Oregon Department of Human Services, Self-Sufficiency Programs

Rule Rule 461-135-0990
Specific Requirements; Reimbursement of Cost-Effective, Employer-Sponsored Health Insurance Premiums


Clients or an eligible applicant (see section (2) of this rule) for a client in the OSIPM program may be reimbursed for their share of the premiums for private or employer-sponsored group health insurance if:


The insurance covers a member of the benefit group (see OAR 461-110-0750 (Benefit Group));


The insurance coverage is a comprehensive major medical plan that includes inpatient and outpatient hospital, physician, lab, x-ray and full prescription coverage; and


The premium is cost-effective (see OAR 461-155-0360 (Pursuit of Cost-Effective Employer Sponsored Health Insurance) and OAR 410-120-1960 (Payment of Private Insurance Premiums)).


An “eligible applicant” may be a non-Medicaid individual living in or outside of the household. The Department may pay a portion of or the entire premium if payment of the premium for the non-Medicaid individual is necessary in order to enroll the Department client in the group health plan (see OAR 410-120-1960 (Payment of Private Insurance Premiums)).

Last accessed
Jun. 8, 2021