| Enrollment and Eligibility We’re Here To Serve You Individual Portability Insurance The Oregon Portability program is implemented as a "State Alternative Mechanism" for guaranteed availability of coverage to eligible individuals. Eligibility for the Oregon Portability Program is extended to all individuals who qualify under Oregon or Federal law whichever is more favorable. If you or your insured dependents lose eligibility for insurance under this Plan you may be entitled to convert to one of our two Portability Plans. The benefits contained in the Portability Plan will be different from the benefits under this Plan. Eligibility For Portability Coverage An individual covered under our Plan has the right to convert to one of our two Portability Plans if he/she is an "Eligible Individual." Eligible Individual means an individual who has left coverage that was continuously in effect for a period of 180 days or more under one or more Oregon group health benefit plans, or meets the eligibility requirements of the Health Insurance Portability Act of 1998. In either case, the individual must apply for portability coverage not later than the 63rd day after termination of group coverage issued by an Oregon carrier and be an Oregon resident at the time of such application. With an exception noted below, the term "Eligible Individual" does not include an individual who remains eligible for his/her prior group coverage or would remain eligible for prior group coverage in a plan under the Federal Employee Retirement Income Security Act of 1974, as amended, were it not for action by the plan sponsor relating to the actual or expected health condition of the individual, or who is covered under another health benefit plan or is eligible for the Federal Medicare program. However, an individual who is eligible to obtain a portability plan may obtain such a plan regardless of whether the Eligible Individual has exercised rights under federal law (COBRA) or under ORS 743.610 (continuation under state law) to continue coverage under a group health benefit plan or whether the Eligible Individual, having exercised such rights, has received any benefits thereunder, unless he/she is an Eligible Individual who is leaving or has left an employee welfare benefit plan or multiple employer welfare arrangement that is exempt from state regulation under the Federal Employee Retirement Income Security Act of 1974, as amended. If an enrollee in a portability health benefit plan elects not to enroll an eligible dependent when the enrollee's coverage commences, that dependent is not eligible for enrollment as a dependent in the plan at any later date. For the purposes of this rule, an eligible dependent is a dependent of the enrollee that was covered by the enrollee's prior group health benefit plan, provided that such dependent meets the eligibility requirements of the portability health benefit plan. After an enrollee's coverage commences in a portability health benefit plan, we shall accept for enrollment any new dependent that is acquired by the enrollee, provided that such dependent meets the eligibility requirement of the portability health benefit plan. The Portability Plans are not available if the Group terminates the Plan and replaces it with a similar group plan within 31 days. Purpose Of Portability Oregon
law requires group health insurers to offer employees certain benefit
plans when they leave employment. The purpose is to make health
coverage portable, or in other words, to improve the availability
and affordability of health benefit plans for individuals leaving
group coverage. Portability Plans must be offered on a "guarantee" issue basis, be guaranteed renewable and may be retained indefinitely subject to certain exceptions as stated below. Additionally, Portability Plans cannot contain pre-existing condition provisions, exclusion periods, waiting periods or other similar limitations on coverage. Portability health benefit plans shall be renewable with respect to all enrollees at the option of the enrollee, except:
Enrollment And Effective Date Of Coverage An explanation of portability coverage will be provided directly to an individual losing group coverage, for any reason other than group replacement of coverage, within 10 days following the date of any administrative action taken by a carrier to initiate or document the loss of coverage. You must submit a written application and pay the first premium no later than the 63rd day after the date your coverage terminated under this plan. Coverage becomes effective on the day following termination of coverage under this plan. Eligible individuals may enroll in Portability coverage before, during, or at the end of their COBRA or state continuation coverage. Portability coverage is guaranteed renewable and may be retained indefinitely. Please Note If you choose Portability rather than COBRA or State Continuation, you will not be eligible to select COBRA or State Continuation at a later date. (COBRA is for employee groups of 20 or more. State Continuation is for employee groups consisting of less than 20 employees.) You may select COBRA or State Continuation (whichever applies to your group situation) or select Portability. Portability Options Portability coverage via the Oregon Medical Insurance Pool (OMIP) is extended to eligible individuals who were covered by a non-Oregon group plan while a resident of Oregon. Portability coverage via OMIP is extended to eligible individuals who were covered by a self-funded multiple employer welfare arrangement or a self-funded group plan operated by a public entity in Oregon. However, these individuals must first complete continuation coverage offered through federal or state law, if they are eligible for such coverage. The Plan offers two options for portability coverage, Low Cost Plan and Prevailing Plan:
Please contact the Plan’s Portability Coordinator, at 503.219.3664 in the Portland area or toll-free 888.393.2940 for further information regarding the Prevailing and Low Cost Plans.
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