Health Benefit Plans, second half

What this document is

Oregon Revised Statutes Chapter 743B - Health Benefit Plans, second half (50 sections, 743B.288-743B.810) is a state statute published by Oregon Legislative Assembly, oregonlegislature.gov (retrieved via an Internet Archive snapshot of the official site). It is one of the Oregon documents that insurance license exam questions are written from, including oregon life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• ORS Chapter 743B § 743B.450(1) (Prompt Payment of Claims)

  “If an insurer requires additional information before payment of a claim, not later than 30 days after the date on which the insurer receives the claim, the insurer shall notify the enrollee and the provider in writing and give the enrollee and the provider an explanation of the additional...”

• ORS Chapter 743B § 743B.423(2)(L) (Utilization Review Requirements for Insurers Offering Health Benefit Plan)

  “The insurer may not alter utilization review requirements, or initiate or implement new utilization review requirements, without giving a 60-day advance notice to all participating providers.”

• ORS Chapter 743B § 743B.330(3) (Notice Required for Cancellation or Nonrenewal)

  “If the cancellation or nonrenewal results in a refund to the policyholder of all or part of a premium, the insurer must mail with the refund a written explanation that includes: (a) The effective date of the cancellation; (b) The reason for the cancellation; and (c) The time period to which the refund is applicable.”

• ORS Chapter 743B § 743B.555(2) (Confidential Communications)

  “A carrier and a third party administrator doing business in this state: (a) Shall permit any enrollee to submit a confidential communications request. (b) Shall update an enrollee on the status of implementing a confidential communications request upon the enrollee’s inquiry.”

• ORS Chapter 743B § 743B.423(2)(k) (Utilization Review Requirements for Insurers Offering Health Benefit Plan)

  “If a change in a drug formulary or other change in coverage impacts the coverage of any enrollee’s treatment plan and the enrollee has been stabilized on the treatment plan for at least 90 days, the insurer must continue to provide coverage of the treatment until utilization review and all internal...”

• ORS Chapter 743B § 743B.450(3) (Limits on Use of Electronic Payment Methods)

  “An insurer may pay a claim using a credit card or electronic funds transfer payment method that imposes on the provider a fee or similar charge to process the payment if: (a) The insurer notifies the provider, in advance, of the fee or other charges associated with the use of the credit card or...”

• ORS Chapter 743B § 743B.505(1)(a) (Provider Networks - Sufficiency)

  “Contract with or employ a network of providers that is sufficient in number, geographic distribution and types of providers to ensure that all covered services under the health benefit plan, including mental health and substance abuse treatment, are accessible to enrollees for initial and follow-up...”

• ORS Chapter 743B § 743B.422(3) (Utilization Review Requirements for Medical Services Contracts; Right to Appeal)

  “Any patient or provider who has had a request for treatment or payment for services denied as not medically necessary or as experimental shall be provided an opportunity for a timely appeal before an appropriate medical consultant or peer review committee.”

• ORS Chapter 743B § 743B.290 (Hospital Payment of Copayment or Deductible for Insured Patient)

  “An insurer offering a policy or certificate of health insurance may not prohibit a hospital, as a condition of reimbursing a claim for hospital services, from paying or waiving all or a portion of a copayment or deductible owed by an insured under the policy or certificate.”

• ORS Chapter 743B § 743B.601 (Synchronization of Prescription Drug Refills)

  “If a drug is dispensed in less than a 30-day supply for the purpose of synchronizing a patient’s prescription drug refills, a health plan shall: (a) Prorate the copayment; or (b) Adjust the copayment using a method approved by the Department of Consumer and Business Services.”

• ORS Chapter 743B § 743B.310 (Rescinding Coverage; Permissible Bases; Notice)

  “An insurer may not rescind coverage of an individual under a health benefit plan or group or individual health insurance policy unless: (a) The individual or a person seeking coverage on behalf of the individual: (A) Performs an act, practice or omission that constitutes fraud; or (B) Makes an...”

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Questions about this source

More Oregon sources

• ORS Chapter 746 - Trade Practices (selected Secs. 746.005-746.240)State statute
• Oregon Revised Statutes Chapter 742 - Insurance Policies Generally (152 sections, 742.001-742.710)State statute
• Oregon Revised Statutes Chapter 743 - Health and Life Insurance, first half (74 sections, 743.004-743.268)State statute
• Oregon Revised Statutes Chapter 743 - Health and Life Insurance, second half (116 sections, 743.269-743.826)State statute
• Oregon Revised Statutes Chapter 743A - Health Insurance Mandated Benefits (whole chapter, 743A.001-743A.335)State statute
• Oregon Revised Statutes Chapter 743B - Health Benefit Plans, first half (47 sections, 743B.001-743B.287)State statute
• Oregon Revised Statutes Chapter 744 - Insurance Producers and Life Settlements, first half (60 sections, 744.052-744.367)State statute
• Oregon Revised Statutes Chapter 744 - Insurance Producers and Life Settlements, second half (86 sections, 744.369-744.994)State statute