ORS 743B.310 Rescinding coverage; permissible bases; notice; rules

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.

An insurer may not rescind coverage of an individual under a health benefit plan or group or individual health insurance policy unless:

The individual or a person seeking coverage on behalf of the individual:

Performs an act, practice or omission that constitutes fraud; or

Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan or policy; and

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.

An insurer may not rescind coverage of a group under a health benefit plan unless:

The plan sponsor:

Performs an act, practice or omission that constitutes fraud; or

Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan; and

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.

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.

This section does not apply to long term care insurance that is subject to ORS 743.650 to 743.665.