(1)(a) Individuals and families may purchase qualified health plans through the health insurance exchange.

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

(b) The following groups may purchase qualified health plans through the Small Business Health Options Program:

(A) Small employers as defined in ORS § 743B.005; and

(B) Districts and eligible employees of districts that are subject to ORS § 243.886, unless their participation is precluded by federal law.

(2)(a) Only individuals who purchase qualified health plans through the exchange may be eligible to receive premium tax credits under section 36B of the Internal Revenue Code and reduced cost-sharing under 42 U.S.C. § 18071.

(b) Only employers that purchase health plans through the SHOP may be eligible to receive small employer health insurance credits under section 45R of the Internal Revenue Code.

(3) Only an insurer that has a certificate of authority to transact insurance in this state and that meets applicable state and federal requirements for participating in the exchange may offer a qualified health plan through the exchange. Any qualified health plan must be certified under ORS § 741.002. Coordinated care organizations that do not have a certificate of authority to transact insurance may serve only medical assistance recipients through the exchange and may not offer qualified health plans.

(4)(a) The Oregon Health Authority shall adopt by rule uniform requirements, standards and criteria for the certification of qualified health plans, including requirements that a qualified health plan provide, at a minimum, essential health benefits and have acceptable consumer and provider satisfaction ratings.

(b) The authority may limit the number of qualified health plans that may be offered through the exchange as long as the same limit applies to all insurers.

(5) The authority shall certify as qualified a dental only health plan as permitted by federal law.

(6) The authority, in collaboration with the Department of Human Services, shall coordinate the application and enrollment processes for the exchange and the state medical assistance program.

(7) The authority may establish risk mediation programs within the exchange.

(8) The authority shall establish by rule a process for certifying insurance producers to facilitate the transaction of insurance through the exchange, in accordance with federal standards and policies.

(9) The authority is authorized to enter into contracts for the performance of the authority’s duties, functions or operations with respect to the exchange, including but not limited to contracting with:

(a) Insurers that meet the requirements of subsections (3) and (4) of this section, to offer qualified health plans through the exchange; and

(b) Navigators, in-person assisters and application counselors certified by the authority under ORS § 741.002.

(10)(a) The authority shall consult with stakeholders, including but not limited to representatives of school administrators, school board members, school employees and the Oregon Educators Benefit Board, regarding the plans that may be offered through the exchange to districts and eligible employees of districts under subsection (1)(b)(B) of this section and the insurers that may offer the plans.

(b) The board and the authority shall each adopt rules to ensure that:

(A) Any plan offered under subsection (1)(b)(B) of this section is underwritten by an insurer using a single risk pool composed of all eligible employees who are enrolled or who will be enrolled in the plan both through the exchange and by the board; and

(B) In every plan offered under subsection (1)(b)(B) of this section, the coverage is comparable to plans offered by the board.

(11) The authority is authorized to apply for and accept federal grants, other federal funds and grants from nongovernmental organizations for purposes of developing, implementing and administering the exchange. Moneys received under this subsection shall be deposited in the Health Insurance Exchange Fund. [2011 c.415 § 11; 2011 c.415 § 12; 2012 c.38 10,11; 2012 c.107 96,97; 2013 c.421 1,2; 2015 c.3 § 25; 2015 c.792 10,11; 2021 c.569 § 28]