OAR 836-053-0021: Plans Offered to Oregon Small Employers

(1) A small employer carrier shall issue a plan to a small employer if the employee eligibility criteria established by the small employer meet the requirements of this section. A carrier must follow the methodology and address the issues included in the “Revised Counting Methodology for Determining Small or Large Group,” as set forth in Exhibit A of OAR 836-053-0015 to collect data to determine the applicable type of group coverage for an employer and to provide disclosure notices as required for small employers. The eligibility criteria must be based solely on the criteria set forth in Exhibit A and completion of a group eligibility waiting period, if applicable. (2) Impermissible employee eligibility criteria include: (a) Health status; (b) Disability; and (c) A requirement that an employee be actively at work when coverage would otherwise begin. (3) A small employer carrier may provide different health benefit plans to different categories of employees of an employer, as determined by the employer only if based on bona fide employment-based classifications that are consistent with the employer's usual business practice. The categories may not relate to the actual or expected health status of the employees or their dependents.