Consumer Guide to Health Insurance

What if I lose my insurance?

You have several coverage options if you lose your employer-sponsored group coverage. These options are available through the Consolidated Omnibus Reconciliation Act (COBRA), state continuation programs, and portability of coverage, which is provided by state and federal programs.

COBRA

COBRA provides federal continuation coverage to people who have lost their insurance coverage because of reduced work hours or lost jobs. COBRA allows qualified individuals to purchase coverage for limited periods. Spouses and dependents may be eligible for coverage if the primary insured has died or is divorced from the former spouse. COBRA may be available if your employer had 20 or more employees. COBRA coverage may include vision, dental, or prescription coverage. COBRA is regulated by the U.S. Department of Labor. Additional information is available on the Web,
http://www.dol.gov/dol/topic/health-plans/cobra.htm.
You may write to the US Department of Labor - Employee Benefits Security Administration, 1111 Third Avenue, Suite 860, Seattle WA 98101-3212. You can call the U.S. Department of Labor, (206) 553-4244.

State continuation of coverage

You may be eligible to continue your group policy if your benefits have been affected by the loss of your job, divorce, or legal separation or if your spouse has died and you do not qualify for COBRA coverage. The employer that provided the group policy must have fewer than 20 employees in order for you to qualify for state continuation of coverage.

A continuation-of-coverage policy will provide protection for six months or until you are eligible for other coverage (including Medicare), whichever is shorter. The coverage may include vision, dental, or prescription coverage.

OMIP also provides health coverage to Oregonians who have exhausted their COBRA benefits and have no other portability plans available to them. OMIP portability rates are similar to insurance companies' rates. For more information, call (800) 848-7280, toll-free.

Portability of coverage

Portability makes ongoing health insurance coverage available if you were enrolled in an employer-sponsored group health plan for at least six months immediately before your coverage ended.

To qualify for portability:

• You must be an Oregon resident.
  
  
• You must apply for portability of coverage within 63 days of losing your group coverage.
  
  
• You can't be eligible to remain enrolled in your prior group coverage, can't be eligible for Medicare, and can't be enrolled in another health insurance plan.

You may qualify for portability under Oregon rules or federal Health Insurance Portability and Accountability Act (HIPAA) rules.

You qualify under Oregon rules if either of the following is true:

• You were enrolled in Oregon-based group coverage for at least six months.
  
  
• You were enrolled in non-Oregon based group coverage for at least six months while residing in Oregon.

If your prior group coverage was in a self-insured plan, you must exhaust your state or COBRA continuation coverage before electing portability. If your prior coverage was in a commercially available plan, you do not need to exhaust COBRA.

You can qualify under federal HIPAA rules if both of the following are true:

• You have at least 18 months of prior health insurance coverage and the most-recent coverage was in a group plan.
  
  
• You have exhausted your state or COBRA continuation coverage. (You may become eligible under Oregon rules before your continuation coverage is exhausted.)
  
  
• You have a choice of two portability plans:
  
  
• Prevailing Benefit Plan, with coverage similar to most group plans.
  
  
• Low-Cost Plan, with higher deductibles and copayments.

In most cases, portability coverage is provided by the same insurance company that provided your group coverage. In the following cases, however, portability coverage is provided by the Oregon Medical Insurance Pool (OMIP):

• You were enrolled in non-Oregon-based group coverage.
  
  
• You were enrolled in self-insured group coverage sponsored by an employer or employer group.
  
  
• You qualified for portability coverage from an Oregon insurance company but moved out of the insurer's service area (yet still reside in Oregon) or the insurance company discontinued serving the area in which you live.

You will not be charged extra for your premium if you qualify for a portability plan through the Oregon Medical Insurance Pool.

Highlights of portability:

• Plans must cover pre-existing conditions.
  
  
• Rates must match typical group insurance rates.
  
  
• Your current health insurer must provide a "certificate of creditable coverage" when your group coverage ends. This proves you had prior insurance, helps determine if you qualify for portability coverage, and ensures coverage for pre-existing conditions.
  
  
• If you're enrolled in a portability plan, you can keep your portability coverage even after you obtain other coverage. The portability plan will pay benefits, as will your individual, group, or Medicare policy. This coordination of benefits will pay up to 100 percent of qualifying medical expenses, but will not pay more than your actual medical expenses.

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