2024 Oregon consumer protections laws included multiple mandates for fully insured group health plans sold in Oregon. The Oregon Division of Financial Regulation (DFR), part of the Oregon Department of Consumer and Business Services, compiled a list of 13 consumer protection laws that became effective January 1, 2024. 8 of these laws have a direct impact on employer sponsored health plans.
Bills that will impact employer sponsored health plans include:
- SB 192 Directs the Oregon Prescription Drug Affordability Board to develop a plan for upper payment limits on prescription drugs, requires pharmacy benefit managers to provide price transparency reports to DCBS, expands health insurance company transparency reporting, and includes changes to strengthen DCBS prescription drug pricing programs.
- SB 628 Requires coverage of certain treatments for pediatric autoimmune neuropsychiatric disorders.
- SB 797 Requires coverage of medically necessary prosthetic and orthotic devices.
- SB 1041 Prohibits a member cost share – deductible, co-insurance, co-payments, or any other out-of-pocket expenses on supplemental and diagnostic breast examinations.
- SB 1529 Requires coverage of three primary care or behavioral health visits with a co-pay of no more than $5 and requires health insurance carriers to automatically assign members to primary care providers. View our previous article here.
- HB 2002 Establishes an individual’s right to make reproductive health choices. Includes a statutory requirement for health benefit plans to cover gender-affirming treatment. Provides protections for individuals and providers participating in reproductive health and gender affirmation treatments.
- HB 2574 Eliminates member cost sharing for coverage of post-exposure prophylactic drugs for the prevention of HIV.
- HB 2994 Expands the coverage of bilateral cochlear implants, hearing aids, and other hearing assistive technology.
The Oregon DFR’s guide to the 2024 consumer protection laws is available here. This includes all 13 laws with more detail on each of the new regulations.
Expanded Definition of Registered Domestic Partner
In addition to the consumer protection laws, the Oregon legislature expanded the definition of registered domestic partner under the Oregon Family Fairness Act. HB 2032 amends the definition of domestic partner under the act to include opposite gender state registered domestic partners.
This change will apply to all fully insured health and life policies issued in Oregon. Employers will be required to offer the same benefit eligibility to same or opposite registered domestic partners as legally married spouses.
Author’s note: As a reminder, domestic partner coverage causes tax complications. For federal taxes, the value of the employer’s contribution toward the coverage of a domestic partner will generally be considered taxable income to the employee. Employees generally may not pay for a domestic partner’s coverage on a pre-tax basis through a Code Section 125 cafeteria plan, and domestic partners expenses may not be reimbursed through a healthcare Flexible Spending Account (FSA). However, for Oregon state income tax purposes, coverage for a registered domestic partner is treated the same as a spouse. The value of the domestic partner’s coverage is not considered income to the employee for state tax purposes in Oregon.
Summary
Fully insured plans sold in Oregon must comply with the new consumer protection and domestic partner laws. Oregon carriers/issuers will be responsible for ensuring compliance and we anticipate they will release amendments to current plans in the coming months.
IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.
This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.