2011 ORS § 414.844¹
Application to participate in program
  • issuance of subsidies
  • restrictions
  • enrollment in employer-sponsored coverage

(1) To enroll in the Family Health Insurance Assistance Program established in ORS 414.841 (Definitions for ORS 414.841 to 414.864) to 414.864 (Sanctions for violation of program requirements), an applicant shall submit a written application to the Office of Private Health Partnerships or to the third party administrator contracted by the office to administer the program pursuant to ORS 414.842 (Purpose) in the form and manner prescribed by the office. Except as provided in ORS 414.848 (Subsidies limited to funds appropriated), if the applicant qualifies as an eligible individual, the applicant shall either be enrolled in the program or placed on a waiting list for enrollment.

(2) After an eligible individual has enrolled in the program, the individual shall remain eligible for enrollment for the period of time established by the office.

(3) After an eligible individual has enrolled in the program, the office or third party administrator shall issue subsidies in an amount determined pursuant to ORS 414.846 (Determination of level of assistance) to either the eligible individual or to the carrier designated by the eligible individual, subject to the following restrictions:

(a) Subsidies may not be issued to an eligible individual unless all eligible children, if any, in the eligible individuals family are covered under a health benefit plan or medical assistance.

(b) Subsidies may not be used to subsidize premiums on a health benefit plan whose premiums are wholly paid by the eligible individuals employer without contribution from the employee.

(c) Such other restrictions as the office may adopt.

(4) The office may issue subsidies to an eligible individual in advance of a purchase of a health benefit plan or a dental plan.

(5) To remain eligible for a subsidy, an eligible individual must enroll in a group health benefit plan if a plan is available to the eligible individual through the individuals employment and the employer makes a monetary contribution toward the cost of the plan, unless the office implements specific cost or benefit structure criteria that make enrollment in an individual health insurance plan more advantageous for the eligible individual.

(6) An individual is eligible for a subsidy for both a health benefit plan and a dental plan, regardless of whether the health benefit plan provides dental coverage. [Formerly 735.724; 2011 c.70 §3]

Note: See note under 414.841 (Definitions for ORS 414.841 to 414.864).