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Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave Oregon. Oregon has expanded protections for certain kinds of health insurance beyond what federal law requires. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do — or do not — protect you as an Oregon resident.

How am I protected?
In Oregon, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All health plans in Oregon must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.

• If you have had at least 6 months of coverage under a group health plan and then lose it, you are guaranteed the right to buy individual coverage, also known as a portability plan, for yourself and your family. Portability plans cannot impose pre-existing condition exclusion periods.

• Portability plan premiums cannot vary because of your health status, though they can vary, within limits, due to age. This is called modified community rating.

• If you have been denied individual coverage because of your health status, you also can buy individual coverage from the Oregon Medical Insurance Pool (OMIP). In this case you will pay a premium surcharge and may have a pre-existing condition exclusion period.

• Individual health plans cannot charge higher premiums due to your health status. Premiums for these plans can vary due to age, family size, and the type of plan you seek. The amount of premium variation based upon age permitted for these plans greater than for portability plans.

• If you are a small employer buying a group health plan for 50 or fewer employees, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. This is called guaranteed issue.

• If you are a small employer buying a group health plan for 25 or fewer employees, you cannot be charged more due to the health status of those in your group. You can, however, be charged higher premiums, within limits, because of the age of those in your group. This is called modified community rating.

• If you have low or modest household income, you may be eligible for free or subsidized health insurance coverage through for yourself or members of your family. The Oregon Medicaid program offers free health coverage for pregnant women, families with children, medically needy, and elderly and disabled individuals. The Oregon Child Health Insurance Program (OR CHIP) also offers coverage for low-income children under the age of 19 who are not eligible for Medicaid and who have limited or no health insurance. In addition, the Family Health Insurance Assistance Program (FHIAP) subsidizes health insurance premiums for qualified Oregonians.