Small Business Group Medical & Health Insurance Portland Oregon

medical

As an Oregon employer you are not required to provide a group health insurance plan for your employees but having good benefits such as health insurance is a great way to retain the best talent. When you reach out to me for your group health insurance needs my employee benefits department will help design a  plan that will meet the needs of your group.

Below are frequently asked questions that I receive regarding group health insurance for Oregon businesses.

  1. What is the definition of a “Small Employer?”
  2. What is the definition of an “Eligible Employee?”
  3. What are small group rates based on?
  4. Can we negotiate rates with our insurance carrier?
  5. Were there any other changes as a result of the new law?
  6. Are we required to offer coverage to Domestic Partners?
  7. I heard about a registry for Domestic Partnerships. How does that work?
  8. Do carriers require proof of domestic partnership?  If so, what do they require?
  9. Is coverage for domestic partners automatic with our carrier?


1. What is the definition of a “Small Employer?” The Oregon Legislature passed House Bill 2002 which fundamentally changes the Small Employer Health Insurance rating rules in the State of Oregon with new and renewing groups beginning on or after April 1, 2008.

HB 2002 expanded the definition of an Oregon Small Employer Groups from 2-25 to 2-50 employees.  “Small Employer” means an employer that employed an average of at least 2 but not more than 50 employees on business days during the preceding calendar year, the majority of whom are employed within this state, and who employs at least 2 eligible employees on the date on which coverage takes effect.

2. What is the definition of an “Eligible Employee?” An employee of a small employer who works on a regularly scheduled basis, with a normal work week of 17.5 or more hours.  The employer may determine hours worked for eligibility between 17.5 and 40 hours per week, subject to the rules of the carrier.

3. What are small group health insurance rates based on? In addition to rating for subscriber ages, plan design, family status and location of groups, carriers may now rate for the following:

  • Dependent or Spouse and Dependent ages (not just employees)
  • Tobacco use
  • Percentage of employees & dependents participating in the insurance plan
  • Premium contribution by the employer and employee
  • Expected claims experience (min or max of 5%)
  • How many years group has had their plan with their current carrier
  • Health promotion engagement by employees and dependents


Each carrier has the ability to file different combinations of the above criteria.

4. Can we negotiate with the insurance carrier if we experience a significant change to our rates? No. Insurance companies are now required to file their rating factors for groups of 2-50 employees, not just 2-25, which means carriers must treat all small groups the same and consistent with how they filed their new rating practice, leaving no flexibility in rate changes.

5. Were there any other changes as a result of the new law? Yes, the small group plans must also comply with the following state defined regulations:

  • Waiting periods for coverage for new hires cannot be longer than 90 days.
  • All categories of employees, management, non-management, etc, must have the same hours per week and probationary period for eligibility.
  • Employers may not ‘class out’ employees for the purpose of denying eligibility for health coverage.


6. Are employers required to offer coverage to Domestic Partners? Yes.  Effective January 1, 2008, Oregon House Bill 2007 established that same-sex domestic partners have essentially the same rights under state law as do spouses. Subsequently, the Oregon Insurance Division interpreted this law to mandate coverage for Oregon registered (same-sex) domestic partners in insurance contracts.

7. I heard about a registry for Domestic Partnerships. How does that work? The law set up a registry program through which domestic partnerships may register with a county clerk’s office to formalize their relationship.  As a result of a temporary injunction that was lifted on Feb. 1, domestic partners were able to register beginning on Feb. 4, 2008.  To register, the individuals in a domestic partnership must file a Declaration of Domestic Partnership, and will receive a Certificate of Registered Domestic Partnership.  This Certificate then becomes part of the state’s Domestic Partnership registry.

8. Do carriers require proof of domestic partnership?  If so, what do they require? Some carriers will require documentations, others will not.  Members interested in registering their domestic partnership should contact their County Clerk’s office to access a Declaration of Domestic Partnership form.  Forms are also available to the public on the Department of Human Services, Center for Health Statistics web site.

9. Is coverage for domestic partners automatic with our carrier? This varies by carrier. Some carriers are automatically offering it to all domestic partners, some will only automatically cover “registered” domestic partners and may require that the employer elect an additional rider (usually at no additional cost) that will allow coverage for non-registered same sex and opposite sex domestic partners. Check with your agent or carrier for specifics on your domestic partner coverage options.

Do carriers require proof of domestic partnership?  If so, what do they require?

Some carriers will require documentations, others will not.  Members interested in registering their domestic partnership should contact their County Clerk’s office to access a Declaration of Domestic Partnership form.  Forms are also available to the public on the Department of Human Services, Center for Health Statistics web site.