1. (1) Clients or an eligible applicant (see section (2) of this rule) for a client in the OSIPM program may be reimbursed for their share of the premiums for private or employer-sponsored group health insurance if:

   1. (a) The insurance covers a member of the benefit group (see OAR 461-110-0750);
   2. (b) The insurance coverage is a comprehensive major medical plan that includes inpatient and outpatient hospital, physician, lab, x-ray and full prescription coverage; and
   3. (c) The premium is cost-effective (see OAR 461-155-0360 and OAR 410-120-1960).
2. (2) An "eligible applicant" may be a non-Medicaid individual living in or outside of the household. The Department may pay a portion of or the entire premium if payment of the premium for the non-Medicaid individual is necessary in order to enroll the Department client in the group health plan (see OAR 410-120-1960).

Statutory/Other Authority

ORS 411.060, 411.070 & 414.042

Statutes/Other Implemented

ORS 411.060, 411.070 & 414.042

History

SSP 31-2016, f. & cert. ef. 9-1-16
SSP 25-2016(Temp), f. 6-30-16, cert. ef. 7-1-16 thru 12-27-16
SSP 16-2014, f. & cert. ef. 7-1-14
SSP 35-2011, f. 12-27-11, cert. ef. 1-1-12
SSP 38-2009, f. 12-31-09, cert. ef. 1-1-10
SSP 29-2009(Temp), f. & cert. ef. 10-1-09 thru 3-30-10
SSP 23-2008, f. & cert. ef. 10-1-08
SSP 10-2007, f. & cert. ef. 10-1-07
SSP 22-2004, f. & cert. ef. 10-1-04
SSP 1-2003, f. 1-31-03, cert. ef. 2-1-03
AFS 15-1999, f. 11-30-99, cert. ef. 12-1-99
AFS 10-1998, f. 6-29-98, cert. ef. 7-1-98
AFS 3-1997, f. 3-31-97, cert. ef. 4-1-97
AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95
AFS 2-1994, f. & cert. ef. 2-1-94
AFS 28-1992, f. & cert. ef. 10-1-92
AFS 2-1992, f. 1-30-92, cert. ef. 2-1-92