Oregon insurance law and regulation
The state insurance department can be reached by telephone at (503) 947-7984 or by mail at PO Box 14480, Salem OR 97309. The state children’s health insurance plan (CHIP) Web site is Oregon Health Plan.
News that affects your health insurance and planning
June 2, 2019 – Status of alternative non-ACA health plans: Oregon does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market. Oregon limits the sale of short-term coverage more strictly than the federal government. A maximum policy of 3 months and a maximum under multiple policies of 3 months per 5 month period is allowed.
March 29, 2019 – Small business health plans – Yesterday a federal court in the District of Columbia ruled in favor of states in striking down U.S. Treasury regulations that permitted the expansion of small business association health plans. Even before the court ruling, association health plans were not showing promise as cost-saving measures as was hoped. What this means to small businesses is that if they want a lower cost health plan then they must design it themselves independently from an insurance company. The problem is that most firms providing benefits services are primarily in the business of selling insurance rather than lowering costs. Freedom Benefits offers an affordable consultation to help small business owners design and document an alternate small business health plan without necessarily requiring the purchase of insurance.
The history of health care planning in Oregon (Information is outdated and links may be expired)
1/28/2016 The state ordered Moda Health to exit the individual health insurance market and to raise capital to protect its insureds. Moda Health was the state’s largest issuer of this type of insurance.
10/20/2015 Health Republic Insurance of Oregon will not offer coverage for 2016, Its 5,000 inividual coverage members and 10,000 members will need to find alternative coverage. The Oregon Insurance Division urged businesses with group coverage through Health Republic to contact their agents right away to pick new insurance.
2/20/2015 The state senate voted to abolish the Cover Oregon health insurance exchange and transfer responsibilities to the Department of Consumer and Business Services. It is not clear whether such a move is in conformity with federal health care reform funding requirements.
12/16/2014 Good news for consumers who missed the December 15 cutoff for January 1 health coverage. Oregon’s Health CO-OP has pushed the enrollment deadline back to midnight December 31st, effectively giving individuals, families and employer groups more time during the busy winter season.
11/18/2014 Cover Oregon released an interactive Cost-sharing comparison tool for 2015 Oregon individual health insurance plans.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
8/13/2013 Cover Oregon insurance exchange announced that it will not have navigators ready to assist consumers with enrollment prior to 2014. Consumers can still enroll through licensed and specifically qualified insurance agents.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Oregon residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
12/14/2012 Oregon is one of a minority of states that will run a health insurance exchange for individuals and small businesses that is not managed by the federal government. Consumer advocates who once viewed a state-run exchange as a positive are growing concerned that the state may not be fully committed to implementing all of the funding and features expected to be part of the federal health insurance exchanges that are expected to open in the fall of 2013.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Regence BlueCross BlueShield of Oregon is the state’s largest health insurance provider and as such, earns the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
7/21/2011 Oregon consumers are caught in the middle of a legal loophole of health reform law that requires state authorities to review rate increases of more than 10%. The law was intended to provide stability to insurance but turns out to have the opposite effect, causing tens of thousands to lose coverage in Oregon. The number of in-force policies decreased from more than 100,000 to less than 60,000 in the three years since the rate cap policy has been in effect. Blue Cross stated that it would be unable to continue to offer insurance under the current rate cap system. Prior to 2007 policyholders typically reacted to a rate increase by adjusting their level of benefits, perhaps by increasing the policy deductible, to keep the premium affordable without determining the insurer’s ability to offer the coverage. That price stability mechanism is not longer effective under the new laws.
Oregon officials changed the average rate increase from 22% to 13% for policies affecting about 59,000 Oregon Blue Cross policyholders. The unintended side effect of the new law is that insurance companies do not continue to offer policies where claims growth is expected to exceed the allowable increase in future premiums. Blue Cross stated that it is unable to continue to operate and honor the coverage provisions on the existing policies at that rate but did not announce plans to cancel coverage. The immediate effect is that provider payments will be trimmed or delayed, according to a company manager. Under the longer term, Blue Cross CEO says the individual insurance plan cannot be maintained. The insurer may stop issuing new policies this year and not offer renewals on block of policies where claims growth is expected to exceed the 10% allowable rate increases. It is unclear whether the company will cancel some or all policies and whether adequate alternative options exist if Blue Cross stops offering the coverage in 2012 or 2013.
Freedom Benefits points out that regardless of whether rate increases are 13% or 22%, the cost increase is unsustainable and that a significant portion of Blue Cross policyholders will be forced to cancel coverage at either level of increase. Although there are no low cost permanent policies available in Oregon at this time, Freedom Benefits can assist affected policyholders with a low cost short term major medical policy that can provide coverage for up to 12 months. This coverage is only available to healthy applicants. The other increasingly popular approach is medical tourism/migration where individuals travel outside of Oregon to obtain more affordable health care and medical insurance in other states or countries.
6/18/2011 A copy of the 2011 Oregon Guide to Medigap, Medicare Advantage and Prescription Drug Plans can be viewed or downloaded at http://www.oregon.gov/DCBS/SHIBA/docs/2011_guide.pdf
5/24/2011 Oregon Insurance Division defended the limited enrollment periods that are intended to minimize the ability of families to wait to buy insurance in an email to insurance producers. Consumers and producers would prefer to have a loophole in the state’s insurance laws that would provide to have permanent open enrollment for unhealthy children who take insurance coverage separately from their parent(s). Insurance companies correctly point out that a permanent open enrollment provision would allow individuals to purchase insurance only when it is needed and this eventually results in making the insurance unaffordable to anyone. Public comments will be received through June but we expect the situation will resolve as it stands now. The next open enrollment for child only coverage is in June. We feel that it is important to clarify that children may apply for guaranteed issue coverage at any time when a parent is also applying for coverage.
3/8/2011 The health exchange bill, as proposed, has drawn criticism from every sector of its stakeholders. Consumer advocates warn that the program would limit consumer choice and competition through selective contracting. The exchange would set product options that may not resemble or be comparable to products offered outside the exchange and insurers expressed concern that the exchange would assume oversight of premiums inside and outside the exchange, rather than house that responsibility with the Oregon Insurance Division as expected. Large employers are concerned that the exchange would regulate self-funded health plans in contrast to the treatment in other states. Hospitals and health care providers don’t like the proposal’s features that assess their performance. We hope to see changes that bring the Oregon health insurance exchange more in-line with the design used in other states.
2/17/2011 Oregon Health Authority was granted more than $48 million from the U.S. Department of Health and Human Services to use commercially available, off-the-shelf software to create a health insurance exchange. This Exchange Early Information Technology Innovation Grant will help Oregon create a modular, reusable IT solution that will provide the Exchange’s customers with seamless access to information, financial assistance and easy health insurance enrollment, with no gaps in coverage or assistance cliffs for anyone up to 400% of the federal poverty level. The Oregon Health Authority estimates that 516,000 Medicaid clients and 277,000 commercial insurance consumers will use the health insurance exchange to shop for and enroll in health coverage.
1/19/2011 Child-only health insurance for children with significant medical problems will be available through an open enrollment period mandated by federal state law under new rules developed by the state. All children, regardless of medical condition, continue to be eligible for insurance when applying as a dependent on a parent’s policy and healthy children are eligible for child-only insurance at any time. When applying for child-only insurance for more than one child, make a separate application for each child.
12/16/2010 Oregon Office for Oregon Health Policy and Research officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, Oregon said that it would: 1) Study the feasibility of a public corporation Exchange model, including: a) Using a public comment web-portal and soliciting feedback, b) Guidance from technical assistance work group and consumer advisory group, c) Partnering with nearby States for joint purchasing, and 2) Create a final operational and technical infrastructure plan.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
10/21/2010 Medicare update: Some Oregon residents covered by a fee for service Medicare Advantage plan must select new insurance for 2011. The 2011 edition of Oregon Guide to Medigap, Medicare Advantage & Prescription Drug Plans is now available online to help with these decisions. The state also offers free individual counseling with Medicare selection.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Oregon is now available at Freedom Benefits.