2021 Oregon Revised Statutes
Chapter 741 - Health Insurance Exchange
Section 741.801 - Insurer to notify health care provider that enrollee is in grace period; effect of failure to provide notice.


(a) "Enrollee" means a person who is:
(A) Enrolled in a qualified health plan purchased through the health insurance exchange;
(B) Responsible for paying the premium on the qualified health plan and has paid at least one premium; and
(C) Receiving an advance payment of the premium tax credit under section 36B of the Internal Revenue Code.
(b) "Grace period" means the period of three consecutive months during which an enrollee’s coverage continues under a qualified health plan without the payment of premiums.
(c) "Health insurance exchange" has the meaning given that term in ORS 741.300.
(d) "Qualified health plan" means a plan that is certified as a qualified health plan in accordance with ORS 741.310.
(2) If an enrollee fails to pay a premium for a qualified health plan, the insurer shall notify any health care provider that the enrollee is in a grace period if the provider requests information from the insurer regarding the eligibility, coverage or benefits of the insureds under the enrollee’s plan.
(3) If an insurer terminates the coverage of an enrollee based on the nonpayment of premiums during a grace period, the insurer shall pay a claim for reimbursement by a health care provider of a service performed during the grace period if:
(a) The insurer fails to notify the health care provider as required by subsection (2) of this section;
(b) The service is covered by the enrollee’s plan; and
(c) The health care provider requests the information described in subsection (2) of this section not more than seven business days before providing the service and the insurer provides the information to the health care provider no later than two business days after the date of the provider’s request.
(4) The requirements of this section may not be waived by agreement, and any provision of a contract entered into on or after January 1, 2016, that purports to waive the requirements of this section or that conflicts with the requirements of this section is null and void. [2015 c.580 §2]

Structure 2021 Oregon Revised Statutes

2021 Oregon Revised Statutes

Volume : 18 - Financial Institutions, Insurance

Chapter 741 - Health Insurance Exchange

Section 741.001 - Health insurance exchange; legislative intent.

Section 741.002 - Duties, powers and functions of Oregon Health Authority; rules.

Section 741.003 - Duties and powers of director.

Section 741.004 - Health Insurance Exchange Advisory Committee.

Section 741.008 - Criminal records check; fingerprints required; persons subject to requirement.

Section 741.105 - Charges and fees to be paid by insurers and state programs; rules.

Section 741.107 - Notice to Legislative Assembly required for procurement request exceeding $1 million for technology product or service.

Section 741.220 - Financial and performance audits of health insurance exchange accounts; report of audit.

Section 741.222 - Annual reports to Legislative Assembly.

Section 741.300 - Definitions.

Section 741.310 - Requirements for purchase of insurance through exchange and for participation of insurers in exchange.

Section 741.340 - Health benefit plans offered through exchange.

Section 741.342 - Small Business Health Options Program.

Section 741.400 - Service of eligibility notices; when notice becomes final order; opportunity to contest actual receipt of notice.

Section 741.500 - Required documentation; rules.

Section 741.510 - Confidential information; public officer privilege; permitted uses of confidential information.

Section 741.520 - Agreements with other agencies regarding sharing and use of confidential information; contents.

Section 741.540 - Complaints and investigations confidential; permitted disclosures.

Section 741.801 - Insurer to notify health care provider that enrollee is in grace period; effect of failure to provide notice.

Section 741.900 - Civil penalties.