Oregon Office of Rural Health

Rural Medical Practitioners Insurance Subsidy Program

Jenny Creek

Established with HB 3630 (2003), continued with SB 183 (2007), SB 608 (2011), and HB 3261 (2017).

This program is authorized by ORS 676.454.

Funding and administrative rules are effective through December 31, 2020.

Eligibilty

  • Must hold an active Oregon license.
  • Eligible practitioners must pay for and be covered by a malpractice insurance policy (an in-force policy of liability insurance with an authorized insurer participating in the program with minimum limits of coverage of $1 million per occurrence and $1 million aggregate to maximum limits of $1 million per occurrence and $3 million aggregate) which specifically names the individual practitioner and calculates that practitioner’s premium. If the practitioner’s site covers the policy, or if the practitioner is a member of a group policy, the preceding criteria must apply and the practitioner must repay the site the subsidy amount awarded to the practitioner.
  • Must practice at least 60 percent of the time in an eligible rural location. This is a map of eligible rural Oregon locations. If the site’s location is in Ashland, the practitioner must practice obstetrics.
  • Must be willing to serve Medicare or Medicaid patients in at least the same proportion to the Medicare and Medicaid population’s percentage in the practice site’s county. This is a list of those percentages by county. This is a map representing those percentages.

Affidavit

  1. Complete and submit the affidavit.
  2. You will receive confirmation at the email address you enter on the form within two weeks.

Liability carriers currently participating in the program are listed below.

Eligibility

  • Must hold an active Oregon license.
  • Eligible practitioners must pay for and be covered by a malpractice insurance policy (an in-force policy of liability insurance with an authorized insurer participating in the program with minimum limits of coverage of $1 million per occurrence and $1 million aggregate to maximum limits of $1 million per occurrence and $3 million aggregate) which specifically names the individual practitioner and calculates that practitioner’s premium. If the practitioner’s site covers the policy, or if the practitioner is a member of a group policy, the preceding criteria must apply and the practitioner must repay the site the subsidy amount awarded to the practitioner.
  • Cannot share limits with a physician.
  • Must practice at least 60 percent of the time in an eligible rural location. This is a map of eligible rural Oregon locations. If the site’s location is in Ashland, the practitioner must practice obstetrics.
  • Must be willing to serve Medicare or Medicaid patients in at least the same proportion to the Medicare and Medicaid population’s percentage in the practice site’s county. This is a list of those percentages by county. This is a map representing those percentages.

Affidavit

  1. Complete and submit the affidavit.
  2. You will receive confirmation at the email address you enter on the form within two weeks.

Liability carriers currently participating in the program are listed below.

  • ORH will process affidavits within two weeks of date of receipt year-round. 
  • This program operates quarterly within a calendar year (January 1 | April 1 | July 1 | October 1). Affidavits received Oct. 1 - Dec. 31 will count towards the next full calendar year. Affidavits received January 1 or later will be applied to the next possible quarter.
  • If you are determined to be eligible, ORH will send multiple emails to the email address reported on the affidavit during the October to December period of time, reminding each participant to complete an affidavit for the next calendar year. ORH also passes this data to each carrier, so that they can communicate renewal reminder messages to their customers.
  • After you are determined to be eligible, if you change practice sites or insurance carriers within a year, you must submit an updated affidavit ASAP to ensure continuation of coverage.
  • If it is determined that you are eligible for the program, the data is forwarded to the Oregon Health Authority (OHA), and you receive confirmation by email. OHA will be responsible for disbursing the funds to the participating liability carriers. If it is determined that you are not eligible for the program based on your practice location, we will notify you by email.
  • OHA will forward your data to your liability carrier to notify them that you are eligible for the program.
  • If your carrier has elected to participate in the program, it is then responsible for invoicing OHA for the appropriate reimbursement amount. Your carrier can reduce the premium charged to you by either:
    • deducting the subsidy from the premium you are billed, or
    • crediting the subsidy to you after payment of the full premium.

    This action takes place after you have paid your quarterly premium.

    Note: If your coverage is provided through a health care facility, you are not an employee of that facility and you are named separately on the professional liability insurance policy that covers you, you must fully reimburse the health care facility the amount of the premium that is credited to you.

Reimbursement at the following percentages is allowed for policy limits not exceeding $1 million per occurrence and $3 million aggregate:

  1. 80 percent for doctors specializing in obstetrics; and
    80 percent for nurse practitioners certified for obstetric care
     
  2. 60 percent for doctors specializing in family or general practice who provide obstetrical services
     
  3. Up to 40 percent for doctors and nurse practitioners engaging in one or more of the following practices:
    • Anesthesiology
    • Family practice without obstetrics
    • General practice
    • General surgery
    • Geriatrics
    • Internal medicine
    • Pediatrics
    • Pulmonary medicine
  4. Up to 15 percent for doctors and nurse practitioners other than those included in one of above.

If your carrier is not on this list, contact your carrier to determine if they intend to participate. You may only participate if your carrier chooses to participate and contracts with the Oregon Health Authority to do so.

Please have your carrier contact the OHA to begin this process: Joe Sullivan | joseph.a.sullivan@state.or.us | 503-559-0340

Contact

Eric Jordan |insurancesubsidy@ohsu.edu | 503-494-4451 | toll-free 866-674-4376