Specific Requirements; Reimbursement of Cost-Effective, Employer-Sponsored Health Insurance Premiums
(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:
(a)The insurance covers a member of the benefit group (see…#
(a) The insurance covers a member of the benefit group (see OAR 461-110-0750);
(b)The insurance coverage is a comprehensive major medical…#
(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
(c)The premium is cost-effective (see OAR 461-155-0360 and…#
(c) The premium is cost-effective (see OAR 461-155-0360 and OAR 410-120-1960).
(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).