ORS 742.065
Insurance against risk of loss assumed under less than fully insured employee health benefit plan


(1)

Insurance against the risk of economic loss assumed under a less than fully insured employee health benefit plan, whether issued or delivered as health or casualty insurance, is subject to the following:

(a)

The policy must be issued to and insure the employer, the trustee or other sponsor of the plan, or the plan itself, but not the employees, members or participants;

(b)

The insurer shall pay the employer, the trustee or other sponsor of the plan, or the plan itself, not the employees, members, participants or health care providers;

(c)

If the policy establishes an aggregate attaching point or retention, the point or retention must not be less than 120 percent of the expected claims; and

(d)

If the policy establishes an attaching point or retention applicable to each individual covered by the plan, the point or retention must not be less than $10,000.

(2)

Insurance against the risk of economic loss assumed under a less than fully insured employee health benefit plan, whether issued or delivered as health or casualty insurance, is subject to this section and to ORS 743.523 (Certain sales practices prohibited), 743.524 (Eligibility of association to be group health policyholder) and 743.526 (Determination of whether trustees are policyholders), but is not subject to other provisions of ORS chapters 743, 743A and 743B. [1993 c.649 §2; 1995 c.506 §13; 2014 c.58 §1]

Source
Last accessed
May. 15, 2020