Chapter 743b. Health Benefit Plans: Individual and Group
Definitions and Purposes
Employer-Sponsored Health Insurance
- ORS 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
- ORS 743B.011 Group Health Benefit Plans Subject to Provisions of Specified Laws; Exemptions
- ORS 743B.012 Requirement to Offer All Health Benefit Plans to Small Employers; Offering of Plan By Carriers; Exceptions
- ORS 743B.013 Requirements For Small Employer Health Benefit Plans
- ORS 743B.020 Eligible Employees and Small Employers; Rules
Marketing Requirements
- ORS 743B.100 Department's Authority to Regulate Market
- ORS 743B.102 Certifications and Disclosure of Coverage
- ORS 743B.103 Use of Health-Related Information
- ORS 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
- ORS 743B.105 Requirements For Group Health Benefit Plans Other Than Small Employer Plans
- ORS 743B.109 Short Term Health Insurance Policies; Rules
- ORS 743B.110 Implementation of Federal Laws; Rules
- ORS 743B.120 [Renumbered]
- ORS 743B.125 Individual Health Benefit Plans; Waiting Or Exclusion Periods; Preexisting Condition Exclusions; Guaranteed Issue and Renewal
- ORS 743B.126 Carrier Marketing of Individual Health Benefit Plans; Rules; Duties of Carrier Regarding Applications; Effect of Discontinuing Offer of Plans
- ORS 743B.127 Rules For Ors 743.022, 743b.125 and 743b.126
- ORS 743B.128 Exceptions to Requirement to Actively Market All Plans
- ORS 743B.129 Shortening Period of Exclusion Following Discontinued Offering; Rules
- ORS 743B.130 Requirement to Offer Bronze and Silver Plans; Rules
- ORS 743B.195 Enforcement of Newborns' and Mothers' Health Protection Act of 1996
- ORS 743B.197 Health Care Consumer Protection Advisory Committee
Managed Health Insurance
- ORS 743B.200 Requirements For Insurers Offering Managed Health Insurance; Quality Assessment
- ORS 743B.202 Requirements For Insurers Offering Managed Health Or Preferred Provider Organization Insurance; Rules; Opportunity to Participate
- ORS 743B.204 Required Managed Health Insurance Contract Provision; Enrollee Liability
- ORS 743B.206 [Repealed]
- ORS 743B.220 Requirements For Insurers that Require Designation of Participating Primary Care Physician; Exceptions
- ORS 743B.222 Designation of Women's Health Care Provider As Primary Care Provider; Direct Access to Women's Health Care Provider
- ORS 743B.225 Continuity of Care
- ORS 743B.227 Referrals to Specialists
Grievances and Appeals
Out-Of-Pocket Costs
- ORS 743B.280 Definitions For Ors 743b.280 to 743b.285
- ORS 743B.281 Estimate of Costs For In-Network Procedure Or Service
- ORS 743B.282 Estimate of Costs For Out-Of-Network Procedure Or Service
- ORS 743B.283 Submission of Methodology Used to Determine Insurer's Allowable Charges
- ORS 743B.284 Alternative Mechanism For Disclosure of Costs and Charges
- ORS 743B.285 Rules
- ORS 743B.287 Balance Billing Prohibited For Health Care Facility Services
- ORS 743B.290 Hospital Payment of Copayment Or Deductible For Insured Patient
Substitution, Rescission, Termination and Continuation
Contracted Health Care Providers
- ORS 743B.400 Decisions Regarding Health Care Facility Length of Stay, Level of Care and Follow-Up Care
- ORS 743B.403 Insurer Prohibited Practices; Patient Communication and Referral
- ORS 743B.405 Medical Services Contract Provisions; Nonprovider Party Prohibitions; Future Contracts
- ORS 743B.406 Vision Care Providers
- ORS 743B.407 Naturopathic Physicians
Utilization Controls
- ORS 743B.420 Prior Authorization Requirements
- ORS 743B.422 Utilization Review Requirements For Medical Services Contracts to Which Insurer Not Party; Right to Appeal
- ORS 743B.423 Utilization Review Requirements For Insurers Offering Health Benefit Plan
- ORS 743B.424 Applicability
- ORS 743B.425 Prior Authorization Prohibited For First 60 Days of Treatment For Opioid Or Opiate Withdrawal and For Post-Exposure Prophylactic Antiretroviral Drugs; Exceptions
- ORS 743B.427 [Operative Until 1/1/2025] Nonquantitative Treatment Limitations On Coverage of Behavioral Health Conditions
- ORS 743B.427 [Operative 1/1/2025] Nonquantitative Treatment Limitations On Coverage of Behavioral Health Conditions
Payment of Claims
- ORS 743B.450 Prompt Payment of Claims; Limits On Use of Electronic Payment Methods; Rules
- ORS 743B.451 Refund of Paid Claims
- ORS 743B.452 Interest On Unpaid Claims
- ORS 743B.453 Underpayment of Claims
- ORS 743B.454 Claims Submitted During Credentialing Period
- ORS 743B.458 Performance-Based Incentive Payments For Primary Care
- ORS 743B.460 Conditions For Restricting Payments to Only In-Network Providers
- ORS 743B.462 Direct Payments to Providers
- ORS 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
- ORS 743B.475 Guidelines For Coordination of Benefits; Rules
- Temporary Provisions Relating to Primary Care Payment Collaborative Are Compiled As Notes Following Ors 743b.475
Provider Panels
- ORS 743B.500 Selling and Leasing of Provider Panels By Contracting Entity; Definitions
- ORS 743B.501 Registration of Contracting Entity
- ORS 743B.502 Third Party Contracts For Leasing of Provider Panels; Requirements
- ORS 743B.503 Additional Requirements For Third Party Contracts
- ORS 743B.505 Provider Networks; Rules
Disclosure of Health Information
Prescription Drug Coverage
Miscellaneous