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2019 Oregon Revised Statutes
Volume : 18 - 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; guaranteed issue and renewal.
- 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; rules.
- Section 743B.290 - Hospital payment of copayment or deductible for insured patient.
- 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.
- 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.
- 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.
Note: 743B.405, 743B.422 and 743B.424 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 743B. See Preface to Oregon Revised Statutes for further explanation.
Note: 743B.500, 743B.502 and 743B.503 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 743B or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
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