ORS 743B.011
Group health benefit plans subject to provisions of specified laws
- exemptions
(1)
Except as provided in subsection (2) of this section, every health benefit plan shall be subject to the provisions of ORS 743B.010 (Issuance of group health benefit plan to affiliated group of employers) to 743B.013 (Requirements for small employer health benefit plans), if the plan provides health benefits covering one or more employees of a small employer and if any one of the following conditions is met:(a)
Any portion of the premium or benefits is paid by a small employer or any employee is reimbursed, whether through wage adjustments or otherwise, by a small employer for any portion of the health benefit plan premium; or(b)
The health benefit plan is treated by the employer or any of the employees as part of a plan or program for the purposes of section 106, section 125 or section 162 of the Internal Revenue Code of 1986, as amended.(2)
Subsection (1) of this section does not apply to:(a)
An individual health benefit plan for which a portion of the premium is reimbursed through a qualified small employer health reimbursement arrangement as defined in section 9831 of the Internal Revenue Code; or(b)
An individual health benefit plan that is considered to be integrated with a health reimbursement arrangement or other account-based group health plan authorized by federal law.(3)
Except as otherwise provided by ORS 743B.010 (Issuance of group health benefit plan to affiliated group of employers) to 743B.013 (Requirements for small employer health benefit plans) or other law, no health benefit plan offered to a small employer shall:(a)
Inhibit a carrier from contracting with providers or groups of providers with respect to health care services or benefits; or(b)
Impose any restriction on the ability of a carrier to negotiate with providers regarding the level or method of reimbursing care or services provided under health benefit plans.(4)
Intentionally left blank —Ed.(a)
A carrier may provide different health benefit plans to different categories of employees of a small employer when the employer has chosen to establish different categories of employees in a manner that does not relate to the actual or expected health status of such employees or their dependents. The categories must be based on bona fide employment-based classifications that are consistent with the employer’s usual business practice.(b)
Except as provided in ORS 743B.012 (Requirement to offer all health benefit plans to small employers) (7), a carrier that offers coverage to a small employer shall offer coverage to all eligible employees of the small employer.(c)
If a small employer elects to offer coverage to dependents of eligible employees, the carrier shall offer coverage to all dependents of eligible employees.(5)
An insurer may not deny, delay or terminate participation of an individual in a group health benefit plan or exclude coverage otherwise provided to an individual under a group health benefit plan based on a preexisting condition of the individual. [Formerly 743.734; 2017 c.152 §9; 2019 c.285 §6]
Source:
Section 743B.011 — Group health benefit plans subject to provisions of specified laws; exemptions, https://www.oregonlegislature.gov/bills_laws/ors/ors743B.html.
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