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.


Or. Admin. R. 945-060-0025
HMP 3-2016, f. & cert. ef. 9/8/2016; HMP 6-2017, minor correction filed 11/02/2017, effective 11/2/2017

Statutory/Other Authority: OL 2016 & Ch. 94

Statutes/Other Implemented: OL 2016 & Ch. 94

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