When do insurers have to sell me a portability policy?

· If you have had at least 6 months of coverage under a fully insured group health plan in Oregon and then lose it, you are guaranteed the right to a portability policy for yourself and your family. You must apply within 63 days of losing your group coverage.

· If your prior coverage was in a self-insured group plan, you can obtain a portability policy from Oregon Medical Insurance Pool (OMIP).

· Portability policies must offer family coverage to eligible enrollees and their dependents who lost group coverage.

What will my portability policy cover?

· You must be offered the type of plan that is most similar to your prior group plan – an indemnity plan or an HMO. These are standardized plans with comprehensive benefits.

· You must also be offered at least two levels of coverage: a high cost option (known as the prevailing plan) and a low cost option. The low cost option will require higher deductibles and cost sharing than the prevailing plan option. Each of these plans covers hospitalization, doctor visits, prescription drugs and maternity care. The prevailing indemnity plan has a $750 annual deductible for individuals. Most services are subject to 20% coinsurance; when you have paid $15,000 in cost sharing the plan will pay 100% for covered services for the rest of the year. The prevailing HMO plan does not have a deductible, and has a $1,500 annual out-of-pocket maximum for individuals.

The low-cost indemnity option has a $1,500 annual deductible for individuals. Most services are subject to 30% coinsurance; when you have paid $20,000 in cost sharing the plan will pay 100% for covered services for the rest of the year.. The low-cost HMO plan does not have a deductible, and has a $3,000 annual out-of-pocket maximum for individuals.

All indemnity plans have a lifetime limit of $2 million on covered benefits.

What about coverage for my pre-existing condition?

· Portability policies cannot impose pre-existing condition exclusion periods.

What can I be charged for a portability policy?

· You cannot be charged more because of your health status, but premiums can vary due to age, family size and the plan option you select. This is called modified community rating.

Can my portability policy be canceled?

· Your policy cannot be canceled because you get sick. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the policy service area.