(1)(a) All individual and group health benefit plans, as defined in ORS § 743B.005, that include coverage for a family member of the insured shall also provide that the health insurance benefits applicable for children in the family shall be payable with respect to:

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

(A) A child of the insured from the moment of birth; and

(B) An adopted child effective upon placement for adoption.

(b) All individual and group health benefit plans, as defined in ORS § 743B.005, that include coverage for a family member of the insured shall also provide that the health insurance benefits applicable for children in the family shall be payable with respect to a disabled child of the insured who is 26 years of age or older, if:

(A) The insured provides a statement from a physician certifying that the child has an ongoing disability that prevents the child from engaging in self-sustaining employment;

(B) The child was covered by a parent’s insurance for at least two years immediately before the time the child exceeded the age for eligibility for coverage under the parent’s insurance; and

(C)(i) The insured claims the child as a dependent of the insured for tax purposes;

(ii) The child files a tax return properly showing adjusted gross income that does not exceed 150 percent of the federal poverty level; or

(iii) The insured is the legal guardian of the insured’s child.

(2) The coverage of natural and adopted children required by subsection (1) of this section shall consist of coverage of preventive health services and treatment of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.

(3) If payment of an additional premium is required to provide coverage for a child, the policy may require that notification of the birth of the child or of the placement for adoption of the child and payment of the premium be furnished to the insurer within 31 days after the date of birth or date of placement in order to effectuate the coverage required by this section and to have the coverage extended beyond the 31-day period.

(4) In any case in which a policy provides coverage for dependent children of participants or beneficiaries, the policy shall provide benefits to dependent children placed with participants or beneficiaries for adoption under the same terms and conditions as apply to the natural, dependent children of the participants and beneficiaries, regardless of whether the adoption has become final.

(5) As used in this section:

(a) ‘Child’ means an individual who is:

(A) Under 26 years of age; or

(B) Disabled and 26 years of age or older, for purposes of coverage under subsection (1)(b) of this section.

(b) ‘Disabled’ means to have a developmental disability, mental illness or a physical disability that began prior to the age of 26 and that prevents an individual from engaging in self-sustaining employment.

(c) ‘Placement for adoption’ means the assumption and retention by a person of a legal obligation for total or partial support of a child in anticipation of the adoption of the child. The child’s placement with a person terminates upon the termination of such legal obligations.

(d) ‘Self-sustaining employment’ means employment with annual earnings that exceed 150 percent of the federal poverty level.

(6) The provisions of ORS § 743A.001 do not apply to this section. [Formerly 743.707; 2011 c.500 § 40; 2013 c.681 § 33; 2021 c.342 § 5]