2021 Oregon Revised Statutes
Chapter 743B - Health Benefit Plans: Individual and Group
Section 743B.400 - Decisions regarding health care facility length of stay, level of care and follow-up care.

2021 Oregon Revised Statutes

Volume : 18 - Financial Institutions, Insurance

Chapter 743B - Health Benefit Plans: Individual and Group

Section 743B.001 - Definitions.

Section 743B.003 - Purposes.

Section 743B.005 - Definitions.

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.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.109 - Short term health insurance policies; rules.

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.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.202 - Requirements for insurers offering managed health or preferred provider organization insurance; rules; opportunity to participate.

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 - Required statements regarding external reviews.

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.260 - Claims and appeals of adverse benefit determinations under disability income insurance policies; rules.

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.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.323 - Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium; rules.

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 60 days of treatment for opioid or opiate withdrawal and for post-exposure prophylactic antiretroviral drugs; exceptions.

Section 743B.427 - Nonquantitative treatment limitations on coverage of behavioral health conditions.

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.

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.