(1) To promote the availability of health insurance coverage to groups regardless of their enrollees’ health status or claims experience;
(2) To prevent abusive rating practices;
(3) To require disclosure of rating practices to purchasers of small employer and individual health benefit plans;
(4) To prohibit the use of preexisting condition exclusions;
(5) To encourage the availability of individual health benefit plans for individuals who are not enrolled in group health benefit plans;
(6) To improve renewability and continuity of coverage for employers and covered individuals;
(7) To improve the efficiency and fairness of the health insurance marketplace; and
(8) To ensure that health insurance coverage in Oregon satisfies the requirements of the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191) and the Patient Protection and Affordable Care Act (P.L. 111-148) as amended by the Health Care and Education Reconciliation Act (P.L. 111-152), and that enforcement authority for those requirements is retained by the Director of the Department of Consumer and Business Services. [Formerly 743.731; 2021 c.281 §1]
Structure 2021 Oregon Revised Statutes
Volume : 18 - Financial Institutions, Insurance
Chapter 743B - Health Benefit Plans: Individual and Group
Section 743B.001 - Definitions.
Section 743B.005 - Definitions.
Section 743B.011 - Group health benefit plans subject to provisions of specified laws; exemptions.
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.103 - Use of health-related information.
Section 743B.105 - Requirements for group health benefit plans other than small employer plans.
Section 743B.109 - Short term health insurance policies; rules.
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.200 - Requirements for insurers offering managed health insurance; quality assessment.
Section 743B.225 - Continuity of care.
Section 743B.227 - Referrals to specialists.
Section 743B.252 - External review; rules.
Section 743B.254 - Required statements regarding external reviews.
Section 743B.256 - Duties of independent review organizations; expedited reviews.
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.287 - Balance billing prohibited for health care facility services.
Section 743B.290 - Hospital payment of copayment or deductible for insured patient.
Section 743B.310 - Rescinding coverage; permissible bases; notice; rules.
Section 743B.324 - Rules for certain notice requirements.
Section 743B.344 - Procedure for obtaining continuation of coverage under ORS 743B.343.
Section 743B.403 - Insurer prohibited practices; patient communication and referral.
Section 743B.406 - Vision care providers.
Section 743B.407 - Naturopathic physicians.
Section 743B.420 - Prior authorization requirements.
Section 743B.423 - Utilization review requirements for insurers offering health benefit plan.
Section 743B.424 - Applicability.
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.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.
Section 743B.555 - Confidential communications.
Section 743B.601 - Synchronization of prescription drug refills.
Section 743B.602 - Step therapy.
Section 743B.800 - Risk adjustment procedures; rules.
Section 743B.810 - Enrollees covered by workers’ compensation.