Chapter 683 Oregon Laws 2003

AN ACT

HB 2160

Relating to Family Health Insurance Assistance Program; creating new provisions; amending ORS 735.722 and 735.724; and declaring an emergency.

Be It Enacted by the People of the State of Oregon:

SECTION 1. ORS 735.724 is amended to read:

735.724. (1) To enroll in the Family Health Insurance Assistance Program established in ORS 735.720 to 735.740, an applicant shall submit a written application to the Insurance Pool Governing Board or to the third-party administrator contracted by the board to administer the program pursuant to ORS 735.722 in the form and manner prescribed by the board. Except as provided in ORS 735.728, 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 board.

(3) After an eligible individual has enrolled in the program, the board or third-party administrator shall issue subsidies in an amount determined pursuant to ORS 735.726 to either the eligible individual or to the health insurance carrier designated by the eligible individual, subject to the following restrictions:

(a) Subsidies may not be issued to an adult unless all children, if any, in the adult’s family are covered under a health benefit plan or Medicaid.

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

(4) The board may issue subsidies to an eligible individual in advance of a purchase of a health benefit 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 individual’s employment and the employer makes a monetary contribution toward the cost of the plan, unless the board implements specific cost or benefit structure criteria that make enrollment in an individual health insurance plan more advantageous for the eligible individual.

(6) Notwithstanding ORS 735.720 (3)(b), if an eligible individual is enrolled in a group health benefit plan available to the eligible individual through the individual’s employment and the employer requires enrollment in both a health benefit plan and a dental plan, the individual is eligible for a subsidy for both the health benefit plan and the dental plan.

SECTION 2. Section 3 of this 2003 Act is added to and made a part of ORS 735.720 to 735.740.

SECTION 3. (1) The Family Health Insurance Assistance Program shall provide coverage of age-appropriate immunizations or other health care services when an eligible individual is enrolled in a health benefit plan that does not provide coverage of age-appropriate immunizations or other health care services required by the waiver program described in ORS 414.829 and the eligible individual is receiving a subsidy described in ORS 414.839.

(2) The Insurance Pool Governing Board shall adopt rules implementing subsection (1) of this section.

SECTION 4. ORS 735.722 is amended to read:

735.722. (1) There is established the Family Health Insurance Assistance Program in the Insurance Pool Governing Board. The purpose of the program is to remove economic barriers to health insurance coverage for residents of the State of Oregon with family income less than 200 percent of the federal poverty level, and investment and savings less than the limit established by the board, while encouraging individual responsibility, promoting health benefit plan coverage of children, building on the private sector health benefit plan system and encouraging employer and employee participation in employer sponsored health benefit plan coverage.

(2) The Insurance Pool Governing Board shall be responsible for the implementation and operation of the Family Health Insurance Assistance Program. The Administrator of the Office for Oregon Health Policy and Research, in consultation with the Oregon Health Council, shall make recommendations to the board regarding program policy, including but not limited to eligibility requirements, assistance levels, benefit criteria and insurance carrier participation. The board shall adopt all policy recommendations made by the Administrator of the Office for Oregon Health Policy and Research pursuant to this subsection.

(3) The board [shall enter into a] may contract with [a] one or more third-party [administrator] administrators to administer one or more components of the Family Health Insurance Assistance Program. Duties of [the] a third-party administrator may include but are not limited to:

(a) Eligibility determination;

(b) Data collection;

(d) Financial tracking and reporting; and

(e) Such other services as the board may deem necessary for the administration of the program.

(4) In entering into a contract with a third-party administrator pursuant to subsection (3) of this section, the board shall engage in competitive bidding. The board shall evaluate bids according to criteria established by the board, including but not limited to:

(a) The applicant’s proven ability to administer a program of the size of the Family Health Insurance Assistance Program;

(b) The efficiency of the applicant’s payment procedures;

(d) The applicant’s ability to operate the program in a cost-effective manner.

SECTION 5. This 2003 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2003 Act takes effect on its passage.

Approved by the Governor August 21, 2003

Filed in the office of Secretary of State August 21, 2003

Effective date August 21, 2003

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