(2) An insurer of a group health insurance policy providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, that seeks to terminate a policy for nonpayment of premium shall notify the policyholder as described in ORS 743B.323.
(3) An insurer of a group health insurance policy providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, shall notify the group policyholder when the policy is terminated and the coverage is not replaced by the group policyholder. The notice required under this subsection:
(a) Must be given on a form prescribed by the Department of Consumer and Business Services;
(b) Must explain the rights of the certificate holders regarding continuation of coverage provided by federal and state law; and
(c) Must be given by mail and must be mailed not later than 10 working days after the date on which the group policy terminates according to the terms of the policy.
(4) A group health insurance policy to which subsection (3) of this section applies shall contain a provision requiring the insurer to notify the group policyholder when the policy is terminated and the coverage is not replaced by the group policyholder. Each certificate issued under the policy shall also contain a statement of the provision required under this subsection.
(5) If an insurer fails to give notice as required by this section, the insurer shall continue the group health insurance policy of the group policyholder in full force from the date notice should have been provided until the date that the notice is received by the policyholder and shall waive the premiums owing for the period for which the coverage is continued under this subsection. The time period within which the certificate holder may exercise any right to continuation shall commence on the date that the policyholder receives the notice.
(6) The insurer shall supply the employer holding the terminated policy with the necessary information for the employer to be able to notify properly the employee of the employee’s right to continuation of coverage under state and federal law. [Formerly 743.560]
Structure 2021 Oregon Revised Statutes
Volume : 18 - Financial Institutions, Insurance
Chapter 743B - Health Benefit Plans: Individual and Group
Section 743B.001 - Definitions.
Section 743B.005 - Definitions.
Section 743B.011 - Group health benefit plans subject to provisions of specified laws; exemptions.
Section 743B.013 - Requirements for small employer health benefit plans.
Section 743B.020 - Eligible employees and small employers; rules.
Section 743B.100 - Department’s authority to regulate market.
Section 743B.103 - Use of health-related information.
Section 743B.105 - Requirements for group health benefit plans other than small employer plans.
Section 743B.109 - Short term health insurance policies; rules.
Section 743B.128 - Exceptions to requirement to actively market all plans.
Section 743B.129 - Shortening period of exclusion following discontinued offering; rules.
Section 743B.130 - Requirement to offer bronze and silver plans; rules.
Section 743B.200 - Requirements for insurers offering managed health insurance; quality assessment.
Section 743B.225 - Continuity of care.
Section 743B.227 - Referrals to specialists.
Section 743B.252 - External review; rules.
Section 743B.254 - Required statements regarding external reviews.
Section 743B.256 - Duties of independent review organizations; expedited reviews.
Section 743B.258 - Private right of action.
Section 743B.280 - Definitions for ORS 743B.280 to 743B.285.
Section 743B.281 - Estimate of costs for in-network procedure or service.
Section 743B.282 - Estimate of costs for out-of-network procedure or service.
Section 743B.283 - Submission of methodology used to determine insurer’s allowable charges.
Section 743B.284 - Alternative mechanism for disclosure of costs and charges.
Section 743B.287 - Balance billing prohibited for health care facility services.
Section 743B.290 - Hospital payment of copayment or deductible for insured patient.
Section 743B.310 - Rescinding coverage; permissible bases; notice; rules.
Section 743B.324 - Rules for certain notice requirements.
Section 743B.344 - Procedure for obtaining continuation of coverage under ORS 743B.343.
Section 743B.403 - Insurer prohibited practices; patient communication and referral.
Section 743B.406 - Vision care providers.
Section 743B.407 - Naturopathic physicians.
Section 743B.420 - Prior authorization requirements.
Section 743B.423 - Utilization review requirements for insurers offering health benefit plan.
Section 743B.424 - Applicability.
Section 743B.450 - Prompt payment of claims; limits on use of electronic payment methods; rules.
Section 743B.451 - Refund of paid claims.
Section 743B.452 - Interest on unpaid claims.
Section 743B.453 - Underpayment of claims.
Section 743B.454 - Claims submitted during credentialing period.
Section 743B.458 - Performance-based incentive payments for primary care.
Section 743B.460 - Conditions for restricting payments to only in-network providers.
Section 743B.462 - Direct payments to providers.
Section 743B.475 - Guidelines for coordination of benefits; rules.
Section 743B.500 - Selling and leasing of provider panels by contracting entity; definitions.
Section 743B.501 - Registration of contracting entity.
Section 743B.502 - Third party contracts for leasing of provider panels; requirements.
Section 743B.503 - Additional requirements for third party contracts.
Section 743B.505 - Provider networks; rules.
Section 743B.555 - Confidential communications.
Section 743B.601 - Synchronization of prescription drug refills.
Section 743B.602 - Step therapy.
Section 743B.800 - Risk adjustment procedures; rules.
Section 743B.810 - Enrollees covered by workers’ compensation.