Requirements for purchase of insurance through exchange and for participation of insurers in exchange
(1)(a) Individuals and families may purchase qualified health plans through the health insurance exchange.
(b) The following groups may purchase qualified health plans through the Small Business Health Options Program:
(A) Employers with no more than 100 employees; and
(B) Districts and eligible employees of districts that are subject to ORS 243.886 (Limitations on district participation in benefit plans), unless their participation is precluded by federal law.
(2)(a) Only individuals who purchase health plans through the exchange may be eligible to receive premium tax credits under section 36B of the Internal Revenue Code and reduced cost-sharing under 42 U.S.C. 18071.
(b) Only employers that purchase health plans through the SHOP may be eligible to receive small employer health insurance credits under section 45R of the Internal Revenue Code.
(3) Only an insurer that has a certificate of authority to transact insurance in this state and that meets applicable federal requirements for participating in the exchange may offer a qualified health plan through the exchange. Any qualified health plan must be certified under ORS 741.002 (Duties, powers and functions of Department of Consumer and Business Services). Coordinated care organizations that do not have a certificate of authority to transact insurance may serve only medical assistance recipients through the exchange and may not offer qualified health plans.
(4)(a) The Department of Consumer and Business Services shall adopt by rule uniform requirements, standards and criteria for the certification of qualified health plans, including requirements that a qualified health plan provide, at a minimum, essential health benefits and have acceptable consumer and provider satisfaction ratings.
(b) The department may limit the number of qualified health plans that may be offered through the exchange as long as the same limit applies to all insurers.
(5) The department shall certify as qualified a dental only health plan as permitted by federal law.
(6) The department, in collaboration with the Oregon Health Authority and the Department of Human Services, shall coordinate the application and enrollment processes for the exchange and the state medical assistance program.
(7) The Department of Consumer and Business Services may establish risk mediation programs within the exchange.
(8) The department shall establish by rule a process for certifying insurance producers to facilitate the transaction of insurance through the exchange, in accordance with federal standards and policies.
(9) The department shall ensure that an insurer charges the same premiums for plans sold through the exchange as for identical plans sold outside of the exchange.
(10) The department is authorized to enter into contracts for the performance of the department’s duties, functions or operations with respect to the exchange, including but not limited to contracting with:
(a) Insurers that meet the requirements of subsections (3) and (4) of this section, to offer qualified health plans through the exchange; and
(b) Navigators, in-person assisters and application counselors certified by the department under ORS 741.002 (Duties, powers and functions of Department of Consumer and Business Services).
(11)(a) The department shall consult with stakeholders, including but not limited to representatives of school administrators, school board members, school employees and the Oregon Educators Benefit Board, regarding the plans that may be offered through the exchange to districts and eligible employees of districts under subsection (1)(b)(B) of this section and the insurers that may offer the plans.
(b) The board and the department shall each adopt rules to ensure that:
(A) Any plan offered under subsection (1)(b)(B) of this section is underwritten by an insurer using a single risk pool composed of all eligible employees who are enrolled or who will be enrolled in the plan both through the exchange and by the board; and
(B) In every plan offered under subsection (1)(b)(B) of this section, the coverage is comparable to plans offered by the board.
(12) The department is authorized to apply for and accept federal grants, other federal funds and grants from nongovernmental organizations for purposes of developing, implementing and administering the exchange. Moneys received under this subsection shall be deposited in the Health Insurance Exchange Fund. [2011 c.415 §11; 2011 c.415 §12; 2012 c.38 §§10,11; 2012 c.107 §§96,97; 2013 c.421 §§1,2; 2015 c.3 §25; 2015 c.792 §§10,11]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent. Currency Information