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Oregon Health Insurance

Having a suitable health insurance is the top priority when it comes to protecting your family against unexpected events. Purchasing health coverage is costly and requires a thorough review of all future risks and its influence on your financial health. In the U.S., nearly 47 million people are uninsured, majority of whom are working families who are exposed to possibility of huge medical bills due to the lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.

In 2008, Oregon stood at the 16th spot on the Healthiest States List as issued by the United Health Foundation. The state was on 20th and 19th position in 2006 and 2007 respectively. Many factors that have contributed to the improved Oregon’s health score include declining prevalence in smoking and ready access to primary care. The state of Oregon, with more than three million residents, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide economical health coverage to the uninsurable citizens of Oregon who meet specific eligibility requirements of age and income.

The Insurance Division of Oregon Department of Consumer & Business Services manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, despite moderate public health funding, approximately 17.4% of the state’s population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 35.1% of uninsured residents come under the above 200% FPL category.

On the whole, Oregon’s Healthcare System needs to work on its weak points to provide its citizens better access to health care services. If you are an Oregon resident in need of suitable health coverage, contact a licensed health insurance agent/broker to the avail the suitable health insurance options and their benefits.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Oregon. These regulations apply to all insurance companies offering individual or family health insurance in Oregon:

Medical Underwriting

Yes

Pre-Existing Condition Exclusion Period

24 months

Look Back Period

12 months

Look Back Standard

Objective

Mandatory Benefits

Cancer screening for women including screening of breast and cervical cancer, IP mastectomy stay, reconstructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as Primary Care Providers, eating disorder parity, maternity care

Market Rate Restrictions

Yes

Guaranteed Issue Options

None

Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Oregon. These regulations apply to all insurance companies offering small group health insurance in Oregon:

Small Group Size

2-50

Employee Qualifications

Two employees must work 17.5 hrs/week for coverage

Guaranteed Issue

Yes

Premium Rating Factors

Adjusted Community Rating

Rate Adjustment Factors

Modified Community Rate

Look-Back Period

6 months

Pre-existing condition exclusionary period

6 months

Mandatory Benefits

Same as Individual

State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Oregon. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option

Yes

Eligible Group Sizes

2-19

Extension of Benefits Period - Standard

9 months

Extension of Benefits Period - Disabled

9 months

Maximum Premium Increase

100%

State Legislation Reference

Oregon Continuation Law

Additional Notes

To qualify for it, you must have been covered under your former group plan for at least 3 months and you must elect continuation coverage within 31 days of termination of employment or notice of continuation right.

State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Oregon to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Oregon is summarized in the chart below:

Plan Name

Oregon Medical Insurance Pool (OMIP)

Website

http://www.omip.state.or.us/

Phone Number

800-848-7280, 503-225-6620

HIPPA Eligibility Required?

No

Available Carriers

Regence Blue Cross Blue Shield of Oregon

Pre-Existing Condition Waiting Period

6 months

Enrollment Periods

Currently Open to New Enrollment

Premium Limits

No more than 125% of standard rate

Lifetime Maximum Benefit

$2 million

Special Notes

To qualify, individuals should be Oregon resident, should be unable to receive health insurance, should have exhausted COBRA benefits and should be federal Health Coverage Tax Credit (HCTC) eligible

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Oregon provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name

Oregon State Children's Health Insurance Program (SCHIP)

Website

http://www.oregon.gov/DHS/healthplan/app_benefits/ohp4u.shtml

Phone Number

800-527-5772

Apply Online

Yes

Age Limits

Under 19

Insurance Carrier

NA

Length of Coverage

Depends on Eligibility Status

Residency Requirements

Oregon resident, U.S. citizen, legal non-citizen

Other Eligibility Requirements

To qualify, the child should be uninsured for 6 months

Pre-Existing Condition Exclusions

None

Cost

Small monthly premiums and co-payments required

Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Oregon:

Governing Agency

Department of Human Services

Website

http://www.oregon.gov/DHS/healthplan/

Phone Number

800-527-5772

Residency Requirements

Oregon resident, U.S. citizen, documented immigrant

Federal Poverty Line Income Limits

Child to Age 5: 133% FPL
Child Age 6-18 or parent: 100% FPL
Pregnant woman: 185%

Additional Resources

Oregon Health Care Options Matrix™ Guide

Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Oregon’s public and private health care choices for individuals and groups with various demographic profiles.

Family Health Insurance Guide by HealthInsuranceFinders.com

The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

Oregon: At-A-Glance

They provide consumers with all-inclusive health data for Oregon. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.


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