State to continue group health benefits for injured worker and covered dependents
- when ended
(1)The State of Oregon shall cause group health benefits to continue in effect with respect to that worker and any covered dependents or family members by timely payment of the premium that includes the contribution due from the state under the applicable benefit plan, subject to any premium contribution due from the worker that the worker paid before the occurrence of the injury or illness. If the premium increases or decreases, the State of Oregon and worker contributions shall be adjusted to remain consistent with similarly situated active employees. The State of Oregon shall continue the worker’s health benefits in effect until whichever of the following events occurs first:
(a)The worker’s attending physician or a nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) has determined the worker to be medically stationary and a notice of closure has been entered;
(b)The worker returns to work for the State of Oregon, after a period of continued coverage under this section, and satisfies any probationary or minimum work requirement to be eligible for group health benefits;
(c)The worker takes full- or part-time employment with another employer that is comparable in terms of the number of hours per week the worker was employed with the State of Oregon or the worker retires;
(d)Twelve months have elapsed since the date the State of Oregon received notice that the worker filed a workers’ compensation claim pursuant to ORS chapter 656;
(e)The claim is denied and the claimant fails to appeal within the time provided by ORS 656.319 (Time within which hearing must be requested) or the Workers’ Compensation Board or a workers’ compensation hearings referee or a court issues an order finding the claim is not compensable;
(f)The worker does not pay the required premium or portion thereof in a timely manner in accordance with the terms and conditions under this section;
(g)The worker elects to discontinue coverage under this section and notifies the State of Oregon in writing of this election;
(h)The worker’s attending physician or a nurse practitioner authorized to provide compensable medical services under ORS 656.245 (Medical services to be provided) has released the worker to modified or regular work, the work has been offered to the worker and the worker refuses to return to work; or
(i)The worker has been terminated from employment for reasons unrelated to the workers’ compensation claim.
(2)If the workers’ compensation claim of a worker for whom health benefits are provided pursuant to subsection (1) of this section is denied and the worker does not appeal or the worker appeals and does not prevail, the State of Oregon may recover from the worker the amount of the premiums plus interest at the rate authorized by ORS 82.010 (Legal rate of interest). The State of Oregon may recover the payments through a payroll deduction not to exceed 10 percent of gross pay for each pay period.
(3)The State of Oregon shall notify the worker of the provisions of ORS 659A.060 (Definitions for ORS 659A.060 to 659A.069) to 659A.069 (Discrimination against state worker applying for benefits under ORS 659A.060 to 659A.069 prohibited), and of the remedies available for breaches of ORS 659A.060 (Definitions for ORS 659A.060 to 659A.069) to 659A.069 (Discrimination against state worker applying for benefits under ORS 659A.060 to 659A.069 prohibited), within a reasonable time after the State of Oregon receives notice that the worker will be absent from work as a result of an injury or illness for which a workers’ compensation claim has been filed pursuant to ORS chapter 656. The notice from the State of Oregon shall include the terms and conditions of the continuation of health benefits and what events will terminate the coverage.
(4)If the worker fails to make timely payment of any premium contribution owing, the State of Oregon shall notify the worker of impending cancellation of the health benefits and provide the worker with 30 days to pay the required premium prior to canceling the policy.
(5)It is an unlawful employment practice for the State of Oregon to discriminate against a worker, as defined in ORS 659A.060 (Definitions for ORS 659A.060 to 659A.069), by terminating the worker’s group health benefits while that worker is absent from the place of employment as a result of an injury or illness for which a workers’ compensation claim has been filed pursuant to ORS chapter 656, except as provided for in this section. [Formerly 659.455; 2003 c.811 §§27,28; 2007 c.365 §14]
Section 659A.063 — State to continue group health benefits for injured worker and covered dependents; when ended,