Oregon Bulletin

February 1, 2011


Oregon Health Authority,
Office of Private Health Partnerships
Chapter 442

Rule Caption: Expedite health insurance enrollment process.

Adm. Order No.: OPHP 1-2011(Temp)

Filed with Sec. of State: 1-5-2011

Certified to be Effective: 1-5-11 thru 4-8-11

Notice Publication Date:

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


Application Process

(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 statements;

(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 requests it.

(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 inconsistent;

(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 - 735.740

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

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