Coverage for Human Monkeypox Virus Vaccination
August 16, 2022
On August 10, 2022, Commissioner Stolfi published Bulletin No. DFR 2022-4, which addresses coverage for human Monkeypox virus (hMPXV) vaccination. According to the bulletin, all health benefit plans (including grandfathered health benefit plans) in Oregon must provide coverage for approved hMPXV vaccines and their administration in accordance with this bulletin. The coverage required under the bulletin includes vaccines administered to an individual after exposure to the virus as post-exposure prophylaxis (PEP). In addition, a health benefit plan may not restrict coverage for an approved hMPXV vaccine and its administration to in-network providers and must not require employee cost-sharing for the vaccine. The coverage requirements became effective on August 5, 2022.
Employers should work closely with insurers to ensure that the coverage is provided according to the bulletin, and to address any related employee questions relating to hMPXV.
Bulletin No. DFR 2022-4 »
Paid Leave Oregon Announced 2023 Contribution Amount
June 07, 2022
The Oregon Employment Department has recently announced that the contribution rate for the state’s paid family and medical leave program (a.k.a., “Paid Leave Oregon”) will be at 1% when contributions begin in 2023.
As a reminder, starting January 1, 2023, employees in Oregon will contribute 60% through payroll withholding, and employers will contribute 40% of the combined contribution rate of 1% of employee wages up to the annual maximum of $132,900. Employers with fewer than 25 employees are not required to contribute. Further, employers have the option to pay some or all of their employees’ portion.
Similar to other states’ paid family and medical leave programs, Paid Leave Oregon will provide paid time off for qualified reasons, including the birth or adoption of a child, employees’ own serious illness or injury, taking care of a seriously ill family member, and safe leave for up to 12 weeks for all combined covered leave reasons in a benefit year.
Employers with at least one employee working in Oregon should be aware of the 2023 contribution amount and start communicating with their payroll vendor and internal payroll department to prepare for the Paid Leave Oregon contributions and other requirements.
Paid Leave Oregon May Bulletin Announcement »
Paid Leave Oregon Main Site »
Oregon Announces End to COVID-19 as a Public Health Emergency
April 26, 2022
Oregon Gov. Kate Brown announced recently that the state’s public health emergency proclamation for COVID-19 would end effective April 1, 2022. Gov. Brown initially extended the current declaration of a public health emergency through June 30, 2022. However, due to the decline in the COVID-19 numbers, Gov. Brown declared the public health emergency would end on April 1, 2022, more than two years after it was first announced. The ending of Oregon’s public health emergency also ended COVID-19 leave benefits in the state.
Employers with employees in Oregon should be aware of the changes.
Executive Order 22-03 »
Oregon’s Paid Sick and Safe Leave Law Expanded Qualifying Reasons
April 12, 2022
Effective April 1, 2022, the Oregon Bureau of Labor and Industries (BOLI) added the use of Oregon paid sick and safe leave to include an eligible employee to take time off in case of an emergency evacuation order and in situations when the air quality index or heat index exceeds a certain level. The authorized public officials will determine a level where continued exposure to such levels would jeopardize the employee’s health.
Employers who have employees in Oregon should be aware of this new update.
Oregon Bureau of Labor and Industries - Permanent Administrative Order BLI 3-2022 »
Paid Sick Time Law Main Site »
Oregon Approves Vaccination and Masking Requirements to Control COVID-19 in Healthcare Settings
February 15, 2022
Effective January 31, 2022, the state Health Authority approved a permanent administrative order (No. PH 11-2022) requiring that healthcare providers and staff must be fully vaccinated in a healthcare setting unless they have provided documentation of a medical or religious exception. "Fully vaccinated" means having received both doses of a two-dose COVID-19 vaccine or one dose of a single-dose COVID-19 vaccine, and at least 14 days have passed since the individual’s final dose of the COVID-19 vaccine.
Additionally, the state Health Authority requires mask mandate in healthcare settings, including patients and visitors, until the State Public Health Director or State Public Health Officer issues an order to lift the requirement.
No. PH 11-2022 »
Coverage of COVID-19 Immunizations
February 17, 2021
On February 4, 2021, Commissioner Stolfi issued Bulletin No. DFR 2021-1, which clarifies the Division of Financial Regulation’s expectations around the coverage of COVID-19 vaccinations. In accordance with Oregon’s COVID-19 public health declaration and the CARES Act, the division confirms that coverage of the COVID-19 vaccine:
- Must be provided by all health benefit plans
- Cannot be restricted to in-network providers
- Cannot have any cost-sharing requirements
- Must be provided without requiring any prior authorization or any other form of utilization review
- May not impose any other limitation that would prevent an enrollee from receiving the vaccine at no out-of-pocket cost
The bulletin is retroactive to January 27, 2021. Although this bulletin is directed towards insurance carriers, employers based in Oregon should familiarize themselves with this guidance as individuals begin to access COVID-19 immunizations.
Bulletin No. DFR 2021-1 »
COVID-19 Temporary Paid Leave Program
February 02, 2021
The Oregon legislature recently established the COVID-19 Temporary Paid Leave Program to provide coverage to individuals that are not eligible for FFCRA leave. The leave is provided if the employee is unable to work due to the need to quarantine or self-isolate because of COVID-19. Up to 10 days of leave will be provided through the program, and it is only available if the employee’s employer does not provide COVID-19-related paid time off.
In order to be eligible under the program, employees must meet all the following requirements:
- They work in Oregon and are required to file an Oregon personal income tax return.
- They are directed to quarantine by a local or tribal public health authority or healthcare provider because of exposure to someone infected or have COVID-19-related symptoms and are seeking a medical diagnosis.
- They are not able to work (including telework) because they need to quarantine or isolate.
- They do not expect to earn more than $60,000 individually or $120,000 jointly in 2020.
- Their employer does not provide COVID-19-related paid sick leave or they have exhausted their available COVID-19-related paid sick leave.
- They are not applying for unemployment insurance benefits for the time off due to quarantine or isolation.
- They are not applying for workers’ compensation benefits for the time off due to quarantine or isolation or experiencing COVID-19 symptoms.
- They are not seeking or using benefits from similar COVID-19 quarantine relief programs in Oregon or another state.
- They are not applying for or receiving other forms of paid leave from their employer during their quarantine or isolation, such as banked sick leave or vacation leave.
- They are not laid off or furloughed by their employer.
- They must have notified their employer that you need to quarantine or isolate.
- They can claim only one quarantine period.
- They are not self-employed.
- They are not part of the gig economy (Lyft, Uber, DoorDash, GrubHub, Instacart, etc.)
- They are not being paid off the record (this means their employer is not reporting their income to the state and often employers who pay off the record pay in cash).
Employees will apply with the state to receive the benefit. Approved applicants will receive a check in the mail, and the money is taxable.
Employers with Oregon employees that are not offering any paid time off for employees who have the need for COVID-related leave should be mindful of this program.
COVID-19 Temporary Paid Leave Program »
Employee Flier »
April 14, 2020
On March 25, 2020, the Department of Consumer and Business Services and Oregon Health Authority issued telehealth guidance in relation to the ongoing COVID-19 outbreak, recognizing the need for Oregonians to be able to access health care services without visiting their provider in person. The guidance requires health plans to:
- Cover telehealth services delivered by in-network providers to replace in-person visits whenever possible and medically or clinically appropriate
- Examine reimbursement rates for telehealth services to ensure they are adequate to enable providers to increase capacity to serve patients with appropriate telehealth delivery methods
- Ensure cost-sharing requirements for services delivered via telehealth are no greater than if the service was delivered through in-person settings
- Clearly communicate to their members and provider networks about options to receive health care services via appropriate telehealth delivery modes as well as how to bill for such services
- Examine their provider networks to ensure robust telehealth services are available and consider contracting with more providers to help bolster telehealth capacity during the current outbreak
- Use telehealth service delivery methods to ensure patients maintain access to behavioral health services
- Eliminate barriers to providing medically and clinically appropriate care using appropriate telehealth delivery models
While insurers will have to comply with this guidance, employers should familiarize themselves with the additional telehealth benefits provided.
Telehealth Guidance »
March 31, 2020
The Oregon Division of Financial Regulation recently issued a number of bulletins addressing the COVID-19 crisis. Two of those bulletins with particular application to employee benefits are as follows:
- Telehealth Guidance: The state recently shared guidance indicating that health plans are expected to provide increased access to health care services through telehealth delivery platforms and to encourage patients to use telehealth delivery options to limit the amount of in-person health care services they seek. The guidance requires insurers to eliminate barriers to providing medically appropriate care through telehealth. One such way that insurers must do this is by ensuring that cost sharing requirements for services delivered via telehealth are no greater than if the services are delivered in-person.
- Grace Period for All Insurers: On March 25, 2020, the Department of Consumer and Business Services issued a temporary emergency order requiring all insurance companies to extend grace periods for premium payments, postpone policy cancellations and nonrenewals, and extend deadlines for reporting claims.
Although these directives are aimed at insurers, employers should familiarize themselves with the guidance should they or their employees need to avail themselves of the services.
Telehealth Guidance »
Grace Period Order »
Oregon Insurers Will Provide Coronavirus Coverage
March 17, 2020
The Division of Financial Regulations has indicated that the state has reached an agreement with several health insurance companies on their coverage for COVID-19 testing and treatment. Specifically, a number of insurers have agreed to cover COVID-19 testing, office visits, urgent care and emergency room visits without cost sharing. Additionally, the insurers have agreed to offer any future immunization without cost sharing. The state’s guidance also provides an FAQ that provides additional information on treatment. Employers can provide this guidance to their plan participants that may need to receive testing.
Coronavirus Information About Insurance and Scams »