plan that provides a legal resident of the state of Oregon access to basic health care through three major components:
- Medicaid Reform (rationing)-extends Medicaid eligibility to those individuals below the federal poverty level, and requires, if possible, that Medicaid benefits be provided through managed careplans.
- Employer Mandate-employers must provide health insurance for all permanent (working at least 17.5 hours per week) employees on a play or pay basis, where the employer plays by providing the employees with a health insurance plan or pays by paying a payroll tax that is passed through to the state's Insurance Pool Fund.
- Market Reform-benefits available must be substantially similar to those provided by Medicaid.
All insurance companies that sell and/or service insurance plans to employers who have 3 to 25 employees must offer at least those basic benefits and cannot refuse to sell this plan to any such employer. In addition, no employee or employee's dependent can be excluded from the plan; there must be portability from any previous individual or group health insurance plan; benefits cannot be denied because of preexisting conditions to include pregnancy; policies cannot be cancelled on a selective basis, even for those employees who develop high-risk health care problems; and premium rates cannot exceed the geographic premium rate maintained for a stipulated geographic area.
