Department of Consumer and Business Services, Insurance Division, Chapter 836
Rule Caption: Notice Requirements for Carriers Regarding State Continuation of Health Insurance.
Adm. Order No.: ID 16-2012
Filed with Sec. of State: 8-24-2012
Certified to be Effective: 8-24-12
Notice Publication Date: 7-1-2012
Rules Adopted: 836-053-0863
Rules Repealed: 836-053-0862
Subject: This rulemaking repeals a rule adopted by the Department of Consumer and Business Services (DCBS) related to state continuation of health insurance. The repealed rule includes material required by federal law (American Recovery and Reinvestment Act) that is no longer applicable to state continuation. The new rule establishes the requirements for carriers as reflected in 2012 legislation, chapter 24, Oregon Laws 2012 (Enrolled Senate Bill 1504) that amended ORS 743.610 to eliminate the notice requirement for state continuation benefits specifically prescribed in statute and gave DCBS the authority to prescribe requirements by rule. Oregon’s state continuation program is crucial in allowing many newly unemployed Oregonians to maintain their health insurance coverage at a time when they need it the most and it is important that notice of the availability of the program be provided in a timely and understandable manner. A standardized notice as proposed in these rules will facilitate this goal.
The notice proposed under this rule includes a provision that defines when the notice requirement is triggered and provision to allow an insurer to send a single notice to multiple persons who are eligible for state continuation as a result of a single qualifying event.
Rules Coordinator: Sue Munson—(503) 947-7272
(1) For purposes of the notice required by ORS 743.610(10), an insurer must use the notice set forth on the website for the Insurance Division of the Department of Consumer and Business Services at www.insurance.oregon.gov. An insurer:
(a) May incorporate the notice into another document provided that the notice remains prominent.
(b) May modify the font of the document but the font must be at least 12 point.
(c) May add headings, logos and other company identifiers.
(d) Must modify the notice to include the information as indicated in the brackets.
(2) An insurer may provide a single notice under ORS 743.610(10) to a covered person and a qualified beneficiary when:
(a) The notice is addressed to the covered person or qualified beneficiary at the last known address of the covered person or qualified beneficiary;
(b) The covered person and qualified beneficiary are eligible for state continuation coverage by virtue of the same qualifying event; and
(c) The covered person and qualified beneficiary have the same last known mailing address.
(3) The requirement to provide written notice under ORS 743.610(1) may be triggered either by the notification of a qualifying event received from the covered person or qualified beneficiary under ORS 743.610(5) or notice of the qualifying event submitted to the insurer by the group policyholder.
(4) An insurer that requires a covered person or qualified beneficiary to complete a form to request continuation of coverage must provide the form to the person. The form may be provided by electronic means including via a specific website address. However, if a covered person or qualified beneficiary asks an insurer to provide the forms via mail, the insurer must do so within two business days of the request. Notice pursuant to ORS 743.610(10) is deemed provided upon receipt of any required forms when the forms are mailed by the insurer.
(5) Notice under ORS 743.610(5) provided to a group policyholder pursuant to the instruction of an insurer constitutes notice to the insurer that meets the requirements of ORS 743.610(5).
Stat. Auth.: ORS
731.244 & 743.610
Stats. Implemented: ORS 743.610
Hist.: ID 6-2012(Temp), f. 3-27-12, cert. ef. 4-15-12 thru 10-10-12; ID 16-2012, f. & cert. ef. 8-24-12