Oregon Health Authority,
Office of Private Health Partnerships Chapter 442
Caption: Expedite health insurance
Order No.: OPHP 1-2011(Temp)
Filed with Sec. of
Certified to be
Effective: 1-5-11 thru 4-8-11
Rules Amended: 442-005-0030
Rules Suspended: 442-005-0030(T)
Subject: FHIAP is amending: 442-005-0030 to enable approved
FHIAP members to enroll in health insurance more quickly.
Rules Coordinator: Margaret Moran—(503) 378-5664
(1) An application form, and any documentation required
on the form, will be used to determine eligibility and subsidy level.
(2) The application process is the only time when
applicants may submit information proving their program eligibility.
Information not submitted during this process will not be accepted for purposes
of audit, appeal or contested case hearing except as provided in OARs
442-005-0310, 442-005-0320, 442-005-0330 and 442-005-0340.
(3) Program openings occur when funds are available.
(4) When there are program openings, applicants are
mailed an application on a first come first served basis.
(5) FHIAP reviews applications in the order they are
received. Eligibility decisions include:
(a) Approval for immediate subsidy;
(b) Denial; or
(c) Request for more information. When there are no
program openings, an application may be approved, but not eligible for
immediate subsidy. These approvals are held in queue. Applicants are mailed a
notice when they are able to enroll for subsidies.
(6) FHIAP must notify applicants of other health care
programs such as OHP and Healthy Kids.
(7) Documents that verify required information
requested on the application must be provided with the application if FHIAP is
not able to verify the information electronically. Required documentation
includes but is not limited to:
(a) A copy of a current Oregon identification or other
proof of Oregon residency for all adult applicants;
(b) For non-United States citizens, a copy of
documentation from the Department of Homeland Security showing their status and
when they arrived in the United States.
(c) Documents verifying all adult applicant’s and
spouse’s earned and unearned income and children’s unearned income for the
three months prior to the month in which the application is signed.
Documentation may include, but is not limited to, pay stubs, award letters,
child support documentation and unemployment benefit stubs or printouts;
(d) A completed Self-Employment Income Worksheet and
documents verifying income from self-employment for the six months prior to the
month the application was signed, if applicable. Documentation may include, but
is not limited to, business ledgers, profit and loss statements and bank
(e) A completed Farming, Fishing and Ranching Income
Worksheet and documents verifying income from farming, fishing and ranching for
the 12 months prior to the month the application was signed, if applicable.
Documentation may include, but is not limited to, business ledgers, profit and
loss statements and bank statements;
(f) The most recently filed federal tax return and all
schedules for applicants who have income from self-employment or farming,
fishing or ranching.
(g) A copy of any group insurance handbook, summary, or
contract that is available to any applicant.
(h) A completed Group Insurance Information (GII) form,
if the applicant has group insurance available to them.
(i) For applicants with no income, the completed No
Income form or other signed statement explaining how the applicant is meeting
their basic needs, such as food, clothing and shelter.
(8) Additional verification must be provided when FHIAP
(9) FHIAP may verify any factors affecting eligibility,
benefit levels or any information reported, such as:
(a) Data or other information received by FHIAP that is
inconsistent with information on the FHIAP application.
(b) Information provided on the application is
(c) Information reported on previous applications that
is inconsistent with a current FHIAP application.
(10) FHIAP may decide at any time during the
application process that additional eligibility factors must be verified.
(11) FHIAP may deny an application or end ongoing
subsidy when acceptable verification or required documentation is not provided.
Stat. Auth.: ORS 735.734,
735.722(2) & 735.728(2)
Stats. Implemented: ORS 735.720 -
Hist.: IPGB 2-2006, f. & cert.
ef. 6-1-06; OPHP 6-2010(Temp), f. & cert. ef. 10-11-10 thru 4-8-11; OPHP
1-2011(Temp), f. & cert. ef. 1-5-11 thru 4-8-11
Notes 1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2010.