§ 743B.126 — Carrier marketing of individual health benefit plans; rules; duties of carrier regarding applications; effect of discontinuing offer of plans

Oregon § 743B.126

• Jurisdiction: Oregon
• Vol.: 18
• Title 56: Insurance
• Ch. 743B: Health Benefit Plans: Individual and Group

Text

(1) Each carrier shall actively market all individual health benefit plans sold by the carrier that are not grandfathered health plans.
(2) Except as provided in subsection (3) of this section, no carrier or insurance producer shall, directly or indirectly, discourage an individual from filing an application for coverage because of the health status, claims experience, occupation or geographic location of the individual.
(3) Subsection (2) of this section does not apply with respect to information provided by a carrier to an individual regarding the established geographic service area or a restricted network provision of a carrier.
(4) Rejection by a carrier of an application for coverage shall be in writing and shall state the reason or reasons for the rejection.
(5) The Director of the Department of Consumer and Business Services may establish by rule additional standards to provide for the fair marketing and broad availability of individual health benefit plans.
(6) A carrier that elects to discontinue offering all of its individual health benefit plans under ORS 743B.125 (5)(c) or to discontinue both offering and renewing all such plans is prohibited from offering and renewing health benefit plans in the individual market in this state for a period of five years from the date of notice to the director pursuant to ORS 743B.125 (5)(c) or, if such notice is not provided, from the date on which the director provides notice to the carrier that the director has determined that the carrier has effectively discontinued offering individual health benefit plans in this state. This subsection does not apply with respect to a health benefit plan discontinued in a specified service area by a carrier that covers services provided only by a particular organization of health care providers or only by health care providers who are under contract with the carrier.
(7) The Department of Consumer and Business Services may, in accordance with ORS 743B.129, shorten the period of prohibition described in subsection (6) of this section if necessary to ensure, in all geographic areas of this state, that:
(a) A competitive health insurance market exists;
(b) Consumers have a reasonable number of health insurance options available to them; and
(c) Consumers who purchase insurance are protected.

Legislative History

Formerly 743.769; 2017 c.206 §6; 2019 c.285 §8