Definition of "Oregon health plan"

Tom & Robin  Tyson (The Tyson Team) real estate agent

Written by

Tom & Robin Tyson (The Tyson Team)elite badge icon

EXIT Real Estate Gallery

Plan that provides a legal resident of the state of Oregon access to basic health care through three major components:

  1. Medicaid Reform (rationing) extends Medicaid eligibility to those individuals below the federal poverty level, and requires, if possible, that Medicaid benefits be provided through MANAGED CARE plans.
  2. Employer Mandate employers must provide health insurance for all permanent (working at least 17.5 hours per week) employees on a play or pay basis, where the employer plays by providing the employees with a health insurance plan or pays by paying a payroll tax that is passed through to the state's Insurance Pool Fund.
  3. Market Reform benefits available must be substantially similar to those provided by Medicaid.
The indemnity insurance plan and the Health Maintenance Organization (HMO) provide similar benefits, and both plans must be accessible to all businesses whose employment is in the range of 3 to 25 employees. The indemnity insurance plan has the following characteristics: (1) $15 co payment for preventive services (most other services require a 50% co payment); (2) no deductible; (3) out-of-pocket expenses to be limited to $3750 annually on an individual basis and $7500 annually on a family basis. After these annual limits have been reached, 100% of the expenses are paid by the insurance plan up to a $1,000,000 lifetime maximum; and (4) preventive services to include children's immunizations, dental examinations, basic medical examinations, vision examinations through age 18, basic blood pressure and cholesterol screening for adults every five years through age 39 and every two years beginning at age 40, maternity care, mental health benefits, alcohol and chemical dependence benefits. All insurance companies that sell and/or service insurance plans to employers who have 3 to 25 employees must offer at least those basic benefits and cannot refuse to sell this plan to any such employer. In addition, no employee or employee's dependent can be excluded from the plan; there must be portability from any previous individual or group health insurance plan; benefits cannot be denied because of preexisting conditions to include pregnancy; policies cannot be cancelled on a selective basis, even for those employees who develop high-risk health care problems; and premium rates cannot exceed the geographic premium rate maintained for a stipulated geographic area.

image of a real estate dictionary page

Have a question or comment?

We're here to help.

*** Your email address will remain confidential.
 

 

Popular Insurance Terms

Method of terminating a split dollar life insurance policy by the company transferring its interest in the policy (after the company has effected the largest policy loan permitted equal to ...

Provision found in juvenile insurance that waives the premiums due on the insured child's policy provided that the payor of the premiums becomes totally disabled or dies before the child ...

Coverage for liability exposure resulting from the activities of a business; includes: direct liability acts of the business resulting in damage or destruction of another party's property ...

Tenant's modifications of leased space to fit his particular needs. Up to 10% of contents coverage inside the structure may be applied to insure against damage or destruction of ...

Time frame during which an annuitant makes premium payments to an insurance company. The obligations of the company to the annuitant during this period depend on whether a pure annuity or ...

Method used to reduce workers compensation insurance costs by using a single database system to electronically link claims administration, medical claim costs, risk management, and vendor ...

One of four types of risks affecting the life insurance company as identified by the society of actuaries. This risk is associated with losses that the life insurance company may incur as ...

Latin phrase meaning "to stand by the decisions." This legal doctrine under common law requires courts to rely on precedents, or previous decisions, when deciding disputes unless there is a ...

Coverage on an all risks basis, subject to exclusions of war, wear and tear, loss resulting from delay, loss of market, infidelity of the insured's employee, loss due to rain, sleet, snow, ...

Popular Insurance Questions