72nd OREGON LEGISLATIVE ASSEMBLY--2003 Regular Session
Enrolled
House Bill 2159
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of Governor Theodore R.
Kulongoski for Insurance Pool Governing Board)
CHAPTER ................
AN ACT
Relating to administration of Family Health Insurance Assistance
Program; amending ORS 735.722 and 735.724.
Be It Enacted by the People of the State of Oregon:
SECTION 1. 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 - } { + may + } enter into a
contract with a third-party administrator to administer the
Family Health Insurance Assistance Program. Duties of the
third-party administrator may include but are not limited to:
(a) Eligibility determination;
(b) Data collection;
(c) Assistance payments;
(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 - } { + If the board decides to
enter + } 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
Enrolled House Bill 2159 (HB 2159-INTRO) Page 1
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;
(c) The estimate provided of the total charges necessary to
administer the program; and
(d) The applicant's ability to operate the program in a
cost-effective manner.
SECTION 2. 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 - }
{ + eligible individual + } unless all children, if any, in the
{ - adult's - } { + eligible individual'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.
(c) Such other restrictions as the board may adopt.
(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.
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Enrolled House Bill 2159 (HB 2159-INTRO) Page 2
Passed by House February 17, 2003
...........................................................
Chief Clerk of House
...........................................................
Speaker of House
Passed by Senate April 16, 2003
...........................................................
President of Senate
Enrolled House Bill 2159 (HB 2159-INTRO) Page 3
Received by Governor:
......M.,............., 2003
Approved:
......M.,............., 2003
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 2003
...........................................................
Secretary of State
Enrolled House Bill 2159 (HB 2159-INTRO) Page 4