Oregon's group health questions come mainly from two continuation laws. ORS 743B.347 covers employees of employers not subject to federal COBRA. ORS 743B.343 to 743B.345 covers spouses age 55 and older. Expect questions on continuation length, eligibility and premium limits. COBRA, HIPAA, ERISA, coordination of benefits and the general mechanics of group coverage are in the national Group Health Insurance guide.

State continuation (ORS 743B.347)

Oregon's law applies to group health coverage of employers that are not subject to federal COBRA.

• Length: continuation is available for up to 9 months after the qualifying event.
• Eligibility: the person must have been covered (a certificate holder) on the day before the qualifying event and for the 3 months before it.
• Premium: the person may be charged no more than the group premium rate for the coverage being continued.
• Rehires: an employee laid off and rehired by the same employer within 9 months, who was eligible at layoff, can't be given a new waiting period.

Continuation for spouses 55 and older (ORS 743B.343-743B.345)

• A group health policy must let a surviving, divorced or legally separated spouse continue coverage if the spouse is at least 55 at the time of the death, divorce or separation.
• Premium: may include an administrative charge of up to 2% of the certificate holder and group contributions.
• When it ends: the right ends if the spouse remarries or becomes eligible for Medicare, among other events.

Small employers

• A small employer had an average of 1 to 50 full-time-equivalent employees in the preceding calendar year, and has at least one employee on the first day of the plan year (ORS 743B.005(26)).

Group life (for combined Life and Health candidates)

Oregon's group life rules (ORS 743.303-743.356) include:

• At least two lives insured at issue. Amounts are based on a plan that precludes individual selection.
• Contesting insurability: an insured person's statement about insurability can be used against that person only if it is in a signed written instrument, and only within 2 years.
• Conversion after employment ends:
  • Apply and pay the first premium within 31 days. No evidence of insurability is needed.
  • The new policy can be any form the insurer customarily issues except term.
  • If the person dies during the 31 days without converting, the convertible amount is payable as a group claim.
• Conversion when the group policy ends: available to members insured at least 5 years. The converted amount may be limited to the smaller of the lost coverage or $10,000.
• Claim payment:
  • Up to $500 may be paid to someone who incurred funeral or last-illness expenses.
  • Lump-sum death claims not paid within 30 days of proof carry interest from the date of death.
• Replacing the group policy: members whose premiums are waived because of disability stay with the replaced insurer.
• Sham groups: selling membership in a group just to qualify someone for group life is prohibited.

Common exam traps

• Oregon continuation is 9 months and applies only where COBRA doesn't.
• Eligibility requires 3 months of prior coverage.
• Spousal continuation starts at age 55 and ends on remarriage or Medicare eligibility. The administrative charge is capped at 2%.
• Group life conversion: 31 days, and the converted policy can't be term. Group-termination conversion needs 5 years of coverage and may be capped at $10,000.