Or. Admin. R. 945-060-0025 - Requirements for Continued Eligibility for COFA Premium Assistance; Disenrollment from Program
(1) A COFA program
participant shall:
(a) Comply with procedural
or documentation requirements established by the department in accordance with
Oregon Laws 2016, Chapter 94, Section 3(4)(c);
(b) Satisfy a request from the department
within the time established by the department for information necessary to
verify the participant's continued eligibility for the program; and
(c) Notify the department in writing within
15 calendar days of a change:
(A) Of address
or telephone number;
(B) In
eligibility for:
(i) Coverage under, or
eligibility for, the qualified health plan eligible for
reimbursement;
(ii) The COFA
Premium Assistance Program;
(iii)
Minimum essential coverage; or
(iv)
Medicaid.
(C) In the
monthly premium costs or the payment amount of the advance premium tax credit;
or
(D) In the COFA applicant's
household size or income that affects eligibility for the qualified health plan
described in OAR
945-060-0005
(2) In
addition to the bases for disenrollment set out in Oregon Laws 2016, Chapter
94, Section 3(3), the department may disenroll a participant from the program
if the participant fails, without good cause, to satisfy a requirement of
paragraph (1) of this rule;
(3) The
department:
(a) Shall establish the effective
date of disenrollment for a reason specified in paragraph 2 of this
rule;
(b) May choose not to pay a
program participant's qualified health plan premium costs or reimburse a
program participant's out-of-pocket costs incurred after the effective date of
disenrollment; and
(c) May seek
reimbursement of monies expended from the COFA Premium Assistance Program Fund
for premium costs or out-of-pocket costs incurred after the effective date
described in paragraph (a) of this subsection.
Notes
Statutory/Other Authority: OL 2016 & Ch. 94
Statutes/Other Implemented: OL 2016 & Ch. 94
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