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Health Insurance Information

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Oregon Health Insurance

 

All health insurance policies in Oregon are considered guaranteed renewable as long as your premiums are paid up to date.  So this means your health insurance can not be canceled because you become sick.  Annual Mammograms are also mandated to be covered by all Oregon Insurance Companies.

 

Oregon mandates that health insurance companies cover newborns and adopted children for the first 31 days, on their parent’s policy.  But inversely pregnancy is, and can be considered a pre-existing condition, except on group health policies.  Pregnancy is a pre-existing condition but not on group health insurance.

 

The Oregon Medical Insurance Program (OMIP) is Oregon's high risk pool.  It is designed to help insure people that are considered uninsurable by private insurance companies.  To qualify you must be an Oregon resident or HIPAA eligible. 

 

If you would like additional information please visit Oregon's Department of Insurance, Division of Health Insurance.

 

                              Request an Oregon Health Insurance Quote

 

 

Oregon Small Business Health Insurance

 

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If you are purchasing an Oregon Small Business Health Insurance policy you should know that it is mandated that every insurance company offer you two standardized policies.  This will help you when comparing coverage's.  Keep in mind insurance companies also have the ability to offer you non standard policies.

 

 

In Oregon, a group health plan, can not base your health insurance premiums on your health.  This is called non discrimination.  Small Business Health Insurance in Oregon is also guaranteed issue, meaning that you can not be turn down for coverage.

 

Pre-existing exclusions are limited on the amount of time they can exclude coverage.  Also if you have current coverage, without lapses, that will be credited against your pre-existing period.  Pregnancy is not considered a pre-existing condition on a group health plan.

 

Oregon small business health insurance companies are allowed to use the look back period method in determining what they will consider pre-existing.

 

The maximum pre-existing waiting period is 12 months for an employee. If you are a late enrollee your maximum waiting period is 18 months.  Any pre-existing periods must be applied only after written notice.

 

Oregon does limit the amount of variation between premiums of different group health plans.  If you have a small business with 2-25 employees, your premiums can not go up because of the group’s health status.  With more than 25 employees your premiums can go up due to your group’s health status.

 

For additional information about Small Business Health Insurance in Oregon click here.

 

                               Request an Oregon Small Business Health Insurance Quote

 

 

Oregon Individual Health Insurance

 

All Oregon Health Insurance Policies have to cover disabled children on their parent’s policy into their adulthood.

 

In Oregon, insurance companies are able to decide if they want to insure you or not.  They can either rate you up or just refuse coverage.  Also Oregon does not mandate what you buy, so insurance companies are able to design specific policies for specific consumers, rather than make insurance companies offer similar policies.

 

Oregon allows health insurance companies to include pre-existing conditions in their policies.  The maximum a period can be is 24 months.  Pregnancy can, and is, considered pre-existing but genetic information is not a pre-existing condition.

 

Relative to Pre-Existing Conditions, Insurance companies in Oregon must give credit to prior credible coverage as long as there was not more than a 63 day lapse in coverage.

 

The rates that an individual pays for an Oregon Health Insurance Plan are based on age, location, family size, sex etc.  Sadly there is no limit on how much an insurance company can charge and individual for coverage.  The only issue your rates can not be based on is your Health Status; this is a community rating.

 

Oregon has a program called CHIP.  This stands for Children’s Health Insurance Plan.  It is designed to help insure Oregon's uninsured children.

 

For additional information about Individual Health Insurance in Oregon click here.

 

                              Request an Oregon Individual Health Insurance Quote

 

 

Oregon Self Employed Health Insurance

 

In Oregon, self employed people are not allowed to buy small business health insurance.  All self employed businesses in Oregon must buy individual health insurance policies.   A self employed persons rights are protected under the laws protecting individuals.

 

Another option for affordable Oregon Self Employed Health Insurance is often associations or self employed groups.  Just keep in mind that not all of these groups or associations are regulated by the state.

 

One benefit for Self Employed people is that they are able to deduct 100% of their health insurance premiums from their taxes!

 

For additional information about Self Employed Health Insurance in Oregon click here.

 

                              Request an Oregon Self Employed Health Insurance Quote

 

 

Temporary Oregon Health Insurance

 

Many situations may arise where you find yourself without health insurance, or about to be without health insurance.  These reasons could range from graduating college to being in-between jobs.  Instead of going without health insurance you should look into getting an Oregon Temporary Health Insurance Policy.  These policies will be cheap, with high deductibles and low coverage, but getting an Oregon Temporary Health Insurance Policy is much better than going with out health insurance.  Oregon Temporary Health Insurance in not guaranteed renewable!

 

For additional information about Temporary Health Insurance in Oregon click here.

 

                               Request an Oregon Temporary Health Insurance Quote

 

 

What types of Oregon Health Insurance are there?

 

HMO- Health Maintenance Organization.  This type of insurance is called managed care.  This means you have certain network of doctors and hospitals in Oregon that you have to go to for care.  Most Oregon HMO’s have office visit co-payments that range from $10 to $35, and hospital deductibles that range from $250 to $1,500.  Often the most affordable health insurance plans are HMO’s due to the fact they are managed care.

 

PPO-Preferred Provider Organization.  This type of insurance is also called managed care but it gives the consumer much more freedom; they allow you to visit any doctor or hospital in or out of network.  Most Oregon PPO’s have an in network and an out of network charge.  If the in network co-insurance is 100% then the out of network co-insurance would be 80%.  If the in network co-insurance is 90% then the out of network co-insurance would be 70%   Typically Oregon PPO’s offer co-payments for doctor visits as well as hospitalization. 

 

Indemnity Plan - In Oregon, as health insurance rates continue to rise, many people are finding it more affordable to drop their health insurance and buy an Oregon Major Medical Health Insurance Plan.  An Indemnity plan can also be called a major medical plan or catastrophic health insurance.  Whatever you call it, typically an Oregon Indemnity Plan would cover more “major” claims.  An Indemnity plan has an annual deductible and will usually allow you to pick different co-insurance options.  Indemnity plans allow you access to any doctor or hospital, and for this reason they are typically very expensive.

 

Discount Medical Plans – In recent years many Discount Medical Plans have started to surface.  These plans have relatively inexpensive, but consumers must realize that this is not insurance.  All these companies do is to get their customers discounted rates (20-50% off) on certain procedures at certain physicians and hospitals. 

 

Federal Mandated Health Insurance Laws

 

HIPAA

Along with Oregon Health Insurance Laws, there are Federal Laws that regulate Health Insurance companies.   HIPAA (Health Insurance Portability and Accountability Act of 1996). This act mandated federal standards for individual and group health insurance plans.  Some of the standards that it established were relative to guaranteed renew ability, crediting for prior health coverage and pre-existing condition waiting periods.

 

ERISA

Large corporations do not have health insurance policies.  Typically they are self funded, meaning the corporation pays for all of their employee’s medical bills instead of buying health insurance.  Most of these “self funded” companies are regulated by the federal government under ERISA (Employee Retirement Income Security Act)

 

COBRA

In Oregon it is mandated, by the state, that all companies that offer an Oregon Group Health Insurance Policy must also enable their employees to extend their health coverage temporarily; called Cobra.  An Oregon Cobra Insurance is typically available for a time period of 18 to 36 months.   In Oregon you are given 60 days to decide if you are going to take Oregon Cobra Insurance or not.  Once you have passed on the opportunity to take Cobra, you are not eligible to receive it.

 

Cobra Insurance was introduced in 1985.  Cobra stands for Consolidated Omnibus Budget Reconciliation Act.  If you would like more information about your Cobra Insurance options please contact your companies HR department.

 

Often employees are surprised at the cost of an Oregon Cobra Insurance.  The reason for this is that they are now responsible for 103% (100% of the premium plus a 3% administration fee) of a monthly health insurance premium when they probably only paid 20% while employed. 

 

Whether nor not to take Cobra is an important question, and you should realize there are alternatives to an Oregon Cobra Insurance Policy.  One should realize what they plan to do in the future.  If you are looking for another job, and it will be a few months before you get a job, it might make sense to look for an Oregon Temporary Health Insurance Plan.  If you are contemplating working at a consultant, it would be in your best interest to look into an Oregon Self Employed Health Insurance Policy.  

 

 

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