Health and life insurance
SB 1504: Technical Changes to 2011 Health Reform Legislation (Chapter 24, 2012 Oregon Laws)
SB 1504 makes technical changes to statutes adopted or amended during the 2011 session in Senate Bill 89, including changes to Oregon's state continuation law and provisions to implement the federal Affordable Care Act (ACA).
Before passage of SB 89, state continuation rights applied to former spouses of employees of employers having 20 or more employees and to former spouses of members of groups of 20 or more certificate holders. SB 89 extended the continuation rights to former spouses of employees or members of employers or groups having 20 or more enrollees. This inadvertent change in terminology expanded the applicability of state continuation rights. SB 1504 changes the statutory provision to the way it existed before passage of SB 89.
SB 1504 also eliminates obsolete state continuation notice provisions and allows DCBS to develop state continuation notice requirements by rule.
Another change made by SB 89 required an insurer to provide special notice under some circumstances when cancelling coverage. The amendment included circumstances when coverage is cancelled for nonpayment of premium which was not intended. SB 1504 excludes cancellation for nonpayment of premium from the special notice requirements enacted in SB 89.
SB 1504 also clarifies that a complaint about a denial of a claim must be treated as reviewable unless the complainant specifically declines review. SB 1504 revises the language included in SB 89 relating to continued coverage pending the outcome of an internal appeal to be consistent with requirements of the ACA.
Before passage of SB 89, under a medical services contract to which an insurer is not a party, a patient had the right to appeal a denial based on the insurer's determination that the procedure is not medically necessary or is experimental. SB 89 inadvertently eliminated this right and SB 1504 restores the right.
Finally, SB 1504 applies retroactively to policies and certificates issued or renewed on or after June 23, 2011, the effective date of SB 89.
- Effective Date: March 5, 2012
- Applicability: Policies and certificates issued or renewed on or after June 23, 2011