Oregon Health Insurance

Shopping for health insurance can be a confusing and frustrating affair if you don’t know the market and the rules under which it must operate.  Therefore, if you’re currently planning to buy coverage in Oregon, it’s a good idea to make sure you know what the law requires of insurance companies, and insurance consumers, in this state.  The list below, while not exhaustive, covers a few of the most significant regulations you’ll need to know about when buying health insurance here.

  • Unlike most other states, Oregon doesn’t explicitly require health insurance companies to guarantee policy-holders the ability to renew their coverage.  Therefore, unless your contract specifically assures that you’re entitled to renew it at will, you won’t necessarily be able to keep it in effect past its listed expiration date.  If you are currently ill, however, your insurer is prohibited from cancelling your coverage (or refusing to let you renew it) on these grounds.
  • Oregon allows insurance companies to specify that certain pre-existing conditions will be excluded from coverage when setting up a new health insurance policy.  These conditions can include any health problem that was diagnosed or treated within the previous six months, and the period of exclusion can last for up to six months after the policy goes into effect.  If you maintain continuous coverage, however, then any exclusion period you’ve already gone through for a given condition will be credited to your new policy whenever you switch insurers in Oregon.
  • Your state of health may not be taken into account by Oregon-based insurance companies when determining the costs you must pay for coverage, but factors like age and family history are fair game.  Insurers here are permitted to consider your health when choosing whether to offer you coverage in the first place, however.
  • Any small business in Oregon is automatically eligible to purchase group health coverage, assuming that they meet certain basic requirements.  First off, a business must have between 2 and 50 employees to qualify as a “small business” for these purposes.  Second, the employer must be able to ensure a certain minimum level of employee enrollment set by the insurer.  Third, the employer may be required to contribute a set amount toward each participating employee’s premiums.  Those that meet the above criteria are guaranteed access to any group policy that is already being offered to other small businesses in Oregon.
  • Oregon also places limits on how much insurers may charge for a small company’s group coverage, but costs can still vary within these limits based on factors like health, age and demographic background of the insured employees.
  • Any self-employed person in Oregon who wishes to purchase small-business group coverage must first meet all relevant requirements; unless there are other employees on his or her payroll, group coverage will not be available.  Individual health insurance is still an option, however, and a large portion of the premiums for a self-employed worker’s individual coverage may be tax-deductible.

Although it can seem confusing, the process of buying health insurance can be made much simpler and less stressful by determining exactly what kind of coverage you need before you begin to shop around.  Once you know what you’re looking for, the scope of your search becomes far narrower and it’s much easier to make direct comparisons between quotes and offers between different insurance companies.

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