(a) "Health benefit plan" has the meaning given that term in ORS 743B.005.
(b) "Originating site" means a location where health services are provided or where the patient is receiving a telemedical health service.
(c) "Telemedical" means delivered through a two-way electronic communication, including but not limited to video, audio, Voice over Internet Protocol or transmission of telemetry, that allows a health professional to interact with a patient, a parent or guardian of a patient or another health professional on a patient’s behalf, who is at an originating site.
(2) A health benefit plan must provide coverage of a telemedical health service provided in connection with the treatment of diabetes if:
(a) The plan provides coverage of the health service when provided in person by the health professional;
(b) The health service is medically necessary;
(c) The telemedical health service relates to a specific patient; and
(d) One of the participants in the telemedical health service is a representative of an academic health center.
(3) A health benefit plan may not distinguish between rural and urban originating sites in providing coverage under subsection (2) of this section.
(4) A health benefit plan may subject coverage of a telemedical health service under subsection (2) of this section to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in person.
(5) This section does not require a health benefit plan to reimburse a provider for a health service that is not a covered benefit under the plan. [2011 c.312 §2]
Note: See 743A.001.
Note: 743A.185 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
Structure 2021 Oregon Revised Statutes
Volume : 18 - Financial Institutions, Insurance
Chapter 743A - Health Insurance: Reimbursement of Claims
Section 743A.001 - Automatic repeal of certain statutes on individual and group health insurance.
Section 743A.012 - Emergency services.
Section 743A.014 - Payments for ambulance care and transportation.
Section 743A.018 - Services provided by osteopathic physician.
Section 743A.020 - Services provided by acupuncturist.
Section 743A.024 - Services provided by clinical social worker.
Section 743A.028 - Services provided by denturist.
Section 743A.034 - Services provided by expanded practice dental hygienist.
Section 743A.036 - Services provided by licensed nurse practitioner or licensed physician assistant.
Section 743A.044 - Services provided by physician assistant.
Section 743A.048 - Services provided by psychologist.
Section 743A.051 - Services provided by pharmacist.
Section 743A.052 - Services provided by professional counselor or marriage and family therapist.
Section 743A.058 - Telemedicine services.
Section 743A.062 - Prescription drugs.
Section 743A.063 - Ninety-day supply of prescription drug refills.
Section 743A.064 - Prescription drugs dispensed at rural health clinics.
Section 743A.065 - Early refills of prescription eye drops for treatment of glaucoma.
Section 743A.066 - Contraceptives.
Section 743A.067 - Reproductive health services.
Section 743A.068 - Orally administered anticancer medication.
Section 743A.070 - Nonprescription enteral formula for home use.
Section 743A.078 - Newborn nurse home visiting services.
Section 743A.080 - Pregnancy and childbirth expenses.
Section 743A.082 - Diabetes management for pregnant women.
Section 743A.084 - Unmarried women and their children.
Section 743A.090 - Natural and adopted children.
Section 743A.100 - Mammograms.
Section 743A.104 - Pelvic examinations and Pap smear examinations.
Section 743A.105 - HPV vaccine.
Section 743A.108 - Physical examination of breast.
Section 743A.110 - Mastectomy-related services; expedited external review required.
Section 743A.111 - Consumer education about post-mastectomy services.
Section 743A.124 - Colorectal cancer screenings and laboratory tests.
Section 743A.130 - Proton beam therapy.
Section 743A.140 - Bilateral cochlear implants.
Section 743A.141 - Hearing aids and hearing assistive technology systems.
Section 743A.148 - Maxillofacial prosthetic services.
Section 743A.150 - Treatment of craniofacial anomaly.
Section 743A.160 - Alcoholism treatment.
Section 743A.168 - Behavioral health treatment; qualified providers; rules.
Section 743A.170 - Tobacco use cessation programs.
Section 743A.175 - Traumatic brain injury.
Section 743A.180 - Tourette Syndrome.
Section 743A.185 - Telemedical health services for treatment of diabetes.
Section 743A.188 - Inborn errors of metabolism.
Section 743A.190 - Children with pervasive developmental disorder.
Section 743A.192 - Clinical trials.
Section 743A.250 - Emergency eye care services.
Section 743A.252 - Child abuse assessments.
Section 743A.262 - Preventive health services; cost sharing.
Section 743A.264 - Disease outbreaks, epidemics and conditions of public health importance.