Oregon Senate Bill 514 – Children’s Reinsurance Program
August 1, 2011

Last fall, rules under the health care reform law barred health insurers from denying new enrollment to children with pre-existing medical conditions. This created guaranteed issue for children up to age 19.  

Oregon has taken a different approach. Health plan leaders and the state’s insurance division formulated a plan that would minimize the risk of guaranteed issue for children enrolling with any single carrier. Those discussions led to Senate Bill 514 during the 2011 Legislative session, creating the Children’s Reinsurance Program. This unique program is effective with new individual applications in August for September effective dates.

The Reinsurance Program applies to all health insurers doing business in Oregon. Using the Oregon Medical Insurance Pool (OMIP) as a model, insurers agreed they would:

• Enroll children under age 19 throughout the year on a guaranteed issue basis;
• Use the existing medical underwriting process to determine the risk of the applicant;
• Determine within 105 days of the effective date of the individual coverage if the carrier wishes to ‘cede’ the risk of the child to the reinsurance program;
• Report those ceded children and the related premium to the Reinsurance Program;
• Process claims according to the terms of the policy purchased;
• Recover from the Reinsurance Pool claims paid under the terms of the policy for those ceded risks;
• Pay assessments to the Reinsurance Pool much like the assessments paid to OMIP.

Members will receive benefits according to the terms, conditions, limitations and provisions of the plan they choose. 

Please contact your Individual Sales Executive with any further questions.

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