions provision to an
enrollee or late enrollee, except as provided in this subsection,
all small employer health benefit plans shall reduce the duration
of the provision by an amount equal to the enrollee's or late
enrollee's aggregate periods of creditable coverage if the most
recent period of creditable coverage is ongoing or ended within
63 days { - of - } { + after + } the enrollment date in the
new small employer health benefit plan. The crediting of prior
coverage in accordance with this subsection shall be applied
without regard to the specific benefits covered during the prior
period. This subsection does not preclude, within a small
employer health benefit plan, application of:
(a) An affiliation period that does not exceed two months for
an enrollee or three months for a late enrollee; or
(b) An exclusion period for specified covered services, as
established { - by the Health Insurance Reform Advisory
Committee - } { + under ORS 743.745 + }, applicable to all
individuals enrolling for the first time in the small employer
health benefit plan.
(4) Late enrollees may be excluded from coverage for up to 12
months or may be subjected to a preexisting conditions provision
for up to 12 months. If both an exclusion from coverage period
and a preexisting conditions provision are applicable to a late
enrollee, the combined period shall not exceed 12 months.
(5) Each small employer health benefit plan shall be renewable
with respect to all eligible enrollees at the option of the
policyholder, small employer or contract holder { - except - }
{ + unless + }:
(a) { - For nonpayment of the required premiums by - } The
policyholder, small employer or contract holder { + fails to pay
required premiums + }.
(b) { - For fraud or misrepresentation of - } The
policyholder, small employer or contract holder or, with respect
to coverage of individual enrollees, { - the enrollees or their
representatives - } { + an enrollee or a representative of an
enrollee engages in fraud or makes an intentional
misrepresentation of a material fact as prohibited by the terms
of the plan + }.
(c) { - When - } The number of enrollees covered under the
plan is less than the number or percentage of enrollees required
by participation requirements under the plan.
(d) { - For noncompliance with - } The small employer
{ - carrier's employer - } { + fails to comply with the + }
contribution requirements under the health benefit plan.
(e) { - When - } The carrier discontinues offering or
renewing, or offering and renewing, all of its small employer
health benefit plans in this state or in a specified service area
within this state. In order to discontinue plans under this
paragraph, the carrier:
(A) Must give notice of the decision to the { - Director of
the - } Department of Consumer and Business Services and to all
policyholders covered by the plans;
(B) May not cancel coverage under the plans for 180 days after
the date of the notice required under subparagraph (A) of this
paragraph if coverage is discontinued in the entire state or,
except as provided in subparagraph (C) of this paragraph, in a
specified service area;
(C) May not cancel coverage under the plans for 90 days after
the date of the notice required under subparagraph (A) of this
paragraph if coverage is discontinued in a specified service area
because of an inability to reach an agreement with the health
care providers or organization of health care providers to
provide services under the plans within the service area; and
(D) Must discontinue offering or renewing, or offering and
renewing, all health benefit plans issued by the carrier in the
small employer market in this state or in the specified service
area.
(f) { - When - } The carrier discontinues offering and
renewing a small employer health benefit plan in a specified
service area within this state because of an inability to reach
an agreement with the health care providers or organization of
health care providers to provide services under the plan within
the service area. In order to discontinue a plan under this
paragraph, the carrier:
(A) Must give notice to the { - director - }
{ + department + } and to all policyholders covered by the plan;
(B) May not cancel coverage under the plan for 90 days after
the date of the notice required under subparagraph (A) of this
paragraph; and
(C) Must offer in writing to each small employer covered by the
plan, all other small employer health benefit plans that the
carrier offers in the specified service area. The carrier shall
issue any such plans pursuant to the provisions of ORS 743.733 to
743.737. The carrier shall offer the plans at least 90 days prior
to discontinuation.
(g) { - When - } The carrier discontinues offering or
renewing, or offering and renewing, a health benefit plan for all
small employers in this state or in a specified service area
within this state, other than a plan discontinued under paragraph
(f) of this subsection. With respect to plans that are being
discontinued, the carrier must:
(A) Offer in writing to each small employer covered by the
plan, all health benefit plans that the carrier offers in the
specified service area.
(B) Issue any such plans pursuant to the provisions of ORS
743.733 to 743.737.
(C) Offer the plans at least 90 days prior to discontinuation.
(D) Act uniformly without regard to the claims experience of
the affected policyholders or the health status of any current or
prospective enrollee.
(h) { - When - } The Director { + of the Department of
Consumer and Business Services + } orders the carrier to
discontinue coverage in accordance with procedures specified or
approved by the director upon finding that the continuation of
the coverage would:
(A) Not be in the best interests of the enrollees; or
(B) Impair the carrier's ability to meet contractual
obligations.
(i) { - When, - } In the case of a small employer health
benefit plan that delivers covered services through a specified
network of health care providers, there is no longer any enrollee
who lives, resides or works in the service area of the provider
network.
(j) { - When, - } In the case of a health benefit plan that
is offered in the small employer market only through one or more
bona fide associations, the membership of an employer in the
association ceases and the termination of coverage is not related
to the health status of any enrollee.
{ - (k) For misuse of a provider network provision. As used
in this paragraph, 'misuse of a provider network provision' means
a disruptive, unruly or abusive action taken by an enrollee that
threatens the physical health or well-being of health care staff
and seriously impairs the ability of the carrier or its
participating providers to provide services to an enrollee. An
enrollee under this paragraph retains the rights of an enrollee
under ORS 743.804. - }
{ - (L) - } { + (6) + } A { - small employer - } carrier
may modify a small employer health benefit plan at the time of
coverage renewal. The modification is not a discontinuation of
the plan under
{ - paragraphs (e) and (g) of this - } subsection { + (5)(e)
and (g) of this section + }.
{ - (6) - } { + (7) + } Notwithstanding any provision of
subsection (5) of this section to the contrary, { + a carrier
may rescind + } any small employer { - carrier - } health
benefit plan { + , or the coverage of an enrollee under a
plan, + } subject to the provisions of ORS 743.733 to 743.737
{ - may be rescinded by a small employer carrier for fraud,
material misrepresentation or concealment by a small employer and
the coverage of an enrollee may be rescinded for fraud, material
misrepresentation or concealment by the enrollee. - } { + if
the small employer or the enrollee:
(a) Performs an act, practice or omission that constitutes
fraud; or
(b) Makes an intentional misrepresentation of a material fact
as prohibited by the terms of the plan. + }
{ - (7) - } { + (8) + } A { - small employer - } carrier
may continue to enforce reasonable employer participation and
contribution requirements on small employers applying for
coverage. However, participation and contribution requirements
shall be applied uniformly among all small employer groups with
the same number of eligible employees applying for coverage or
receiving coverage from the { - small employer - } carrier. In
determining minimum participation requirements, a carrier shall
count only those employees who are not covered by an existing
group health benefit plan, Medicaid, Medicare, CHAMPUS, Indian
Health Service or a publicly sponsored or subsidized health plan,
including but not limited to the medical assistance program under
ORS chapter 414.
{ - (8) - } { + (9) + } Premium rates for small employer
health benefit plans shall be subject to the following
provisions:
(a) Each { - small employer - } carrier issuing health
benefit plans to small employers must file its geographic average
rate for a rating period with the { - director - }
{ + department + } at least once every 12 months.
(b)(A) The premium rates charged during a rating period for
health benefit plans issued to small employers may not vary from
the geographic average rate by more than 50 percent on or after
January 1, 2008, except as provided in subparagraph (D) of this
paragraph.
(B) The variations in premium rates described in subparagraph
(A) of this paragraph shall be based solely on the factors
specified in subparagraph (C) of this paragraph. A { - small
employer - } carrier may elect which of the factors specified in
subparagraph (C) of this paragraph apply to premium rates for
{ + health benefit plans for + } small employers. The factors
that are based on contributions or participation may vary with
the size of the employer. All other factors must be applied in
the same actuarially sound way to all small { - employers - }
{ + employer health benefit plans + }.
(C) The variations in premium rates described in subparagraph
(A) of this paragraph may be based on one or more of the
following factors:
(i) The ages of enrolled employees and their dependents;
(ii) The level at which the small employer contributes to the
premiums payable for enrolled employees and their dependents;
(iii) The level at which eligible employees participate in the
health benefit plan;
(iv) The level at which enrolled employees and their dependents
engage in tobacco use;
(v) The level at which enrolled employees and their dependents
engage in health promotion, disease prevention or wellness
programs;
(vi) The period of time during which a small employer retains
uninterrupted coverage in force with the same { - small
employer - } carrier; and
(vii) Adjustments to reflect the provision of benefits not
required to be covered by the basic health benefit plan and
differences in family composition.
(D)(i) The premium rates determined in accordance with this
paragraph may be further adjusted by a { - small employer - }
carrier to reflect the expected claims experience of { - a - }
{ + the covered + } small employer, but the extent of this
adjustment may not exceed five percent of the annual premium rate
otherwise payable by the small employer. The adjustment under
this subparagraph may not be cumulative from year to year.
(ii) { - Except for small employers with 25 or fewer
employees, - } The premium rates adjusted under this
subparagraph { + , except rates for small employers with 25 or
fewer employees, + } are not subject to the provisions of
subparagraph (A) of this paragraph.
(E) A { - small employer - } carrier shall apply the
carrier's schedule of premium rate variations as approved by
{ - the Director of - } the department { - of Consumer and
Business Services - } and in accordance with this paragraph.
Except as otherwise provided in this section, the premium rate
established { + by a carrier + } for a { + small employer + }
health benefit plan { - by a small employer carrier - } shall
apply uniformly to all employees of the small employer enrolled
in that plan.
(c) Except as provided in paragraph (b) of this subsection, the
variation in premium rates between different { - small
employer - } health benefit plans offered by a { - small
employer - } carrier { + to small employers + } must be based
solely on objective differences in plan design or coverage and
must not include differences based on the risk characteristics of
groups assumed to select a particular health benefit plan.
(d) A { - small employer - } carrier may not increase the
rates of a health benefit plan issued to a small employer more
than once in a 12-month period. Annual rate increases shall be
effective on the plan anniversary date of the health benefit plan
issued to a small employer. The percentage increase in the
premium rate charged to a small employer for a new rating period
may not exceed the sum of the following:
(A) The percentage change in the geographic average rate
measured from the first day of the prior rating period to the
first day of the new period; and
(B) Any adjustment attributable to changes in age, except an
additional adjustment may be made to reflect the provision of
benefits not required to be covered by the basic health benefit
plan and differences in family composition.
(e) Premium rates for { + small employer + } health benefit
plans shall comply with the requirements of this section.
{ - (9) - } { + (10) + } In connection with the offering
for sale of any health benefit plan to a small employer, each
{ - small employer - } carrier shall make a reasonable
disclosure as part of its solicitation and sales materials of:
(a) The full array of health benefit plans that are offered to
small employers by the carrier;
(b) The authority of the carrier to adjust rates, and the
extent to which the carrier will consider age, family composition
and geographic factors in establishing and adjusting rates;
(c) Provisions relating to renewability of policies and
contracts; and
(d) Provisions affecting any preexisting conditions provision.
{ - (10)(a) - } { + (11)(a) + } Each { - small
employer - } carrier shall maintain at its principal place of
business a complete and detailed description of its rating
practices and renewal underwriting practices { + relating to its
small employer health benefit plans + }, including information
and documentation that demonstrate that its rating methods and
practices are based upon commonly accepted actuarial practices
and are in accordance with sound actuarial principles.
(b) { - Each small employer - } { + A + } carrier
{ + offering a small employer health benefit plan + } shall file
with the { - director - } { + department + } at least once
every 12 months an actuarial certification that the carrier is in
compliance with ORS 743.733 to 743.737 and that the rating
methods of the { - small employer - } carrier are actuarially
sound. Each { - such - } certification shall be in a uniform
form and manner and shall contain such information as specified
by the
{ - director - } { + department + }. A copy of { - such - }
{ + each + } certification shall be retained by the { - small
employer - } carrier at its principal place of business.
(c) A { - small employer - } carrier shall make the
information and documentation described in paragraph (a) of this
subsection available to the { - director - } { +
department + } upon request. Except as provided in ORS 743.018
and except in cases of violations of ORS 743.733 to 743.737, the
information shall be considered proprietary and trade secret
information and shall not be subject to disclosure { - by the
director - } to persons outside the department
{ - of Consumer and Business Services - } except as agreed to
by the
{ - small employer - } carrier or as ordered by a court of
competent jurisdiction.
{ - (11) - } { + (12) + } A { - small employer - }
carrier shall not provide any financial or other incentive to any
insurance producer that would encourage the insurance producer to
market and sell health benefit plans of the carrier to small
employer groups based on a small employer group's anticipated
claims experience.
{ - (12) - } { + (13) + } For purposes of this section, the
date a small employer health benefit plan is continued shall be
the anniversary date of the first issuance of the health benefit
plan.
{ - (13) - } { + (14) + } A { - small employer - }
carrier must include a provision that offers coverage to all
eligible employees { + of a small employer + } and to all
dependents { + of the eligible employees + } to the extent the
employer chooses to offer coverage to dependents.
{ - (14) - } { + (15) + } All small employer health benefit
plans shall contain special enrollment periods during which
eligible employees and dependents may enroll for coverage, as
provided in 42 U.S.C. 300gg as amended and in effect on
{ - July 1, 1997 - } { + February 17, 2009 + }.
SECTION 4. ORS 743.754 is amended to read:
743.754. The following requirements apply to all group health
benefit plans covering two or more certificate holders:
(1) A preexisting conditions provision in a group health
benefit plan shall apply only to a condition for which medical
advice, diagnosis, care or treatment was recommended or received
during the six-month period immediately preceding the enrollment
date of an enrollee or late enrollee. As used in this section,
the enrollment date of an enrollee shall be the earlier of the
effective date of coverage or the first day of any required group
eligibility waiting period and the enrollment date of a late
enrollee shall be the effective date of coverage.
(2) A preexisting conditions provision in a group health
benefit plan shall { - terminate its effect - } { + expire
+ }as follows:
(a) For an enrollee { + , on the earlier of + } { - not later
than the first of - } the following dates:
(A) Six months { - following - } { + after + } the
enrollee's effective date of coverage; or
(B) Twelve months { - following - } { + after + } the start
of any required group eligibility waiting period.
(b) For a late enrollee, not later than 12 months
{ - following - } { + after + } the late enrollee's effective
date of coverage.
(3) In applying a preexisting conditions provision to an
enrollee or late enrollee, except as provided in this subsection,
all group benefit plans shall reduce the duration of the
provision by an amount equal to the enrollee's or late enrollee's
aggregate periods of creditable coverage if the most recent
period of creditable coverage is ongoing or ended within 63 days
{ - of - } { + after + } the enrollment date in the new group
health benefit plan. The crediting of prior coverage in
accordance with this subsection shall be applied without regard
to the specific benefits covered during the prior period. This
subsection does not preclude, within a group health benefit plan,
application of:
(a) An affiliation period that does not exceed two months for
an enrollee or three months for a late enrollee; or
(b) An exclusion period for specified covered services
applicable to all individuals enrolling for the first time in the
group health benefit plan.
(4) Late enrollees may be excluded from coverage for up to 12
months or may be subjected to a preexisting conditions provision
for up to 12 months. If both an exclusion from coverage period
and a preexisting conditions provision are applicable to a late
enrollee, the combined period shall not exceed 12 months.
(5) { - All group health benefit plans shall contain special
enrollment periods - } { + Each group health benefit plan shall
contain a special enrollment period + } during which eligible
employees and dependents may enroll for coverage, as provided in
42 U.S.C. 300gg as amended and in effect on { - July 1,
1997 - } { + February 17, 2009 + }.
(6) Each group health benefit plan shall be renewable with
respect to all eligible enrollees at the option of the
policyholder { - except - } { + unless + }:
(a) { - For nonpayment of - } { + The policyholder fails to
pay + } the required premiums { - by the policyholder - } .
(b) { - For fraud or misrepresentation of - } The
policyholder or, with respect to coverage of individual
enrollees, { - the enrollees or their representatives - }
{ + an enrollee or a representative of an enrollee engages in
fraud or makes an intentional misrepresentation of a material
fact as prohibited by the terms of the plan + }.
(c) { - When - } The number of enrollees covered under the
plan is less than the number or percentage of enrollees required
by participation requirements under the plan.
(d) { - For noncompliance with the carrier's employer - }
{ + The policyholder fails to comply with the + } contribution
requirements under the health benefit plan.
(e) { - When - } The carrier discontinues offering or
renewing, or offering and renewing, all of its group health
benefit plans in this state or in a specified service area within
this state. In order to discontinue plans under this paragraph,
the carrier:
(A) Must give notice of the decision to { - the Director
of - } the Department of Consumer and Business Services and to
all policyholders covered by the plans;
(B) May not cancel coverage under the plans for 180 days after
the date of the notice required under subparagraph (A) of this
paragraph if coverage is discontinued in the entire state or,
except as provided in subparagraph (C) of this paragraph, in a
specified service area;
(C) May not cancel coverage under the plans for 90 days after
the date of the notice required under subparagraph (A) of this
paragraph if coverage is discontinued in a specified service area
because of an inability to reach an agreement with the health
care providers or organization of health care providers to
provide services under the plans within the service area; and
(D) Must discontinue offering or renewing, or offering and
renewing, all health benefit plans issued by the carrier in the
group market in this state or in the specified service area.
(f) { - When - } The carrier discontinues offering and
renewing a group health benefit plan in a specified service area
within this state because of an inability to reach an agreement
with the health care providers or organization of health care
providers to provide services under the plan within the service
area. In order to discontinue a plan under this paragraph, the
carrier:
(A) Must give notice of the decision to the { - director - }
{ + department + } and to all policyholders covered by the
plan;
(B) May not cancel coverage under the plan for 90 days after
the date of the notice required under subparagraph (A) of this
paragraph; and
(C) Must offer in writing to each policyholder covered by the
plan, all other group health benefit plans that the carrier
offers in the specified service area. The carrier shall offer the
plans at least 90 days prior to discontinuation.
(g) { - When - } The carrier discontinues offering or
renewing, or offering and renewing, a health benefit plan for all
groups in this state or in a specified service area within this
state, other than a plan discontinued under paragraph (f) of this
subsection. With respect to plans that are being discontinued,
the carrier must:
(A) Offer in writing to each policyholder covered by the plan,
one or more health benefit plans that the carrier offers in the
specified service area.
(B) Offer the plans at least 90 days prior to discontinuation.
(C) Act uniformly without regard to the claims experience of
the affected policyholders or the health status of any current or
prospective enrollee.
(h) { - When - } The Director { + of the Department of
Consumer and Business Services + } orders the carrier to
discontinue coverage in accordance with procedures specified or
approved by the director upon finding that the continuation of
the coverage would:
(A) Not be in the best interests of the enrollees; or
(B) Impair the carrier's ability to meet contractual
obligations.
(i) { - When, - } In the case of a group health benefit plan
that delivers covered services through a specified network of
health care providers, there is no longer any enrollee who lives,
resides or works in the service area of the provider network.
(j) { - When, - } In the case of a health benefit plan that
is offered in the group market only through one or more bona fide
associations, the membership of an employer in the association
ceases and the termination of coverage is not related to the
health status of any enrollee.
{ - (k) For misuse of a provider network provision. As used
in this paragraph, 'misuse of a provider network provision' means
a disruptive, unruly or abusive action taken by an enrollee that
threatens the physical health or well-being of health care staff
and seriously impairs the ability of the carrier or its
participating providers to provide services to an enrollee. An
enrollee under this paragraph retains the rights of an enrollee
under ORS 743.804. - }
{ - (L) - } { + (7) + } A carrier may modify a group health
benefit plan at the time of coverage renewal. The modification is
not a discontinuation of the plan under { - paragraphs (e) and
(g) of this - } subsection { + (6)(e) and (g) of this
section + }.
{ - (7) - } { + (8) + } Notwithstanding any provision of
subsection (6) of this section to the contrary, a { + carrier
may rescind a + } group health benefit plan { + , or coverage of
an enrollee under a group health benefit plan, + } { - may be
rescinded by a carrier for fraud, material misrepresentation or
concealment by a policyholder and the coverage of an enrollee may
be rescinded for fraud, material misrepresentation or concealment
by the enrollee. - } { + if the enrollee:
(a) Performs an act, practice or omission that constitutes
fraud; or
(b) Makes an intentional misrepresentation of a material fact
as prohibited by the terms of the plan. + }
{ - (8) - } { + (9) + } A carrier that continues to offer
coverage in the group market in this state is not required to
offer coverage in all of the carrier's group health benefit
plans. If a carrier, however, elects to continue a plan that is
closed to new policyholders instead of offering alternative
coverage in its other group health benefit plans, the coverage
for all existing policyholders in the closed plan is renewable in
accordance with subsection (6) of this section.
{ - (9) This section applies only to group health benefit
plans that are not small employer health benefit plans. - }
SECTION 5. ORS 743.760 is amended to read:
743.760. (1) As used in this section:
(a) 'Carrier' means an insurer authorized to issue a policy of
health insurance in this state. 'Carrier' does not include a
multiple employer welfare arrangement.
(b)(A) 'Eligible individual' means an individual who:
(i) Has left coverage that was continuously in effect for a
period of 180 days or more under one or more Oregon group health
benefit plans, has applied for portability coverage not later
than the 63rd day after termination of group coverage issued by
an Oregon carrier and is an Oregon resident at the time of such
application; or
(ii) On or after January 1, 1998, meets the eligibility
requirements of 42 U.S.C. 300gg-41, as amended and in effect on
January 1, 1998, has applied for portability coverage not later
than the 63rd day after termination of group coverage issued by
an Oregon carrier and is an Oregon resident at the time of such
application.
(B) Except as provided in subsection (12) of this section, '
eligible individual' does not include an individual who remains
eligible for the individual's prior group coverage or would
remain eligible for prior group coverage in a plan under the
federal Employee Retirement Income Security Act of 1974, as
amended, were it not for action by the plan sponsor relating to
the actual or expected health condition of the individual, or who
is covered under another health benefit plan at the time that
portability coverage would commence or is eligible for the
federal Medicare program.
(c) 'Portability health benefit plans' and 'portability plans'
mean health benefit plans for eligible individuals that are
required to be offered by all carriers offering group health
benefit plans and that have been approved by the Director of the
Department of Consumer and Business Services in accordance with
this section.
(2)(a) In order to improve the availability and affordability
of health benefit plans for individuals leaving coverage under
group health benefit plans, the Health Insurance Reform Advisory
Committee created under ORS 743.745 shall submit to the director
two portability health benefit plans pursuant to ORS 743.745. One
plan shall be in the form of insurance and the second plan shall
be consistent with the type of coverage provided by health
maintenance organizations. For each type of portability plan, the
committee shall design and submit to the director:
(A) A prevailing benefit plan, which shall reflect the benefit
coverages that are prevalent in the group health insurance
market; and
(B) A low cost benefit plan, which shall emphasize
affordability for eligible individuals.
(b) Except as provided in ORS 743.730 to 743.773, no law
requiring the coverage or the offer of coverage of a health care
service or benefit shall apply to portability health benefit
plans.
(3) The director shall approve the portability health benefit
plans if the director determines that the plans provide for
appropriate accessibility and affordability of needed health care
services and comply with all other provisions of this section.
(4) After the director's approval of the portability plans
submitted by the committee under this section, each carrier
offering group health benefit plans shall submit to the director
the policy form or forms containing at least one low cost benefit
and one prevailing benefit portability plan offered by the
carrier that meets the required standards. Each policy form must
be submitted as prescribed by the director and is subject to
review and approval pursuant to ORS 742.003.
(5) Within 180 days after approval by the director of the
portability plans submitted by the committee, as a condition of
transacting group health insurance in this state, each carrier
offering group health benefit plans shall make available to
eligible individuals the prevailing benefit and low cost benefit
portability plans that have been submitted by the carrier and
approved by the director under subsection (4) of this section.
(6) A carrier offering group health benefit plans shall issue
to an eligible individual who is leaving or has left group
coverage provided by that carrier any portability plan offered by
the carrier if the eligible individual applies for the plan
within 63 days { - of - } { + after + } termination of prior
coverage and agrees to make the required premium payments and to
satisfy the other provisions of the portability plan.
(7) Premium rates for portability plans shall be subject to the
following provisions:
(a) Each carrier must file the geographic average rate for each
of its portability health benefit plans for a rating period with
the director on or before March 15 of each year.
(b) The premium rates charged during the rating period for each
portability health benefit plan shall not vary from the
geographic average rate, except that the premium rate may be
adjusted to reflect differences in benefit design, family
composition and age. Adjustments for age shall comply with the
following:
(A) For each plan, the variation between the lowest premium
rate and the highest premium rate shall not exceed 100 percent of
the lowest premium rate.
(B) Premium variations shall be determined by applying
uniformly the carrier's schedule of age adjustments for
portability plans as approved by the director.
(c) Premium variations between the portability plans and the
rest of the carrier's group plans must be based solely on
objective differences in plan design or coverage and must not
include differences based on the actual or expected health status
of individuals who select portability health benefit plans. For
purposes of determining the premium variations under this
paragraph, a carrier may:
(A) Pool all portability plans with all group health benefit
plans; or
(B) Pool all portability plans for eligible individuals leaving
small employer group health benefit plan coverage with all plans
offered to small employers and pool all portability plans for
eligible individuals leaving other group health benefit plan
coverage with all health benefit plans offered to such other
groups.
(d) A carrier may not increase the rates of a portability plan
issued to { - an enrollee - } { + a policyholder + } more
than once in any 12-month period. Annual rate increases shall be
effective on the anniversary date of the plan issued to the
{ - enrollee - } { + policyholder + }. The percentage increase
in the premium rate charged to { - an enrollee - } { + a
policyholder + } for a new rating period may not exceed the
average increase in the rest of the carrier's applicable group
health benefit plans plus an adjustment for age.
(8) { - No - } { + A + } portability { - plans - }
{ + plan + } under this section may { + not + } contain
preexisting conditions provisions, exclusion periods, waiting
periods or other similar limitations on coverage.
(9) Portability health benefit plans shall be renewable with
respect to all enrollees at the option of the enrollee { - ,
except - } { + unless + }:
(a) { - For nonpayment of the required premiums by - } The
policyholder { + fails to pay required premiums + };
(b) { - For fraud or misrepresentation by - } The
policyholder { + engages in fraud or makes an intentional
misrepresentation of a material fact as prohibited by the terms
of the policy + };
(c) { - When - } The carrier elects to discontinue offering
all of its group health benefit plans in accordance with ORS
743.737 and 743.754; or
(d) { - When - } The director orders the carrier to
discontinue coverage in accordance with procedures specified or
approved by the director upon finding that the continuation of
the coverage would:
(A) Not be in the best interests of the enrollees; or
(B) Impair the carrier's ability to meet its contractual
obligations.
(10)(a) { - Each - } { + A + } carrier offering { + a + }
group health benefit
{ - plans - } { + plan + } shall maintain at its principal
place of business a complete and detailed description of its
rating practices and renewal underwriting practices relating to
its portability plans, including information and documentation
that demonstrate that its rating methods and practices are based
upon commonly accepted actuarial practices and are in accordance
with sound actuarial principles.
(b) { - Each such - } { + A + } carrier { + offering a
group health benefit plan + } shall file with the
{ - director - } { + Department of Consumer and Business
Services + } annually on or before March 15 an actuarial
certification that the carrier is in compliance with this section
and that its rating methods are actuarially sound. Each
{ - such - } certification shall be in a form and manner and
shall contain such information as specified by the
{ - director - } { + department + }. A copy of
{ - such - } { + each + } certification shall be retained by
the carrier at its principal place of business.
(c) { - Each such - } { + A + } carrier { + offering a
group health benefit plan + } shall make the information and
documentation described in paragraph (a) of this subsection
available to the { - director - } { + department + } upon
request. Except as provided in ORS 743.018 and except in cases of
violations of the Insurance Code, the information is proprietary
and trade secret information and shall not be subject to
disclosure { - by the director - } to persons outside the
department { - of Consumer and Business Services - } except as
agreed to by the carrier or as ordered by a court of competent
jurisdiction.
(11) A carrier offering { + a + } group health benefit
{ - plans - } { + plan + } shall not provide any financial or
other incentive to any insurance producer that would encourage
the insurance producer to market and sell portability plans of
the carrier on the basis of an eligible individual's anticipated
claims experience.
(12) An individual who is eligible to obtain a portability plan
in accordance with this section may obtain such a plan regardless
of whether the eligible individual qualifies for a period of
continuation coverage under federal law or under ORS 743.600 or
743.610. However, an individual who has elected such continuation
coverage is not eligible to obtain a portability plan until the
continuation coverage has been discontinued by the individual or
has been exhausted.
{ + (13) A carrier may rescind a portability health benefit
plan issued to a policyholder if the policyholder:
(a) Performs an act, practice or omission that constitutes
fraud; or
(b) Makes an intentional misrepresentation of a material fact
as prohibited by the terms of the policy. + }
SECTION 6. ORS 743.766 is amended to read:
743.766. (1) All carriers { - who - } { + that + } offer
{ + an + } individual health benefit { - plans - } { +
plan + } and evaluate the health status of individuals for
purposes of eligibility shall use the standard health statement
established { - by the Health Insurance Reform Advisory
Committee - } { + under ORS 743.745 + } and may not use any
other method to determine the health status of an individual.
Nothing in this subsection shall prevent a carrier from using
health information after enrollment for the purpose of providing
services or arranging for the provision of services under a
health benefit plan.
(2)(a) If an individual is accepted for coverage under an
individual health benefit plan, the carrier shall not impose
exclusions or limitations { - on coverage greater - } { +
other + } than:
(A) A preexisting conditions provision that complies with the
following requirements:
(i) The provision shall apply only to a condition for which
medical advice, diagnosis, care or treatment was recommended or
received during the six-month period immediately preceding the
individual's effective date of coverage; and
(ii) The provision shall terminate its effect no later than six
months following the individual's effective date of coverage;
(B) An individual coverage waiting period of 90 days; or
(C) An exclusion period for specified covered services
applicable to all individuals enrolling for the first time in the
individual health benefit plan.
(b) Pregnancy may constitute a preexisting condition for
purposes of this section.
(3) If the carrier elects to restrict coverage through the
application of a preexisting conditions provision or an
individual coverage waiting period provision, the carrier shall
reduce the duration of the provision by an amount equal to the
individual's aggregate periods of creditable coverage if the most
recent period of creditable coverage is ongoing or ended within
63 days { - of - } { + after + } the effective date of
coverage in the new individual health benefit plan. The crediting
of prior coverage in accordance with this subsection shall be
applied without regard to the specific benefits covered during
the prior period.
(4) If an eligible prospective enrollee is rejected for
coverage under an individual health benefit plan, the prospective
enrollee shall be eligible to apply for coverage under the Oregon
Medical Insurance Pool.
(5) If a carrier accepts an individual for coverage under an
individual health benefit plan, the carrier shall renew the
policy
{ - except - } { + unless + }:
(a) { - For nonpayment of the required premiums by - } The
policyholder { + fails to pay the required premiums + }.
(b) { - For fraud or misrepresentation by - } The
policyholder { + engages in fraud or makes an intentional
misrepresentation of a material fact as prohibited by the terms
of the policy + }.
(c) { - When - } The carrier discontinues offering or
renewing, or offering and renewing, all of its individual health
benefit plans in this state or in a specified service area within
this state. In order to discontinue the plans under this
paragraph, the carrier:
(A) Must give notice of the decision to the { - Director of
the - } Department of Consumer and Business Services and to all
policyholders covered by the plans;
(B) May not cancel coverage under the plans for 180 days after
the date of the notice required under subparagraph (A) of this
paragraph if coverage is discontinued in the entire state or,
except as provided in subparagraph (C) of this paragraph, in a
specified service area;
(C) May not cancel coverage under the plans for 90 days after
the date of the notice required under subparagraph (A) of this
paragraph if coverage is discontinued in a specified service area
because of an inability to reach an agreement with the health
care providers or organization of health care providers to
provide services under the plans within the service area; and
(D) Must discontinue offering or renewing, or offering and
renewing, all health benefit plans issued by the carrier in the
individual market in this state or in the specified service area.
(d) { - When - } The carrier discontinues offering and
renewing an individual health benefit plan in a specified service
area within this state because of an inability to reach an
agreement with the health care providers or organization of
health care providers to provide services under the plan within
the service area. In order to discontinue a plan under this
paragraph, the carrier:
(A) Must give notice of the decision to the { - director - }
{ + department + } and to all policyholders covered by the plan;
(B) May not cancel coverage under the plan for 90 days after
the date of the notice required under subparagraph (A) of this
paragraph; and
(C) Must offer in writing to each policyholder covered by the
plan, all other individual health benefit plans that the carrier
offers in the specified service area. The carrier shall offer the
plans at least 90 days prior to discontinuation.
(e) { - When - } The carrier discontinues offering or
renewing, or offering and renewing, an individual health benefit
plan for all individuals in this state or in a specified service
area within this state, other than a plan discontinued under
paragraph (d) of this subsection. With respect to plans that are
being discontinued, the carrier must:
(A) Offer in writing to each policyholder covered by the plan,
one or more individual health benefit plans that the carrier
offers in the specified service area.
(B) Offer the plans at least 90 days prior to discontinuation.
(C) Act uniformly without regard to the claims experience of
the affected policyholders or the health status of any current or
prospective enrollee.
(f) { - When - } The Director { + of the Department of
Consumer and Business Services + } orders the carrier to
discontinue coverage in accordance with procedures specified or
approved by the director upon finding that the continuation of
the coverage would:
(A) Not be in the best interests of the enrollee; or
(B) Impair the carrier's ability to meet its contractual
obligations.
(g) { - When, - } In the case of an individual health
benefit plan that delivers covered services through a specified
network of health care providers, the enrollee no longer lives,
resides or works in the service area of the provider network and
the termination of coverage is not related to the health status
of any enrollee.
(h) { - When, - } In the case of a health benefit plan that
is offered in the individual market only through one or more bona
fide associations, the membership of an individual in the
association ceases and the termination of coverage is not related
to the health status of any enrollee.
{ - (i) For misuse of a provider network provision. As used
in this paragraph, 'misuse of a provider network provision' means
a disruptive, unruly or abusive action taken by an enrollee that
threatens the physical health or well-being of health care staff
and seriously impairs the ability of the carrier or its
participating providers to provide service to an enrollee. An
enrollee under this paragraph retains the rights of an enrollee
under ORS 743.804. - }
{ - (j) - } { + (6) + } A carrier may modify an individual
health benefit plan at the time of coverage renewal. The
modification is not a discontinuation of the plan under
{ - paragraphs (c) and (e) of this - } subsection { + (5)(c)
and (e) of this section + }.
{ - (6) - } { + (7) + } Notwithstanding any other provision
of this section, a carrier may rescind an individual health
benefit plan
{ - for fraud, material misrepresentation or concealment by an
enrollee. - } { + if the policyholder:
(a) Performs an act, practice or omission that constitutes
fraud; or
(b) Makes an intentional misrepresentation of a material fact
as prohibited by the terms of the policy. + }
{ - (7) - } { + (8) + } A carrier that withdraws from the
market for individual health benefit plans must continue to renew
its portability health benefit plans that have been approved
pursuant to ORS 743.761.
{ - (8) - } { + (9) + } A carrier that continues to offer
coverage in the individual market in this state is not required
to offer coverage in all of the carrier's individual health
benefit plans. However, if a carrier elects to continue a plan
that is closed to new individual policyholders instead of
offering alternative coverage in its other individual health
benefit plans, the coverage for all existing policyholders in the
closed plan is renewable in accordance with subsection (5) of
this section.
SECTION 7. ORS 743.801 is amended to read:
743.801. As used in { + this section and + } ORS
{ - 743.801, - } 743.803, 743.804, 743.806, 743.807, 743.808,
743.811, 743.814, 743.817, 743.819, 743.821, 743.823, 743.827,
743.829, 743.831, 743.834, 743.837, 743.839, 743.854, 743.856,
743.857, 743.858, 743.859, 743.861, 743.862, 743.863, 743.864,
743.911, 743.912, 743.913, 743.917, 743.918 { + , + }
{ - and - } 743A.012 { + and 750.333 and section 2 of this
2011 Act + }:
(1) 'Emergency medical condition' means a medical condition
that manifests itself by acute symptoms of sufficient severity,
including severe pain, that a prudent layperson possessing an
average knowledge of health and medicine would reasonably expect
that failure to receive immediate medical attention would place
the health of a person, or a fetus in the case of a pregnant
woman, in serious jeopardy.
(2) 'Emergency medical screening exam' means the medical
history, examination, ancillary tests and medical determinations
required to ascertain the nature and extent of an emergency
medical condition.
(3) 'Emergency services' means those health care items and
services furnished in an emergency department and all ancillary
services routinely available to an emergency department to the
extent they are required for the stabilization of a patient.
(4) 'Enrollee' has the meaning given that term in ORS 743.730.
(5) 'Grievance' means a written complaint submitted by or on
behalf of an enrollee regarding the:
(a) Availability, delivery or quality of health care services,
including a complaint regarding an adverse determination made
pursuant to utilization review;
(b) Claims payment, handling or reimbursement for health care
services; or
(c) Matters pertaining to the contractual relationship between
an enrollee and an insurer.
(6) 'Health benefit plan' has the meaning provided for that
term in ORS 743.730.
(7) 'Independent practice association' means a corporation
wholly owned by providers, or whose membership consists entirely
of providers, formed for the sole purpose of contracting with
insurers for the provision of health care services to enrollees,
or with employers for the provision of health care services to
employees, or with a group, as described in ORS 743.522, to
provide health care services to group members.
(8) 'Insurer' { - has the meaning provided for that term in
ORS 731.106. For purposes of ORS 743.801, 743.803, 743.804,
743.806, 743.807, 743.808, 743.811, 743.814, 743.817, 743.819,
743.821, 743.823, 743.827, 743.829, 743.831, 743.834, 743.837,
743.839, 743.854, 743.856, 743.857, 743.858, 743.859, 743.861,
743.862, 743.863, 743.864, 743.911, 743.912, 743.913, 743.917,
743A.012, 750.055 and 750.333, 'insurer' also - } includes a
health care service contractor as defined in ORS 750.005.
(9) 'Managed health insurance' means any health benefit plan
that:
(a) Requires an enrollee to use a specified network or networks
of providers managed, owned, under contract with or employed by
the insurer in order to receive benefits under the plan, except
for emergency or other specified limited service; or
(b) In addition to the requirements of paragraph (a) of this
subsection, offers a point-of-service provision that allows an
enrollee to use providers outside of the specified network or
networks at the option of the enrollee and receive a reduced
level of benefits.
(10) 'Medical services contract' means a contract between an
insurer and an independent practice association, between an
insurer and a provider, between an independent practice
association and a provider or organization of providers, between
medical or mental health clinics, and between a medical or mental
health clinic and a provider to provide medical or mental health
services. 'Medical services contract' does not include a contract
of employment or a contract creating legal entities and ownership
thereof that are authorized under ORS chapter 58, 60 or 70, or
other similar professional organizations permitted by statute.
(11)(a) 'Preferred provider organization insurance' means any
health benefit plan that:
(A) Specifies a preferred network of providers managed, owned
or under contract with or employed by an insurer;
(B) Does not require an enrollee to use the preferred network
of providers in order to receive benefits under the plan; and
(C) Creates financial incentives for an enrollee to use the
preferred network of providers by providing an increased level of
benefits.
(b) 'Preferred provider organization insurance' does not mean a
health benefit plan that has as its sole financial incentive a
hold harmless provision under which providers in the preferred
network agree to accept as payment in full the maximum allowable
amounts that are specified in the medical services contracts.
(12) 'Prior authorization' means a determination by an insurer
prior to provision of services that the insurer will provide
reimbursement for the services. 'Prior authorization ' does not
include referral approval for evaluation and management services
between providers.
(13) 'Provider' means a person licensed, certified or otherwise
authorized or permitted by laws of this state to administer
medical or mental health services in the ordinary course of
business or practice of a profession.
(14) 'Stabilization' means that, within reasonable medical
probability, no material deterioration of an emergency medical
condition is likely to occur.
(15) 'Utilization review' means a set of formal techniques used
by an insurer or delegated by the insurer designed to monitor the
use of or evaluate the medical necessity, appropriateness,
efficacy or efficiency of health care services, procedures or
settings.
SECTION 8. Section 4, chapter 75, Oregon Laws 2010, is amended
to read:
{ + Sec. 4. + } (1) An insurer who elects to offer discounted
rates for a health insurance plan utilizing electronic
administration shall include the schedule of discounts for
utilization of electronic administration as part of a small
employer group health insurance or individual health insurance
rate filing. The rate discounts may be graduated and must be
proportionate to the amount of administrative cost savings the
insurer anticipates as a result of the use of electronic
transactions described in section 3 { - of this 2010 Act - }
{ + , chapter 75, Oregon Laws 2010 + }.
(2) Discounted rates allowed under this section shall be
applied uniformly to all similarly situated small employer group
or individual health insurance purchasers of an insurer.
(3) Discounts in premium rates under this section are not
premium rate variations for purposes of ORS 743.737 { - (8) - }
{ + (9) + } or 743.767.
SECTION 9. ORS 750.055 is amended to read:
750.055. (1) The following provisions of the Insurance Code
apply to health care service contractors to the extent not
inconsistent with the express provisions of ORS 750.005 to
750.095:
(a) ORS 705.137, 705.139, 731.004 to 731.150, 731.162, 731.216
to 731.362, 731.382, 731.385, 731.386, 731.390, 731.398 to
731.430, 731.428, 731.450, 731.454, 731.488, 731.504, 731.508,
731.509, 731.510, 731.511, 731.512, 731.574 to 731.620, 731.592,
731.594, 731.640 to 731.652, 731.730, 731.731, 731.735, 731.737,
731.750, 731.752, 731.804, 731.844 to 731.992 and 731.870.
(b) ORS 732.215, 732.220, 732.230, 732.245, 732.250, 732.320,
732.325 and 732.517 to 732.592, not including ORS 732.582.
(c) ORS 733.010 to 733.050, 733.080, 733.140 to 733.170,
733.210, 733.510 to 733.680 and 733.695 to 733.780.
(d) ORS chapter 734.
(e) ORS 742.001 to 742.009, 742.013, 742.061, 742.065, 742.150
to 742.162, 742.400, 742.520 to 742.540, 743.010, 743.013,
743.018 to 743.030, 743.050, 743.100 to 743.109, 743.402,
743.472, 743.492, 743.495, 743.498, 743.522, 743.523, 743.524,
743.526, 743.527, 743.528, 743.529, 743.549 to 743.552, 743.560,
743.600 to 743.610, 743.650 to 743.656, 743.804, 743.807,
743.808, 743.814 to 743.839, 743.842, 743.845, 743.847, 743.854,
743.856, 743.857, 743.858, 743.859, 743.861, 743.862, 743.863,
743.864, 743.911, 743.912, 743.913, 743.917, 743A.010, 743A.012,
743A.020, 743A.036, 743A.048, 743A.058, 743A.062, 743A.064,
743A.066, 743A.068, 743A.070, 743A.080, 743A.084, 743A.088,
743A.090, 743A.100, 743A.104, 743A.105, 743A.110, 743A.140,
743A.141, 743A.144, 743A.148, 743A.160, 743A.164, 743A.168,
743A.170, 743A.175, 743A.184, 743A.188, 743A.190 and
743A.192 { + and section 2 of this 2011 Act + }.
(f) The provisions of ORS chapter 744 relating to the
regulation of insurance producers.
(g) ORS 746.005 to 746.140, 746.160, 746.220 to 746.370,
746.600, 746.605, 746.607, 746.608, 746.610, 746.615, 746.625,
746.635, 746.650, 746.655, 746.660, 746.668, 746.670, 746.675,
746.680 and 746.690.
(h) ORS 743A.024, except in the case of group practice health
maintenance organizations that are federally qualified pursuant
to Title XIII of the Public Health Service Act unless the patient
is referred by a physician associated with a group practice
health maintenance organization.
(i) ORS 735.600 to 735.650.
(j) ORS 743.680 to 743.689.
(k) ORS 744.700 to 744.740.
(L) ORS 743.730 to 743.773.
(m) ORS 731.485, except in the case of a group practice health
maintenance organization that is federally qualified pursuant to
Title XIII of the Public Health Service Act and that wholly owns
and operates an in-house drug outlet.
(2) For the purposes of this section, health care service
contractors shall be deemed insurers.
(3) Any for-profit health care service contractor organized
under the laws of any other state that is not governed by the
insurance laws of the other state is subject to all requirements
of ORS chapter 732.
(4) The Director of the Department of Consumer and Business
Services may, after notice and hearing, adopt reasonable rules
not inconsistent with this section and ORS 750.003, 750.005,
750.025 and 750.045 that are deemed necessary for the proper
administration of these provisions.
SECTION 10. ORS 750.333 is amended to read:
750.333. (1) The following provisions of the Insurance Code
apply to trusts carrying out a multiple employer welfare
arrangement:
(a) ORS 731.004 to 731.150, 731.162, 731.216 to 731.268,
731.296 to 731.316, 731.324, 731.328, 731.378, 731.386, 731.390,
731.398, 731.406, 731.410, 731.414, 731.418 to 731.434, 731.454,
731.484, 731.486, 731.488, 731.512, 731.574 to 731.620, 731.640
to 731.652 and 731.804 to 731.992.
(b) ORS 733.010 to 733.050, 733.140 to 733.170, 733.210,
733.510 to 733.680 and 733.695 to 733.780.
(c) ORS chapter 734.
(d) ORS 742.001 to 742.009, 742.013, 742.061 and 742.400.
(e) ORS 743.028, 743.053, 743.524, 743.526, 743.527, 743.528,
743.529, 743.530, 743.560, 743.562, 743.600, 743.601, 743.602,
743.610, 743.730 to 743.773 (except 743.760 to 743.773), 743.801,
743.804, 743.807, 743.808, 743.814 to 743.839, 743.842, 743.845,
743.847, 743.854, 743.856, 743.857, 743.858, 743.859, 743.861,
743.862, 743.863, 743.864, 743.912, 743.917, 743A.012, 743A.020,
743A.052, 743A.064, 743A.080, 743A.100, 743A.104, 743A.110,
743A.144, 743A.170, 743A.175, 743A.184 and 743A.192 { + and
section 2 of this 2011 Act + }.
(f) ORS 743A.010, 743A.014, 743A.024, 743A.028, 743A.032,
743A.036, 743A.040, 743A.048, 743A.058, 743A.066, 743A.068,
743A.070, 743A.084, 743A.088, 743A.090, 743A.105, 743A.140,
743A.141, 743A.148, 743A.168, 743A.180, 743A.188 and 743A.190.
Multiple employer welfare arrangements to which ORS 743.730 to
743.773 apply are subject to the sections referred to in this
paragraph only as provided in ORS 743.730 to 743.773.
(g) Provisions of ORS chapter 744 relating to the regulation of
insurance producers and insurance consultants, and ORS 744.700 to
744.740.
(h) ORS 746.005 to 746.140, 746.160 and 746.220 to 746.370.
(i) ORS 731.592 and 731.594.
(j) ORS 731.870.
(2) For the purposes of this section:
(a) A trust carrying out a multiple employer welfare
arrangement shall be considered an insurer.
(b) References to certificates of authority shall be considered
references to certificates of multiple employer welfare
arrangement.
(c) Contributions shall be considered premiums.
(3) The provision of health benefits under ORS 750.301 to
750.341 shall be considered to be the transaction of health
insurance.
SECTION 11. { + Section 2 of this 2011 Act and the amendments
to ORS 743.737, 743.754, 743.760, 743.766, 743.801, 750.055 and
750.333 and section 4, chapter 75, Oregon Laws 2010, by sections
3 to 10 of this 2011 Act apply to policies issued or renewed on
or after September 23, 2010. + }
SECTION 12. { + This 2011 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2011 Act takes effect on
its passage. + }
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