(a) Is a resident;
(b) Is a COFA citizen;
(c) Enrolls in a qualified health plan;
(d) Has income that is less than 138 percent of the federal poverty guidelines; and
(e) Qualifies for an advance premium tax credit toward the cost of the individual’s qualified health plan.
(2) Within the limits of moneys in the COFA Premium Assistance Program Fund, the Oregon Health Authority shall pay the premium cost for a qualified health plan and the out-of-pocket costs for the coverage provided by the plan for an individual who meets the criteria in subsection (1) of this section.
(3) The authority may disenroll a participant from the program if the participant:
(a) No longer meets the eligibility criteria specified in subsection (1) of this section;
(b) Fails, without good cause, to comply with procedural or documentation requirements established by the authority in accordance with subsection (4) of this section;
(c) Fails, without good cause, to notify the authority of a change of address in a timely manner;
(d) Withdraws the participant’s application or requests termination of coverage; or
(e) Performs an act, practice or omission that constitutes fraud and, as a result, an insurer rescinds the participant’s policy for the qualified health plan.
(4) The authority shall establish:
(a) Application, enrollment and renewal processes for the COFA Premium Assistance Program;
(b) The qualified health plans that are eligible for reimbursement under the program;
(c) Procedural requirements for continued participation in the program, including participant documentation requirements that are necessary for the authority to administer the program;
(d) Open enrollment periods and special enrollment periods consistent with the enrollment periods for the health insurance exchange; and
(e) A comprehensive community education and outreach campaign, working with stakeholder and community organizations, to facilitate applications for, and enrollment in, the program. [Formerly 735.608]
Note: See note under 413.610.