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2017 Oregon Revised Statutes
Volume : 16 - Financial Institutions, Insurance
Chapter 743B - Health Benefit Plans: Individual and Group
DEFINITIONS AND PURPOSES
EMPLOYER-SPONSORED HEALTH INSURANCE
- Section 743B.010 - Issuance of group health benefit plan to affiliated group of employers; determination of number of employees for purpose of determining eligibility as small employer.
- Section 743B.011 - Group health benefit plans subject to provisions of specified laws; exemptions.
- Section 743B.012 - Requirement to offer all health benefit plans to small employers; offering of plan by carriers; exceptions.
- Section 743B.013 - Requirements for small employer health benefit plans.
- Section 743B.020 - Eligible employees and small employers; rules.
- Section 743B.100 - Department’s authority to regulate market.
- Section 743B.102 - Certifications and disclosure of coverage.
- Section 743B.103 - Use of health-related information.
- Section 743B.104 - Coverage in group health benefit plans; consideration of prospective enrollee health status restricted; effect of discontinuing offer of plans; exceptions; coverage by multiple employer welfare arrangements.
- Section 743B.105 - Requirements for group health benefit plans other than small employer plans.
- Section 743B.110 - Implementation of federal laws; rules.
- Section 743B.120
- Section 743B.125 - Individual health benefit plans; waiting or exclusion periods; preexisting condition exclusions; essential health benefits.
- Section 743B.126 - Carrier marketing of individual health benefit plans; rules; duties of carrier regarding applications; effect of discontinuing offer of plans.
- Section 743B.127 - Rules for ORS 743.022, 743B.125 and 743B.126.
- Section 743B.128 - Exceptions to requirement to actively market all plans.
- Section 743B.129 - Shortening period of exclusion following discontinued offering; rules.
- Section 743B.130 - Requirement to offer bronze and silver plans; rules.
- Section 743B.195 - Enforcement of Newborns’ and Mothers’ Health Protection Act of 1996.
- Section 743B.197 - Health Care Consumer Protection Advisory Committee.
- Section 743B.200 - Requirements for insurers offering managed health insurance; quality assessment.
- Section 743B.202 - Requirements for insurers offering managed health or preferred provider organization insurance; rules; opportunity to participate.
- Section 743B.204 - Required managed health insurance contract provision; enrollee liability.
- Section 743B.206 [Formerly 743.831; repealed by 2017 c.101 §53 and 2017 c.384 §13]
- Section 743B.220 - Requirements for insurers that require designation of participating primary care physician; exceptions.
- Section 743B.222 - Designation of women’s health care provider as primary care provider; direct access to women’s health care provider.
- Section 743B.225 - Continuity of care.
- Section 743B.227 - Referrals to specialists.
- Section 743B.250 - Required notices to applicants and enrollees; grievances, internal appeals and external reviews.
- Section 743B.252 - External review; rules.
- Section 743B.253 - Director to contract with independent review organizations to provide external review; rules.
- Section 743B.254 - Notice to enrollee of right to sue if insurer does not follow decision of independent review organization.
- Section 743B.255 - Enrollee application for external review; when enrollee deemed to have exhausted internal appeal.
- Section 743B.256 - Duties of independent review organizations; expedited reviews.
- Section 743B.257 - Civil penalty for failure to comply by insurer that agreed to be bound by decision.
- Section 743B.258 - Private right of action.
- Section 743B.280 - Definitions for ORS 743B.280 to 743B.285.
- Section 743B.281 - Estimate of costs for in-network procedure or service.
- Section 743B.282 - Estimate of costs for out-of-network procedure or service.
- Section 743B.283 - Submission of methodology used to determine insurer’s allowable charges.
- Section 743B.284 - Alternative mechanism for disclosure of costs and charges.
- Section 743B.285 - Rules.
- Section 743B.287 - Balance billing prohibited for health care facility services.
- Section 743B.300 - Disclosure of differences in replacement health insurance policies; nonduplication for persons 65 and older; rules.
- Section 743B.310 - Rescinding coverage; permissible bases; notice; rules.
- Section 743B.320 - Minimum grace period; notice upon termination of policy; effect of failure to notify.
- Section 743B.321 - Applicability of ORS 743B.320.
- Section 743B.323 - Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium.
- Section 743B.324 - Rules for certain notice requirements.
- Section 743B.330 - Notice to policyholder required for cancellation or nonrenewal of health benefit plan; effect of failure to give notice.
- Section 743B.340 - When group health insurance policies to continue in effect upon payment of premium by insured individual.
- Section 743B.341 - Continuation of benefits after termination of group health insurance policy; rules.
- Section 743B.342 - Continuation of benefits after injury or illness covered by workers’ compensation.
- Section 743B.343 - Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older.
- Section 743B.344 - Procedure for obtaining continuation of coverage under ORS 743B.343.
- Section 743B.345 - Premium for continuation of coverage under ORS 743B.344; termination of right to continuation.
- Section 743B.347 - Continuation of coverage under group policy upon termination of membership in group health insurance policy; applicability of waiting period to rehired employee.
- Section 743B.400 - Decisions regarding health care facility length of stay, level of care and follow-up care.
- Section 743B.403 - Insurer prohibited practices; patient communication and referral.
- Section 743B.405 - Medical services contract provisions; nonprovider party prohibitions; future contracts.
- Note 743B.405, 743B.422 and 743B.424
- Section 743B.406 - Vision care providers.
- Section 743B.407 - Naturopathic physicians.
- Section 743B.420 - Prior authorization requirements.
- Section 743B.422 - Utilization review requirements for medical services contracts to which insurer not party; right to appeal.
- Section 743B.423 - Utilization review requirements for insurers offering health benefit plan.
- Section 743B.424 - Applicability.
- Section 743B.425 - Prior authorization prohibited for first 30 days of treatment for opioid or opiate withdrawal.
- Section 743B.450 - Prompt payment of claims; limits on use of electronic payment methods; rules.
- Section 743B.451 - Refund of paid claims.
- Section 743B.452 - Interest on unpaid claims.
- Section 743B.453 - Underpayment of claims.
- Section 743B.454 - Claims submitted during credentialing period.
- Section 743B.458 - Performance-based incentive payments for primary care.
- Section 743B.460 - Conditions for restricting payments to only in-network providers.
- Section 743B.462 - Direct payments to providers.
- Section 743B.470 - Medicaid not considered in coverage eligibility determination; claims for services paid for by medical assistance; prohibited ground for denial of enrollment of child; insurer duties.
- Section 743B.475 - Guidelines for coordination of benefits; rules.
- Section 743B.500 - Selling and leasing of provider panels by contracting entity; definitions.
- Note 743B.500, 743B.502 and 743B.503
- Section 743B.501 - Registration of contracting entity.
- Section 743B.502 - Third party contracts for leasing of provider panels; requirements.
- Section 743B.503 - Additional requirements for third party contracts.
- Section 743B.505 - Provider networks; rules.
Disclaimer: These codes may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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