(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.
Structure 2021 Oregon Revised Statutes
Volume : 11 - Juvenile Code, Human Services
Chapter 413 - Oregon Health Authority
Section 413.006 - Establishment of Oregon Health Policy Board.
Section 413.007 - Composition of board.
Section 413.008 - Chairperson; quorum; meetings.
Section 413.011 - Duties of board.
Section 413.016 - Authority of board to establish advisory and technical committees.
Section 413.032 - Establishment of Oregon Health Authority.
Section 413.033 - Oregon Health Authority director.
Section 413.036 - Use of abuse and neglect reports for screening subject individuals; rules.
Section 413.037 - Administering oaths; depositions; subpoenas.
Section 413.038 - Service of notice by regular mail.
Section 413.041 - Persons authorized to represent parties in contested cases.
Section 413.046 - Right to courteous, fair and dignified treatment; grievances.
Section 413.071 - Authorization to request federal waivers.
Section 413.072 - Public process required if waiver of federal requirement involves policy change.
Section 413.083 - Dental director; duties; rules.
Section 413.084 - State School Nursing Consultant; duties.
Section 413.101 - Oregon Health Authority Fund.
Section 413.105 - Deposit of reimbursements received for medical assistance expenditures.
Section 413.109 - Acceptance and expenditures of funds received from private sources.
Section 413.121 - Oregon Health Authority Special Checking Account.
Section 413.125 - Revolving fund.
Section 413.129 - Aggregation of warrants and payments.
Section 413.135 - Combining and eliminating accounts.
Section 413.151 - Setoff of liquidated and delinquent debts.
Section 413.162 - Reports to Legislative Assembly on collection of data under ORS 413.161.
Section 413.164 - Collection and reporting of data by health care providers and insurers; rules.
Section 413.166 - Grants for data collection; rules.
Section 413.167 - Reports to Legislative Assembly.
Section 413.171 - Sharing of data with Department of Human Services; rules.
Section 413.175 - Prohibition on disclosure of information; exceptions.
Section 413.195 - Disclosure of information about cremated or reduced remains.
Section 413.223 - School-based health centers; certification; best practices; rules.
Section 413.231 - Recruitment of primary care providers.
Section 413.234 - Supplemental payments to emergency services providers.
Section 413.235 - Emergency services intergovernmental transfer program.
Section 413.246 - Information provided to retired physicians and health care providers.
Section 413.248 - Physician Visa Waiver Program; rules; fees.
Section 413.250 - Statewide Health Improvement Program.
Section 413.256 - Regional health equity coalitions.
Section 413.257 - Experimental, prototype health care of tomorrow.
Section 413.259 - Patient centered primary care home program and behavioral health home program.
Section 413.260 - Patient centered primary care and behavioral health home delivery models.
Section 413.270 - Advisory council; membership; duties.
Section 413.271 - Palliative care information and resources.
Section 413.300 - Definitions for ORS 413.300 to 413.308, 413.310 and ORS chapter 414.
Section 413.301 - Health Information Technology Oversight Council.
Section 413.303 - Council chairperson; quorum; meetings.
Section 413.308 - Duties of council.
Section 413.310 - Oregon Health Information Technology program; fees; rules.
Section 413.430 - Functions of Director of Oregon Health Authority regarding health professionals.
Section 413.435 - Administrative requirements for students in clinical training.
Section 413.450 - Continuing education in cultural competency.
Section 413.500 - Women, Infants and Children Program; rules; civil penalties.
Section 413.520 - Gambling addiction programs in Oregon Health Authority; advisory committee.
Section 413.522 - Problem Gambling Treatment Fund.
Section 413.550 - Definitions for ORS 413.550 to 413.559.
Section 413.552 - Legislative findings and policy on health care interpreters.
Section 413.554 - Oregon Council on Health Care Interpreters.
Section 413.556 - Testing, qualification and certification standards for health care interpreters.
Section 413.560 - Moneys received credited to account in Oregon Health Authority Fund.
Section 413.561 - Agencies or boards with enforcement authority.
Section 413.570 - Pain Management Commission; duties; staffing.
Section 413.572 - Additional duties of commission.
Section 413.574 - Membership of commission.
Section 413.580 - Pain Management Fund.
Section 413.582 - Acceptance of contributions.
Section 413.600 - Traditional Health Workers Commission.
Section 413.610 - Purpose of Compact of Free Association Premium Assistance Program.
Section 413.611 - Definitions.