For purposes of ORS 735.720 to 735.740:
(1) “Carrier” has the meaning given that term in ORS 735.700.
(2) “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 Office of Private Health Partnerships, or meets exception criteria established by the office;
(d) Except as otherwise provided by the office, has family income less than 200 percent of the federal poverty level;
(e) Has investments and savings less than the limit established by the office; and
(f) Meets other eligibility criteria established by the office.
(3)(a) “Family” means:
(A) A single individual;
(B) An adult and the adult’s spouse;
(C) An adult and the adult’s spouse, all unmarried, dependent children under 23 years of age, including adopted children, children placed for adoption and children under the legal guardianship of the adult or the adult’s spouse, and all dependent children of a dependent child; or
(D) An adult and the adult’s unmarried, dependent children under 23 years of age, including adopted children, children placed for adoption and children under the legal guardianship of the adult, and all dependent children of a dependent child.
(b) A family includes a dependent elderly relative or a dependent adult child with a disability who meets the criteria established by the office and who lives in the home of the adult described in paragraph (a) of this subsection.
(4)(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 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, 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 or coverage obtained or provided in another state but not available in Oregon.
(5) “Income” means gross income in cash or kind available to the applicant or the applicant’s family. Income does not include earned income of the applicant’s children or income earned by a spouse if there is a legal separation.
(6) “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 office may establish that are available to the applicant or the applicant’s family to contribute toward meeting the needs of an applicant or eligible individual.
(7) “Medicaid” means medical assistance provided under 42 U.S.C. section 1396a (section 1902 of the Social Security Act).
(8) “Resident” means an individual who meets the residency requirements established by rule by the office.
(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 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. [Formerly 653.800; 2003 c.684 §8; 2005 c.727 §§5,5a; 2005 c.744 §§23d,23e,23g; 2007 c.70 §317]
Note: 735.720 to 735.740 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 735 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
Section: Previous 735.707 735.708 735.709 735.710 735.711 735.712 735.714 735.720 735.722 735.724 735.726 735.728 735.730 735.731 735.732 NextLast modified: August 7, 2008