Oregon Statutes 743B.310 – Rescinding coverage; permissible bases; notice; rules
(1) As used in this section, ‘rescind’ means to retroactively cancel or discontinue coverage under a health benefit plan or group or individual health insurance policy for reasons other than failure to timely pay required premiums or required contributions toward the cost of coverage.
Terms Used In Oregon Statutes 743B.310
- Fraud: Intentional deception resulting in injury to another.
- Person: includes individuals, corporations, associations, firms, partnerships, limited liability companies and joint stock companies. See Oregon Statutes 174.100
- Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
(2) An insurer may not rescind coverage of an individual under a health benefit plan or group or individual health insurance policy unless:
(a) The individual or a person seeking coverage on behalf of the individual:
(A) Performs an act, practice or omission that constitutes fraud; or
(B) Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan or policy; and
(b) The insurer provides at least 30 days’ advance written notice, in the form and manner prescribed by the Department of Consumer and Business Services, to the individual.
(3) An insurer may not rescind coverage of a group under a health benefit plan unless:
(a) The plan sponsor:
(A) Performs an act, practice or omission that constitutes fraud; or
(B) Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan; and
(b) The insurer provides at least 30 days’ advance written notice, in the form and manner prescribed by the department, to each plan enrollee or policy holder who would be affected by the rescission of coverage.
(4) An insurer that rescinds a plan or policy must provide notice of the rescission to the department in the form, manner and time frame prescribed by the department by rule.
(5) This section does not apply to long term care insurance that is subject to ORS § 743.650 to 743.665. [Formerly 743.894]
743B.310 was added to and made a part of the Insurance Code by legislative action but was not added to ORS Chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.
(Termination)