OAR 409-065-0005: Definitions

The following definitions apply to OAR 409-065-0000 to 409-065-0055: (1) “Accident policy” means an insurance policy that provides benefits only for a loss due to accidental bodily injury. (2) “Authority” means the Oregon Health Authority. (3) “Calendar year” means a twelve-month year beginning on January 1 and ending on December 31. (4) “Cost Growth Target-1” or “CGT-1” means the Data Submission Template as set forth on the website of the Authority. (5) "Cost Growth Target-2” or “CGT-2” means the Cost Growth Target Data Specification Manual as set forth on the website of the Authority. (6) "Cost Growth Target-3” or “CGT-3” means the Cost Growth Target Waiver/Extension Request as set forth on the website of the Authority. (7) "Cost Growth Target-4” or “CGT-4” means the Cost Growth Target Frontline Worker Data Submission Template as set forth on the website of the Authority. (8) "Cost Growth Target-5” or “CGT-5” means the Cost Growth Target Performance Improvement Plan Template as set forth on the website of the Authority. (9) "Cost Growth Target-6” or “CGT-6” means the Cost Growth Target Performance Improvement Plan Guidance as set forth on the website of the Authority. (10) "Cost Growth Target-7” or “CGT-7” means the Cost Growth Target Sub-Regulatory Guidance on Accountability document as set forth on the website of the Authority. (11) “DCBS” means the Oregon Department of Consumer and Business Services. (12) “Dental-only insurance” means an insurance policy that provides benefits only for dental services. (13) “Disability policy” means an insurance policy that provides benefits for losses due to a covered illness or disability. (14) “Frontline worker” means any worker whose total annual compensation is less than $200,000, adjusted by the annual percentage increase (if any) in the Consumer Price Index for All Urban Consumers, West Region (All Items), as published by the Bureau of Labor Statistics of the United States Department of Labor, excluding executive managers and salaried managers. (15) “Health benefit plan” has the meaning provided in ORS 743B.005. (16) “Health care” has the meaning provided in ORS 442.385. (17) “Health insurance” has the meaning provided in ORS 731.162. (18) “Hospital indemnity policy” means an insurance policy that provides benefits only for covered hospital stays. (19) “Long-term care insurance” has the meaning provided in ORS 743.652. (20) “Mandatory reporter” means any reporting entity determined to be a mandatory reporter in OAR 409-065-0010. (21) “Medicare supplemental insurance” or “Medicare supplemental policy” has the meaning provided in OAR 836-052-0119. (22) “Payer” has the meaning provided in ORS 442.385. (23) “Performance improvement plan” (PIP) has the meaning provided in OAR 409-065-0040. (24) “Program website” means the Authority’s website for the Sustainable Health Care Cost Growth Target Program, currently at https://www.oregon.gov/oha/hpa/hp/pages/sustainable-health-care-cost-growth-target.aspx. (25) “Provider organization” means an entity including but not limited to a clinic, health system, hospitals with primary care, medical group, accountable care organization, or independent practice association. (26) “Specific disease policy” means an insurance policy that provides benefits only for a loss due to a covered disease. (27) “Stand-alone prescription drug plan” means an insurance policy that provides benefits only for prescription drugs. (28) “Stop-loss plan” means insurance against the risk of economic loss assumed under a less than fully-insured employee health benefit plan as provided in ORS 742.065. (29) “Third-party administrator (TPA)” means any person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts or settles claims on, residents of Oregon or residents of another state from offices in Oregon, in connection with life insurance or health insurance coverage; or any person or entity who must otherwise be licensed under ORS 744.702. (30) “Vision policy” means a health benefits plan covering only vision health care. (31) “Voluntary reporter” means a payer or third-party administrator that does not meet the requirements to be considered a Mandatory reporter and elects to submit cost growth target data on a voluntary basis.