Oregon Administrative Rules Chapter 945 - OREGON HEALTH AUTHORITY, HEALTH INSURANCE MARKETPLACE
Oregon Administrative Rules (OAR) Chapter 945 is dedicated to the Oregon Health Authority, Health Insurance Marketplace. These rules govern the operations and functions of the state's health insurance exchange, which plays a crucial role in implementing the Affordable Care Act (ACA) in Oregon.
The primary purpose of OAR Chapter 945 is to regulate the Oregon Health Insurance Marketplace (also referred to as the Exchange), ensuring that individuals and small businesses in Oregon have access to affordable and comprehensive health insurance coverage. While Oregon partners with the Federally Facilitated Marketplace (HealthCare.gov) for enrollment and eligibility, the state still has its own oversight and regulatory responsibilities.
Here's a breakdown of the key areas typically covered in OAR Chapter 945:
Division 1: Procedural Rules:
These are the general administrative rules for the Oregon Health Insurance Marketplace, outlining how rules are adopted, amended, or repealed, and general procedures for its operations.
Division 20: Qualified Health Plans (QHPs) and Stand-Alone Dental Plans (SADPs); Addendum for Indian Health Providers:
This division sets the standards and requirements for health insurance plans to be certified as "Qualified Health Plans" (QHPs) or "Stand-Alone Dental Plans" (SADPs) to be offered through the Marketplace.
It covers criteria for certification, including essential health benefits, network adequacy, and other consumer protections.
It also addresses specific provisions related to Indian Health Care Providers.
Division 30: Administrative Charge for Operating Expenses:
This is a significant division that details how the Oregon Health Insurance Marketplace collects an administrative charge from insurers offering QHPs and SADPs through the Marketplace. This charge helps fund the Marketplace's administrative and operational expenses, including grants to navigators and in-person assisters who help consumers enroll.
It outlines reporting requirements for insurers regarding enrollment and the assessment and collection process for these charges. Penalties for late payment or non-payment are also specified.
Division 40: Eligibility Standards, Application Process, and Appeals of Eligibility Determinations:
This division defines the eligibility criteria for individuals and families to enroll in health insurance plans through the Marketplace and to receive federal financial assistance (such as advance payments of the premium tax credit or cost-sharing reductions).
It details the application process and the procedures for appealing eligibility determinations made by the Marketplace. This includes definitions related to residency, household income, and other factors impacting eligibility.
Division 50: Certification of Insurance Producers [Repealed]:
It's important to note that this division may be marked as "Repealed" in current OAR versions, as the regulatory landscape for insurance producers working with the Marketplace has evolved.
Division 60: COFA Premium Assistance Program:
This division establishes requirements for the COFA (Compact of Free Association) Premium Assistance Program, which provides assistance to eligible individuals from the Freely Associated States.
Key Functions and Importance of the Oregon Health Insurance Marketplace:
The Oregon Health Insurance Marketplace, through the regulations in OAR Chapter 945, aims to:
Increase Access to Coverage: Provide a platform where individuals and small businesses can compare and purchase health insurance plans.
Affordability: Facilitate access to federal financial assistance (subsidies) to make health insurance more affordable for eligible Oregonians.
Consumer Protection: Ensure that plans offered meet certain quality and benefit standards and protect consumers' rights in the health insurance market.
Oversight: Maintain regulatory oversight of insurers participating in the Marketplace and the overall functioning of the exchange.
Accessing the Rules:
For the most current and official version of OAR Chapter 945, you should always consult the Oregon Secretary of State's website or the Oregon Health Authority (OHA) / Oregon Health Insurance Marketplace website. While legal databases like Justia and Cornell Law provide access, the official state sources will have the most up-to-date regulations.
Oregon Health Authority, Health Insurance Marketplace Contact Information:
RELATED Blog
0 comments