OAR 945-060-0025
Requirements for Continued Eligibility for COFA Premium Assistance; Disenrollment from Program

(1)

A COFA program participant shall:

(a)

Comply with procedural or documentation requirements established by the department in accordance with Oregon Laws 2016, Chapter 94, Section 3(4)(c);

(b)

Satisfy a request from the department within the time established by the department for information necessary to verify the participant’s continued eligibility for the program; and

(c)

Notify the department in writing within 15 calendar days of a change:

(A)

Of address or telephone number;

(B)

In eligibility for:
(i)
Coverage under, or eligibility for, the qualified health plan eligible for reimbursement;
(ii)
The COFA Premium Assistance Program;
(iii)
Minimum essential coverage; or
(iv)
Medicaid.

(C)

In the monthly premium costs or the payment amount of the advance premium tax credit; or

(D)

In the COFA applicant’s household size or income that affects eligibility for the qualified health plan described in OAR 945-060-0005 (Eligible Qualified Health Plan)

(2)

In addition to the bases for disenrollment set out in Oregon Laws 2016, Chapter 94, Section 3(3), the department may disenroll a participant from the program if the participant fails, without good cause, to satisfy a requirement of paragraph (1) of this rule;

(3)

The department:

(a)

Shall establish the effective date of disenrollment for a reason specified in paragraph 2 of this rule;

(b)

May choose not to pay a program participant’s qualified health plan premium costs or reimburse a program participant’s out-of-pocket costs incurred after the effective date of disenrollment; and

(c)

May seek reimbursement of monies expended from the COFA Premium Assistance Program Fund for premium costs or out-of-pocket costs incurred after the effective date described in paragraph (a) of this subsection.

Source: Rule 945-060-0025 — Requirements for Continued Eligibility for COFA Premium Assistance; Disenrollment from Program, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=945-060-0025.

Last Updated

Jun. 8, 2021

Rule 945-060-0025’s source at or​.us