(a) The person designated as the plan administrator by the instrument under which the group health insurance plan is operated; or
(b) If no plan administrator is designated, the plan sponsor.
(2) Within 60 days of legal separation or the entry of a judgment of dissolution of marriage, a legally separated or divorced spouse eligible for continued coverage under ORS 743B.343 who seeks such coverage shall give the plan administrator written notice of the legal separation or dissolution. The notice shall include the mailing address of the legally separated or divorced spouse.
(3) Within 30 days of the death of a covered person whose surviving spouse is eligible for continued coverage under ORS 743B.343, the group policyholder shall give the plan administrator written notice of the death and of the mailing address of the surviving spouse.
(4) Within 14 days of receipt of notice under subsection (2) or (3) of this section, the plan administrator shall notify the legally separated, divorced or surviving spouse that the policy may be continued. The notice shall be mailed to the mailing address provided to the plan administrator and shall include:
(a) A form for election to continue the coverage;
(b) A statement of the amount of periodic premiums to be charged for the continuation of coverage and of the method and place of payment; and
(c) Instructions for returning the election form by mail within 60 days after the date of mailing of the notice by the plan administrator.
(5) Failure of the legally separated, divorced or surviving spouse to exercise the election in accordance with subsection (4) of this section shall terminate the right to continuation of benefits.
(6) If a plan administrator fails to notify the legally separated, divorced or surviving spouse as required by subsection (4) of this section, premiums shall be waived from the date the notice was required until the date notice is received by the legally separated, divorced or surviving spouse.
(7) The provisions of this section and ORS 743B.343 and 743B.345 apply only to employers with 20 or more employees and group health insurance plans with 20 or more certificate holders on a typical business day during the preceding calendar year. [Formerly 743.601]
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.