Oregon Revised Statutes
It is the intent of the Legislative Assembly that the health insurance exchange be administered in such a manner as to: Incorporate the goals of improving the lifelong health of all Oregonians, increasing the quality, reliability and availability of health insurance for all Oregonians and lowering or containing the cost of health insurance so that health in…
The duties of the Oregon Health Authority include: Administering a health insurance exchange in accordance with federal law to make qualified health plans available to individuals and groups throughout this state. Providing information in writing, through an Internet-based clearinghouse and through a toll-free telephone line, that will assist individuals a…
The health insurance exchange is under the supervision of the Director of the Oregon Health Authority. The director has such powers as are necessary to carry out ORS 741.001 to 741.540. The director may employ, supervise and terminate the employment of such staff as the director deems necessary. The director shall prescribe their duties and fix their compe…
The Health Insurance Exchange Advisory Committee is created to advise the Oregon Health Policy Board in the development and implementation of the policies and operational procedures governing the administration of a health insurance exchange in this state including, but not limited to, all of the following: The amount of the assessment imposed on insurers u…
The Oregon Health Authority shall conduct a state or nationwide criminal records check under ORS 181A.195 on, and for that purpose may require the fingerprints of, a person who: Is employed by or applying for employment with the authority in a position related to the administration of the health insurance exchange; or Is, or will be, providing services to …
The Oregon Health Authority shall procure and administer an information technology platform or service, separate from the federal platform, to provide electronic access to the health insurance exchange in this state on and after November 1, 2026. [2023 c.585 §2] Note: The amendments to 741.012 by section 5, chapter 585, Oregon Laws 2023, become operative No…
(Financing Operations of Exchange)
The Health Insurance Exchange Fund is established in the State Treasury, separate and distinct from the General Fund. Interest earned by the Health Insurance Exchange Fund shall be credited to the fund. The Health Insurance Exchange Fund consists of moneys received by the Oregon Health Authority under ORS 741.001 to 741.540. Moneys in the fund are continuous…
The Oregon Health Authority shall establish, by rule, an administrative charge. The authority shall impose and collect the charge from all insurers participating in the health insurance exchange or offering a health plan certified by the authority and state programs participating in the health insurance exchange. The Health Insurance Exchange Advisory Commit…
(Audits and Reports)
The Oregon Health Authority shall keep an accurate accounting of the operation and all activities, receipts and expenditures of the authority with respect to the health insurance exchange. The Secretary of State shall conduct an annual financial audit of the authority’s revenues and expenditures in carrying out ORS 741.001 to 741.540. The audit shall includ…
The Director of the Oregon Health Authority shall report to the Legislative Assembly each year on: The financial condition of the health insurance exchange, including actual and projected revenues and expenses of the administrative operations of the exchange and commissions paid to insurance producers out of fees collected under ORS 741.105 (6); The operat…
HEALTH INSURANCE EXCHANGE (Definitions)
As used in ORS 741.001 to 741.540: “Coordinated care organization” has the meaning given that term in ORS 414.025. “Essential health benefits” has the meaning given that term in ORS 731.097. “Health benefit plan” has the meaning given that term in ORS 743B.005. “Health care service contractor” has the meaning given that term in ORS 750.005. “Health insu…
Individuals and families may purchase qualified health plans through the health insurance exchange. The following groups may purchase qualified health plans through the Small Business Health Options Program: Small employers as defined in ORS 743B.005; and Districts and eligible employees of districts that are subject to ORS 243.886, unless their participa…
The Oregon Health Authority, in developing and offering the health benefit package required by ORS 413.011 (1)(j), may not establish policies or procedures that discourage insurers from offering more comprehensive health benefit plans that provide greater consumer choice at a higher cost. The health benefit package approved by the Oregon Health Policy Board …
Health benefit plans offered through a Small Business Health Options Program, as defined in ORS 741.300, are subject to ORS 743.004, 743.022, 743.535 and 743B.003 to 743B.127 and to other provisions of the Insurance Code applicable to small employer group health insurance. Note: 741.342 was added to and made a part of the Insurance Code by legislative actio…
The activities of insurers working under the direction of the Oregon Health Authority and the Department of Consumer and Business Services pursuant to ORS 413.011 (1)(j) or participating in the health insurance exchange administered under ORS 741.002 do not constitute a conspiracy or restraint of trade or an illegal monopoly, nor are they carried out for the…
A person may not file or cause to be filed with the Oregon Health Authority any article, certificate, report, statement, application or any other information related to the health insurance exchange required or permitted by the authority to be filed, that is known by the person to be false or misleading in any material respect.
The Oregon Health Authority may serve by regular mail or, if requested by the recipient, by electronic mail a notice described in ORS 183.415 of the authority’s determination of: A person’s eligibility to purchase or to continue to purchase a qualified health plan through the health insurance exchange; A person’s eligibility for a premium tax credit for pu…
(Collection and Disclosure of Information by Exchange)
The Oregon Health Authority shall adopt by rule the information that must be documented in order for a person to qualify for: Qualified health plan coverage through the health insurance exchange; Premium tax credits; and Cost-sharing reductions. The documentation specified by the authority under this subsection shall include but is not limited to documen…
Except as provided in subsection (3) of this section, documents, materials or other information that is in the possession or control of the Oregon Health Authority for the purpose of carrying out ORS 741.002, 741.310 and 741.500 or complying with federal health insurance exchange requirements, and that is protected from disclosure by state or federal law, re…
The Director of the Oregon Health Authority may enter into agreements governing the sharing and use of information consistent with this section and ORS 741.510 with other state or federal health insurance exchanges or regulatory authorities, the Department of Consumer and Business Services, the Department of Revenue, law enforcement agencies or federal autho…
A complaint made to the Oregon Health Authority or the Department of Consumer and Business Services with respect to any prospective or certified qualified health plan, and the record thereof, shall be confidential and may not be disclosed except as provided in ORS 741.510 and 741.520. No such complaint, or the record thereof, shall be used by the authority o…
MISCELLANEOUS (Grace Period)
Upon receipt of any inquiry from a health care provider regarding the eligibility, coverage or benefits of an insured under an enrollee’s plan, an insurer shall notify the health care provider, in the manner prescribed by the insurer, that the coverage is provided through a qualified health plan.
As used in this section and ORS 741.800: “Enrollee” means a person who is: Enrolled in a qualified health plan purchased through the health insurance exchange; Responsible for paying the premium on the qualified health plan and has paid at least one premium; and Receiving an advance payment of the premium tax credit under section 36B of the Internal Reve…
The Oregon Health Authority shall produce written materials containing information for consumers about the requirements for paying the premiums for qualified health plans. The authority shall distribute the materials to health care providers upon request. (Penalties)
The Director of the Oregon Health Authority, in accordance with ORS 183.745, may impose a civil penalty for a violation of ORS 741.390 of no more than $10,000. All penalties recovered under this section shall be deposited in the Health Insurance Exchange Fund.
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