Chapter 634 Oregon Laws 1999
Session Law
AN ACT
SB 1291
Relating to the Family
Health Insurance Assistance Program; amending ORS 653.800, 653.810, 653.815,
653.820 and 653.850.
Be It Enacted by the People of the State of Oregon:
SECTION 1.
ORS 653.800 is amended to read:
653.800. For purposes of ORS 653.800 to 653.850:
[(1) "Assistance
voucher" means payment or reimbursement to an eligible individual toward
the purchase of a health benefit plan, and may include a net billing
arrangement with insurance carriers or prospective or retrospective payment for
health benefit plan premiums directly to the eligible individual.]
[(2)] (1) "Eligible individual"
means an individual who:
(a) Is a resident of the State of Oregon;
(b) Is not eligible for Medicare;
(c) Either has been without health benefit plan coverage for a
period of time established by the Insurance Pool Governing Board, or meets
exception criteria established by the board;
(d) Except as otherwise provided by the board, has family
income less than 200 percent of the federal poverty level;
(e) Has investments and savings less than the limit established
by the board; and
(f) Meets other eligibility criteria established by the board.
[(3)] (2) "Family" means:
(a) A single individual who is not claimed as a dependent for
state income tax purposes;
(b) An adult and the adult's spouse;
(c) An adult and the adult's spouse and all unmarried,
dependent children under 23 years of age, including adopted children and
children placed for adoption; or
(d) An adult and the adult's unmarried, dependent children
under 23 years of age, including adopted children and children placed for
adoption.
[(4)(a)] (3)(a) "Health benefit plan"
means a policy or certificate of group or individual health insurance, as
defined in ORS 731.162, providing payment or reimbursement for hospital,
medical and surgical expenses. "Health benefit plan" includes a
medical savings account, health care service contractor or health maintenance
organization subscriber contract, the Oregon Medical Insurance Pool and any
plan provided by a less than fully insured multiple employer welfare
arrangement or by another benefit arrangement defined in the federal Employee
Retirement Income Security Act of 1974, as amended.
(b) "Health benefit plan" does not include coverage
for accident only, specific disease or condition only, credit, disability
income, coverage of Medicare services pursuant to contracts with the Federal
Government, Medicare supplement insurance, student accident and health
insurance, long term care insurance, hospital indemnity only, dental only,
vision only, coverage issued as a supplement to liability insurance, insurance
arising out of a workers' compensation or similar law, automobile medical
payment insurance or insurance under which the benefits are payable with or
without regard to fault and that is legally required to be contained in any
liability insurance policy or equivalent self-insurance.
[(5)] (4) "Income" means gross
income in cash or kind available to the applicant or recipient[, the receipt of which is regular and
predictable enough to afford security in the sense that the applicant or
recipient may rely upon it to contribute toward meeting the needs of the
applicant or recipient].
[(6)] (5) "Investment and savings"
means cash, securities as defined in ORS 59.015, negotiable instruments as
defined in ORS 73.0104 and such similar investments or savings as the board may
establish that are available to the applicant or recipient to contribute toward
meeting the needs of an applicant or eligible individual.
[(7)] (6) "Medicaid" means medical
assistance provided under 42 U.S.C. section 396a (section 1902 of the Social
Security Act).
[(8)] (7) "Medical savings account"
means a trust that is created exclusively for the purpose of paying qualified
medical expenses of the account holder and that qualifies for tax deduction
under section 220 of the Internal Revenue Code. "Medical savings
account" includes an associated high deductible health benefit plan.
[(9)] (8) "Resident" means an
individual who demonstrates to the Insurance Pool Governing Board that the
individual is lawfully residing in Oregon and intends to reside in Oregon
permanently.
(9) "Subsidy"
means payment or reimbursement to an eligible individual toward the purchase of
a health benefit plan, and may include a net billing arrangement with insurance
carriers or a prospective or retrospective payment for health benefit plan
premiums and eligible copayments or deductible expenses directly related to the
eligible individual.
(10) "Third-party administrator" means any insurance
company or other entity licensed under the Insurance Code to administer health
insurance benefit programs.
SECTION 2.
ORS 653.810 is amended to read:
653.810. (1) To enroll in the Family Health Insurance
Assistance Program established in ORS 653.800 to 653.850, 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 653.805 in the form and manner prescribed by the board. Except as
provided in ORS 653.820, if the applicant qualifies as an eligible individual [as defined in ORS 653.800], 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 [assistance vouchers] subsidies
in an amount determined pursuant to ORS 653.815 to either the eligible
individual or to the health insurance carrier designated by the eligible
individual, subject to the following restrictions:
(a) [Assistance vouchers]
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) [Assistance vouchers]
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) Assistance vouchers
shall never exceed the amount paid by an individual in contribution to an
employer-sponsored health benefit plan or the premium for an individual health
benefit plan or a combination of the two.]
[(d) Assistance vouchers
may be used only to subsidize health benefit plan premium payments. Vouchers
may not be used toward payment of copayment or deductible expenses unless the
eligible individual has a medical savings account. Vouchers may be used in a
medical savings account only up to the allowed contribution level.]
[(e)] (c) Such other restrictions as the
board may adopt.
(4) The board may issue [assistance
vouchers] subsidies to an
eligible individual in advance of a purchase of a health benefit plan.
(5) To remain eligible for [assistance
vouchers] 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 [toward which] 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.
SECTION 3.
ORS 653.815 is amended to read:
653.815. (1) The Insurance Pool Governing Board shall determine
the level of assistance to be granted under ORS 653.810 based on a sliding
scale that considers:
(a) Family size;
(b) Family income;
(c) The number of [family]
members of a family who will receive
health benefit plan coverage subsidized through the Family Health Insurance
Assistance Program; and
(d) Such other factors as the board may establish.
(2) Notwithstanding the sliding scale established in subsection
(1) of this section, the board may establish different assistance levels for
otherwise similarly situated eligible individuals based on factors including
but not limited to whether the individual is enrolled in an employer-sponsored
group health benefit plan or an individual health benefit plan.
SECTION 4.
ORS 653.820 is amended to read:
653.820. (1) Notwithstanding eligibility criteria and [assistance voucher] subsidy amounts established pursuant to ORS 653.800 to 653.850, [assistance vouchers] subsidies shall be provided only to the
extent the Legislative Assembly specifically appropriates funds to provide such
assistance.
(2) The Insurance Pool Governing Board shall prohibit or limit
enrollment in the Family Health Insurance Assistance Program to ensure that
program expenditures are within legislatively appropriated amounts.
Prohibitions or limitations allowed under this section may include but are not limited
to:
(a) Lowering the allowable income level necessary to qualify as
an eligible individual; and
(b) Establishing a waiting list of eligible individuals who
shall receive [assistance vouchers] subsidies only when sufficient funds
are available.
SECTION 5.
ORS 653.850 is amended to read:
653.850. (1) The Insurance Pool Governing Board may impose
sanctions against an individual who violates any provision of ORS 653.800 to
653.850 or rules adopted thereto, including but not limited to suspension or termination
from the Family Health Insurance Assistance Program and repayment of any [assistance voucher] subsidy amounts paid due to the fraudulent misrepresentation of an
applicant or enrolled individual. Sanctions allowed under this subsection shall
be imposed in the manner prescribed in ORS 183.310 to 183.550.
(2) In addition to the sanctions available pursuant to
subsection (1) of this section, the board may impose a civil penalty not to
exceed $1,000 against any individual who violates any provision of ORS 653.800
to 653.850 or rules adopted pursuant thereto. Civil penalties imposed pursuant
to this section shall be imposed pursuant to ORS 183.090.
Approved by the Governor
July 12, 1999
Filed in the office of
Secretary of State July 12, 1999
Effective date October 23,
1999
__________