(1) "Advance premium tax credit" means the premium assistance amount determined in accordance with 26 U.S.C. 36B.
(2) "COFA citizen" means an individual who is a citizen of:
(a) The Republic of the Marshall Islands;
(b) The Federated States of Micronesia; or
(c) The Republic of Palau.
(3) "Health insurance exchange" or "exchange" has the meaning given that term in ORS 741.300.
(4) "Income" means the modified adjusted gross income that is attributed to an individual in determining the individual’s eligibility for advance premium tax credits.
(5) "In-network provider" means a health care provider or group of providers that directly contract with an insurer to provide health benefits covered by a health benefit plan offered by the insurer.
(6) "Open enrollment period" means the period during which a person may enroll in a qualified health plan.
(7) "Out-of-pocket costs" means copayments, coinsurance, deductibles and other cost-sharing requirements imposed under a qualified health plan for services, pharmaceuticals, devices and other health benefits that are covered by the plan and that are rendered by in-network providers.
(8) "Premium cost" means an individual’s premium for a qualified health plan less the amount of the individual’s advance premium tax credit.
(9) "Qualified health plan" means a health benefit plan, as defined in ORS 743B.005, offered through the health insurance exchange.
(10) "Resident" means a person who is domiciled in this state.
(11) "Special enrollment period" means a period during which a person who has not done so during the open enrollment period may enroll in a qualified health plan through the exchange if the person meets specified requirements. [Formerly 735.604]
Note: See note under 413.610.