ORS 413.612
Eligibility for program

  • payment for plan and out-of-pocket costs
  • disenrollment
  • application, enrollment and renewal procedures
  • education and outreach

(1)

An individual is eligible for the COFA Premium Assistance Program if the individual:

(a)

Is a resident;

(b)

Is a COFA citizen;

(c)

Enrolls in a qualified health plan;

(d)

Has income that is less than 138 percent of the federal poverty guidelines; and

(e)

Qualifies for an advance premium tax credit toward the cost of the individual’s qualified health plan.

(2)

Within the limits of moneys in the COFA Premium Assistance Program Fund, the Oregon Health Authority shall pay the premium cost for a qualified health plan and the out-of-pocket costs for the coverage provided by the plan for an individual who meets the criteria in subsection (1) of this section.

(3)

The authority may disenroll a participant from the program if the participant:

(a)

No longer meets the eligibility criteria specified in subsection (1) of this section;

(b)

Fails, without good cause, to comply with procedural or documentation requirements established by the authority in accordance with subsection (4) of this section;

(c)

Fails, without good cause, to notify the authority of a change of address in a timely manner;

(d)

Withdraws the participant’s application or requests termination of coverage; or

(e)

Performs an act, practice or omission that constitutes fraud and, as a result, an insurer rescinds the participant’s policy for the qualified health plan.

(4)

The authority shall establish:

(a)

Application, enrollment and renewal processes for the COFA Premium Assistance Program;

(b)

The qualified health plans that are eligible for reimbursement under the program;

(c)

Procedural requirements for continued participation in the program, including participant documentation requirements that are necessary for the authority to administer the program;

(d)

Open enrollment periods and special enrollment periods consistent with the enrollment periods for the health insurance exchange; and

(e)

A comprehensive community education and outreach campaign, working with stakeholder and community organizations, to facilitate applications for, and enrollment in, the program. [Formerly 735.608]
Note: See note under 413.610 (Purpose of Compact of Free Association Premium Assistance Program).

Source: Section 413.612 — Eligibility for program; payment for plan and out-of-pocket costs; disenrollment; application, enrollment and renewal procedures; education and outreach, https://www.­oregonlegislature.­gov/bills_laws/ors/ors413.­html.

413.006
Establishment of Oregon Health Policy Board 413.007
Composition of board 413.008
Chairperson 413.011
Duties of board 413.014
Rules 413.016
Authority of board to establish advisory and technical committees 413.017
Public Health Benefit Purchasers Committee, Health Care Workforce Committee, Health Plan Quality Metrics Committee and Behavioral Health Committee 413.032
Establishment of Oregon Health Authority 413.033
Oregon Health Authority director 413.034
Oregon Health Authority officers and employees 413.036
Use of abuse and neglect reports for screening subject individuals 413.037
Administering oaths 413.038
Service of notice by regular mail 413.041
Persons authorized to represent parties in contested cases 413.042
Rules 413.046
Right to courteous, fair and dignified treatment 413.071
Authorization to request federal waivers 413.072
Public process required if waiver of federal requirement involves policy change 413.083
Dental director 413.084
State School Nursing Consultant 413.085
Cross-delegation by directors of Department of Human Services, Department of Consumer and Business Services and Oregon Health Authority 413.101
Oregon Health Authority Fund 413.105
Deposit of reimbursements received for medical assistance expenditures 413.109
Acceptance and expenditures of funds received from private sources 413.121
Oregon Health Authority Special Checking Account 413.125
Revolving fund 413.129
Aggregation of warrants and payments 413.135
Combining and eliminating accounts 413.151
Setoff of liquidated and delinquent debts 413.161
Collection of data on race, ethnicity, language, disability status, sexual orientation and gender identity 413.162
Reports to Legislative Assembly on collection of data under ORS 413.161 413.163
System for collecting data on race, ethnicity, language, disability, sexual orientation and gender identity 413.164
Collection and reporting of data by health care providers and insurers 413.166
Grants for data collection 413.167
Reports to Legislative Assembly 413.171
Sharing of data with Department of Human Services 413.175
Prohibition on disclosure of information 413.181
Disclosure of insurer information by Department of Consumer and Business Services for purpose of administering Oregon Integrated and Coordinated Care Delivery System 413.195
Disclosure of information about cremated or reduced remains 413.196
Confidentiality and inadmissibility of information obtained in connection with epidemiologic morbidity and mortality studies 413.201
Targeted outreach for Cover All People program 413.223
School-based health centers 413.225
Grants to safety net providers 413.227
Oregon Health Authority reimbursement of coordinated care organization’s costs to provide services related to improving student access to school-based oral health services 413.231
Recruitment of primary care providers 413.234
Supplemental payments to emergency services providers 413.235
Emergency services intergovernmental transfer program 413.236
Coordinated care organization reimbursement of emergency medical services providers 413.246
Information provided to retired physicians and health care providers 413.248
Physician Visa Waiver Program 413.250
Statewide Health Improvement Program 413.255
Cooperative research and demonstration projects for health and health care purposes 413.256
Regional health equity coalitions 413.257
Experimental, prototype health care of tomorrow 413.259
Patient centered primary care home program and behavioral health home program 413.260
Patient centered primary care and behavioral health home delivery models 413.270
Advisory council 413.271
Palliative care information and resources 413.273
Palliative care for patients and residents of hospitals, long term care facilities and residential care facilities 413.300
Definitions for ORS 413.300 to 413.308, 413.310 and ORS chapter 414 413.301
Health Information Technology Oversight Council 413.303
Council chairperson 413.308
Duties of council 413.310
Oregon Health Information Technology program 413.430
Functions of Director of Oregon Health Authority regarding health professionals 413.435
Administrative requirements for students in clinical training 413.450
Continuing education in cultural competency 413.500
Women, Infants and Children Program 413.520
Gambling addiction programs in Oregon Health Authority 413.522
Problem Gambling Treatment Fund 413.550
Definitions for ORS 413.550 to 413.559 413.552
Legislative findings and policy on health care interpreters 413.554
Oregon Council on Health Care Interpreters 413.556
Testing, qualification and certification standards for health care interpreters 413.558
Procedures for testing, qualifications and certification of health care interpreters 413.559
Requirement for provider to work with health care interpreter from registry 413.560
Moneys received credited to account in Oregon Health Authority Fund 413.561
Agencies or boards with enforcement authority 413.562
State of Oregon as employer of health care interpreters for purposes of collective bargaining only 413.563
Requirement for interpretation service company to use health care interpreters from registry 413.570
Pain Management Commission 413.572
Additional duties of commission 413.574
Membership of commission 413.576
Selection of chairperson and vice chairperson 413.580
Pain Management Fund 413.582
Acceptance of contributions 413.590
Pain management education required of certain licensed health care professionals 413.599
Rules 413.600
Traditional Health Workers Commission 413.610
Purpose of Compact of Free Association Premium Assistance Program 413.611
Definitions 413.612
Eligibility for program 413.613
COFA Premium Assistance Program Fund 413.800
Emergency planning
Green check means up to date. Up to date

Current through early 2024

§ 413.612’s source at oregon​.gov