743A.001Automatic repeal of certain statutes on individual and group health insurance. (1) Except asprovided in subsection (4) of this section, any statute described in subsection(2) of this section that becomes effective on or after July 13, 1985, isrepealed on the sixth anniversary of the effective date of the statute, unlessthe Legislative Assembly specifically provides otherwise.
(2)This section governs any statute that applies to individual or group healthinsurance policies and does any of the following:
(a)Requires the insurer to include coverage for specific physical or mentalconditions or specific hospital, medical, surgical or dental health services.
(b)Requires the insurer to include coverage for specified persons.
(c)Requires the insurer to provide payment or reimbursement to specified providersof services if the services are within the lawful scope of practice of theprovider and the insurance policy provides payment or reimbursement for thoseservices.
(d)Requires the insurer to provide any specific coverage on a nondiscriminatorybasis.
(e)Forbids the insurer to exclude from payment or reimbursement any coveredservices.
(f)Forbids the insurer to exclude coverage of a person because of that person’smedical history.
(3)A repeal of a statute under subsection (1) of this section does not apply toany insurance policy in effect on the effective date of the repeal. However,the repeal of the statute applies to a renewal or extension of an existinginsurance policy on or after the effective date of the repealer as well as to anew policy issued on or after the effective date of the repealer.
(4)This section does not apply to ORS 743A.020, 743A.080, 743A.100, 743A.104 and743A.108. [Formerly 743.700]
743A.010Services provided by state hospital or state approved program. No policy ofhealth insurance shall exclude from payment or reimbursement losses incurred byan insured for any covered service because the service was rendered at anyhospital owned or operated by the State of Oregon or any state approvedcommunity mental health and developmental disabilities program. [Formerly743.701]
743A.012Emergency services.(1) All insurers offering a health benefit plan shall provide coverage withoutprior authorization for:
(a)Emergency medical screening exams;
(b)Stabilization of an emergency medical condition; and
(c)Emergency services provided by a nonparticipating provider if a prudentlayperson possessing an average knowledge of health and medicine wouldreasonably believe that the time required to go to a participating providerwould place the health of the person, or a fetus in the case of a pregnantwoman, in serious jeopardy.
(2)All insurers described in subsection (1) of this section shall provideinformation to enrollees in plain language regarding:
(a)What constitutes an emergency medical condition;
(b)The coverage provided for emergency services;
(c)How and where to obtain emergency services; and
(d)The appropriate use of 9-1-1.
(3)An insurer offering a health benefit plan may not discourage appropriate use of9-1-1 and shall not deny coverage for emergency services solely because 9-1-1was used.
(4)This section is exempt from ORS 743A.001. [Formerly 743.699]
Note: See definitionsin 743.801.
743A.014Payments for ambulance care and transportation. Any insurancepolicy issued or issued for delivery in this state that provides coverage forambulance care and transportation shall provide that payments will be madejointly to the provider of the ambulance care and transportation and to theinsured, unless the policy provides for direct payment to the provider. [Formerly743.718]
Note: See 743A.001.
743A.020Services provided by acupuncturist. (1) An individual or group healthinsurance policy that provides coverage for acupuncture services performed by aphysician shall provide coverage for acupuncture services performed by anacupuncturist licensed under ORS 677.757 to 677.770.
(2)The coverage required by subsection (1) of this section may be made subject toprovisions of the policy that apply to other benefits under the policy,including, but not limited to, provisions related to deductibles andcoinsurance and shall be computed in the same manner whether performed by aphysician or an acupuncturist.
(3)Subsection (1) of this section does not require group practice healthmaintenance organizations that are federally qualified pursuant to Title XIIIsubchapter XI of the Public Health Service Act (42 U.S.C. 300e et seq.) toemploy acupuncturists licensed under ORS 677.757 to 677.770.
(4)This section also applies to health care service contractors, as defined in ORS750.005, and trusts carrying out multiple employer welfare arrangements, asdefined in ORS 750.301. [2007 c.313 §2]
Note: 743A.020 wasadded to and made a part of the Insurance Code by legislative action but wasnot added to ORS chapter 743A or any series therein. See Preface to OregonRevised Statutes for further explanation.
743A.024Services provided by clinical social worker. Whenever any individual or grouphealth insurance policy or blanket health insurance policy described in ORS743.534 (3) provides for payment or reimbursement for any service within thelawful scope of service of a clinical social worker licensed under ORS 675.530:
(1)The insured under the policy shall be entitled to the services of a clinicalsocial worker licensed under ORS 675.530, upon referral by a physician orpsychologist.
(2)The insured under the policy shall be entitled to have payment or reimbursementmade to the insured or on behalf of the insured for the services performed. Thepayment or reimbursement shall be in accordance with the benefits provided inthe policy and shall be computed in the same manner whether performed by aphysician, by a psychologist or by a clinical social worker, according to thecustomary and usual fee of clinical social workers in the area served. [Formerly743.714; 2009 c.442 §46]
743A.028Services provided by denturist. Notwithstanding any provisions of anypolicy of insurance covering dental health, whenever such policy provides forreimbursement for any service that is within the lawful scope of practice of adenturist, the insured under such policy shall be entitled to reimbursement forsuch service, whether the service is performed by a licensed dentist or alicensed denturist as defined in ORS 680.500. [Formerly 743.713]
Note: 743A.028 wasadded to and made a part of the Insurance Code by the people in the exercise oftheir initiative power but was not added to ORS chapter 743A or any seriestherein. See Preface to Oregon Revised Statutes for further explanation.
743A.032Surgical services provided by dentist. Notwithstanding any provision of apolicy of health insurance, whenever the policy provides for payment of asurgical service, the performance for the insured of such surgical service byany dentist acting within the scope of the dentist’s license is compensable ifperformance of that service by a physician acting within the scope of thephysician’s license would be compensable. [Formerly 743.719]
743A.036Services provided by nurse practitioner. (1) Whenever any policy of healthinsurance provides for reimbursement for any service which is within the lawfulscope of practice of a duly licensed and certified nurse practitioner,including prescribing or dispensing drugs, the insured under the policy isentitled to reimbursement for such service whether it is performed by aphysician licensed by the Oregon Medical Board or by a duly licensed nursepractitioner.
(2)This section does not apply to group practice health maintenance organizationsthat are federally qualified pursuant to Title XIII of the Health MaintenanceOrganization Act. [Formerly 743.712]
743A.040Services provided by optometrist. Notwithstanding any provision of anypolicy of health insurance, whenever the policy provides for payment orreimbursement for a service that is within the lawful scope of practice of alicensed optometrist, the insurer shall provide payment or reimbursement forthe service, whether the service is performed by a physician or a licensedoptometrist. Unless the policy provides otherwise, there shall be noreimbursement for ophthalmic materials, lenses, spectacles, eyeglasses orappurtenances thereto. [Formerly 743.703]
743A.044Services provided by physician assistant. (1) An insurer may not refuse aclaim solely on the ground that the claim was submitted by a physicianassistant rather than by the supervising physician for the physician assistant.
(2)This section is exempt from ORS 743A.001. [Formerly 743.725]
743A.048Services provided by psychologist. Whenever any provision of anyindividual or group health insurance policy or contract provides for payment orreimbursement for any service which is within the lawful scope of apsychologist licensed under ORS 675.010 to 675.150:
(1)The insured under such policy or contract shall be free to select, and shallhave direct access to, a psychologist licensed under ORS 675.010 to 675.150,without supervision or referral by a physician or another health practitioner,and wherever such psychologist is authorized to practice.
(2)The insured under such policy or contract shall be entitled to have payment orreimbursement made to the insured or on the insured’s behalf for the servicesperformed. Such payment or reimbursement shall be in accordance with thebenefits provided in the policy and shall be the same whether performed by aphysician or a psychologist licensed under ORS 675.010 to 675.150. [Formerly743.709]
743A.050Services provided by registered nurse first assistant. (1) An insureroffering a health insurance policy that provides coverage for hospital, medicalor surgical expenses, other than coverage limited to expenses from accidents orspecific diseases, shall provide payment or reimbursement for professionalservices performed by a registered nurse whose certification as a registerednurse first assistant has been recognized by the Oregon State Board of Nursingunder ORS 678.366.
(2)This section also applies to health care service contractors, as defined in ORS750.005, and trusts carrying out multiple employer welfare arrangements, asdefined in ORS 750.301. [Formerly 743.798]
Note: See 743A.001.
743A.052Services provided by professional counselor or marriage and family therapist. (1) If a grouphealth benefit plan, as described in ORS 743.730, provides for coverage forservices performed by a clinical social worker or nurse practitioner, the planalso must cover services provided by a professional counselor or marriage andfamily therapist licensed under ORS 675.715 to 675.835 when the counselor ortherapist is acting within the counselor’s or therapist’s lawful scope ofpractice.
(2)Health maintenance organizations may limit the receipt of covered servicesperformed by professional counselors and marriage and family therapists toservices provided by or upon referral by providers contracting with the healthmaintenance organization. Health maintenance organizations and health careservice contractors may create substantive plan benefit and reimbursementdifferentials at the same level as, and subject to limitations not morerestrictive than, those imposed on coverage or reimbursement of expensesarising out of other medical conditions and apply them to contracting andnoncontracting providers.
(3)The provisions of ORS 743A.001 do not apply to this section. [2009 c.549 §2]
Note: 743A.052 wasadded to and made a part of ORS chapter 743 by legislative action but was notadded to ORS chapter 743A or any smaller series therein. See Preface to OregonRevised Statutes for further explanation.
743A.058Telemedical services.(1) As used in this section:
(a)“Health benefit plan” has the meaning given that term in ORS 743.730.
(b)“Originating site” means the physical location of the patient receiving atelemedical health service.
(c)“Telemedical” means delivered through a two-way video communication that allowsa health professional to interact with a patient who is at an originating site.
(2)A health benefit plan must provide coverage of a telemedical health service if:
(a)The plan provides coverage of the health service when provided in person by thehealth professional;
(b)The health service is medically necessary; and
(c)The health service does not duplicate or supplant a health service that isavailable to the patient in person.
(3)An originating site for a telemedical health service subject to subsection (2)of this section includes but is not limited to a:
743A.001Automatic repeal of certain statutes on individual and group health insurance. (1) Except asprovided in subsection (4) of this section, any statute described in subsection(2) of this section that becomes effective on or after July 13, 1985, isrepealed on the sixth anniversary of the effective date of the statute, unlessthe Legislative Assembly specifically provides otherwise.
(2)This section governs any statute that applies to individual or group healthinsurance policies and does any of the following:
(a)Requires the insurer to include coverage for specific physical or mentalconditions or specific hospital, medical, surgical or dental health services.
(b)Requires the insurer to include coverage for specified persons.
(c)Requires the insurer to provide payment or reimbursement to specified providersof services if the services are within the lawful scope of practice of theprovider and the insurance policy provides payment or reimbursement for thoseservices.
(d)Requires the insurer to provide any specific coverage on a nondiscriminatorybasis.
(e)Forbids the insurer to exclude from payment or reimbursement any coveredservices.
(f)Forbids the insurer to exclude coverage of a person because of that person’smedical history.
(3)A repeal of a statute under subsection (1) of this section does not apply toany insurance policy in effect on the effective date of the repeal. However,the repeal of the statute applies to a renewal or extension of an existinginsurance policy on or after the effective date of the repealer as well as to anew policy issued on or after the effective date of the repealer.
(4)This section does not apply to ORS 743A.020, 743A.080, 743A.100, 743A.104 and743A.108. [Formerly 743.700]
743A.010Services provided by state hospital or state approved program. No policy ofhealth insurance shall exclude from payment or reimbursement losses incurred byan insured for any covered service because the service was rendered at anyhospital owned or operated by the State of Oregon or any state approvedcommunity mental health and developmental disabilities program. [Formerly743.701]
743A.012Emergency services.(1) All insurers offering a health benefit plan shall provide coverage withoutprior authorization for:
(a)Emergency medical screening exams;
(b)Stabilization of an emergency medical condition; and
(c)Emergency services provided by a nonparticipating provider if a prudentlayperson possessing an average knowledge of health and medicine wouldreasonably believe that the time required to go to a participating providerwould place the health of the person, or a fetus in the case of a pregnantwoman, in serious jeopardy.
(2)All insurers described in subsection (1) of this section shall provideinformation to enrollees in plain language regarding:
(a)What constitutes an emergency medical condition;
(b)The coverage provided for emergency services;
(c)How and where to obtain emergency services; and
(d)The appropriate use of 9-1-1.
(3)An insurer offering a health benefit plan may not discourage appropriate use of9-1-1 and shall not deny coverage for emergency services solely because 9-1-1was used.
(4)This section is exempt from ORS 743A.001. [Formerly 743.699]
Note: See definitionsin 743.801.
743A.014Payments for ambulance care and transportation. Any insurancepolicy issued or issued for delivery in this state that provides coverage forambulance care and transportation shall provide that payments will be madejointly to the provider of the ambulance care and transportation and to theinsured, unless the policy provides for direct payment to the provider. [Formerly743.718]
Note: See 743A.001.
743A.020Services provided by acupuncturist. (1) An individual or group healthinsurance policy that provides coverage for acupuncture services performed by aphysician shall provide coverage for acupuncture services performed by anacupuncturist licensed under ORS 677.757 to 677.770.
(2)The coverage required by subsection (1) of this section may be made subject toprovisions of the policy that apply to other benefits under the policy,including, but not limited to, provisions related to deductibles andcoinsurance and shall be computed in the same manner whether performed by aphysician or an acupuncturist.
(3)Subsection (1) of this section does not require group practice healthmaintenance organizations that are federally qualified pursuant to Title XIIIsubchapter XI of the Public Health Service Act (42 U.S.C. 300e et seq.) toemploy acupuncturists licensed under ORS 677.757 to 677.770.
(4)This section also applies to health care service contractors, as defined in ORS750.005, and trusts carrying out multiple employer welfare arrangements, asdefined in ORS 750.301. [2007 c.313 §2]
Note: 743A.020 wasadded to and made a part of the Insurance Code by legislative action but wasnot added to ORS chapter 743A or any series therein. See Preface to OregonRevised Statutes for further explanation.
743A.024Services provided by clinical social worker. Whenever any individual or grouphealth insurance policy or blanket health insurance policy described in ORS743.534 (3) provides for payment or reimbursement for any service within thelawful scope of service of a clinical social worker licensed under ORS 675.530:
(1)The insured under the policy shall be entitled to the services of a clinicalsocial worker licensed under ORS 675.530, upon referral by a physician orpsychologist.
(2)The insured under the policy shall be entitled to have payment or reimbursementmade to the insured or on behalf of the insured for the services performed. Thepayment or reimbursement shall be in accordance with the benefits provided inthe policy and shall be computed in the same manner whether performed by aphysician, by a psychologist or by a clinical social worker, according to thecustomary and usual fee of clinical social workers in the area served. [Formerly743.714; 2009 c.442 §46]
743A.028Services provided by denturist. Notwithstanding any provisions of anypolicy of insurance covering dental health, whenever such policy provides forreimbursement for any service that is within the lawful scope of practice of adenturist, the insured under such policy shall be entitled to reimbursement forsuch service, whether the service is performed by a licensed dentist or alicensed denturist as defined in ORS 680.500. [Formerly 743.713]
Note: 743A.028 wasadded to and made a part of the Insurance Code by the people in the exercise oftheir initiative power but was not added to ORS chapter 743A or any seriestherein. See Preface to Oregon Revised Statutes for further explanation.
743A.032Surgical services provided by dentist. Notwithstanding any provision of apolicy of health insurance, whenever the policy provides for payment of asurgical service, the performance for the insured of such surgical service byany dentist acting within the scope of the dentist’s license is compensable ifperformance of that service by a physician acting within the scope of thephysician’s license would be compensable. [Formerly 743.719]
743A.036Services provided by nurse practitioner. (1) Whenever any policy of healthinsurance provides for reimbursement for any service which is within the lawfulscope of practice of a duly licensed and certified nurse practitioner,including prescribing or dispensing drugs, the insured under the policy isentitled to reimbursement for such service whether it is performed by aphysician licensed by the Oregon Medical Board or by a duly licensed nursepractitioner.
(2)This section does not apply to group practice health maintenance organizationsthat are federally qualified pursuant to Title XIII of the Health MaintenanceOrganization Act. [Formerly 743.712]
743A.040Services provided by optometrist. Notwithstanding any provision of anypolicy of health insurance, whenever the policy provides for payment orreimbursement for a service that is within the lawful scope of practice of alicensed optometrist, the insurer shall provide payment or reimbursement forthe service, whether the service is performed by a physician or a licensedoptometrist. Unless the policy provides otherwise, there shall be noreimbursement for ophthalmic materials, lenses, spectacles, eyeglasses orappurtenances thereto. [Formerly 743.703]
743A.044Services provided by physician assistant. (1) An insurer may not refuse aclaim solely on the ground that the claim was submitted by a physicianassistant rather than by the supervising physician for the physician assistant.
(2)This section is exempt from ORS 743A.001. [Formerly 743.725]
743A.048Services provided by psychologist. Whenever any provision of anyindividual or group health insurance policy or contract provides for payment orreimbursement for any service which is within the lawful scope of apsychologist licensed under ORS 675.010 to 675.150:
(1)The insured under such policy or contract shall be free to select, and shallhave direct access to, a psychologist licensed under ORS 675.010 to 675.150,without supervision or referral by a physician or another health practitioner,and wherever such psychologist is authorized to practice.
(2)The insured under such policy or contract shall be entitled to have payment orreimbursement made to the insured or on the insured’s behalf for the servicesperformed. Such payment or reimbursement shall be in accordance with thebenefits provided in the policy and shall be the same whether performed by aphysician or a psychologist licensed under ORS 675.010 to 675.150. [Formerly743.709]
743A.050Services provided by registered nurse first assistant. (1) An insureroffering a health insurance policy that provides coverage for hospital, medicalor surgical expenses, other than coverage limited to expenses from accidents orspecific diseases, shall provide payment or reimbursement for professionalservices performed by a registered nurse whose certification as a registerednurse first assistant has been recognized by the Oregon State Board of Nursingunder ORS 678.366.
(2)This section also applies to health care service contractors, as defined in ORS750.005, and trusts carrying out multiple employer welfare arrangements, asdefined in ORS 750.301. [Formerly 743.798]
Note: See 743A.001.
743A.052Services provided by professional counselor or marriage and family therapist. (1) If a grouphealth benefit plan, as described in ORS 743.730, provides for coverage forservices performed by a clinical social worker or nurse practitioner, the planalso must cover services provided by a professional counselor or marriage andfamily therapist licensed under ORS 675.715 to 675.835 when the counselor ortherapist is acting within the counselor’s or therapist’s lawful scope ofpractice.
(2)Health maintenance organizations may limit the receipt of covered servicesperformed by professional counselors and marriage and family therapists toservices provided by or upon referral by providers contracting with the healthmaintenance organization. Health maintenance organizations and health careservice contractors may create substantive plan benefit and reimbursementdifferentials at the same level as, and subject to limitations not morerestrictive than, those imposed on coverage or reimbursement of expensesarising out of other medical conditions and apply them to contracting andnoncontracting providers.
(3)The provisions of ORS 743A.001 do not apply to this section. [2009 c.549 §2]
Note: 743A.052 wasadded to and made a part of ORS chapter 743 by legislative action but was notadded to ORS chapter 743A or any smaller series therein. See Preface to OregonRevised Statutes for further explanation.
743A.058Telemedical services.(1) As used in this section:
(a)“Health benefit plan” has the meaning given that term in ORS 743.730.
(b)“Originating site” means the physical location of the patient receiving atelemedical health service.
(c)“Telemedical” means delivered through a two-way video communication that allowsa health professional to interact with a patient who is at an originating site.
(2)A health benefit plan must provide coverage of a telemedical health service if:
(a)The plan provides coverage of the health service when provided in person by thehealth professional;
(b)The health service is medically necessary; and
(c)The health service does not duplicate or supplant a health service that isavailable to the patient in person.
(3)An originating site for a telemedical health service subject to subsection (2)of this section includes but is not limited to a:
(a)Hospital;
(b)Rural health clinic;
(c)Federally qualified health center;
(d)Physician’s office;
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743A.001Automatic repeal of certain statutes on individual and group health insurance. (1) Except asprovided in subsection (4) of this section, any statute described in subsection(2) of this section that becomes effective on or after July 13, 1985, isrepealed on the sixth anniversary of the effective date of the statute, unlessthe Legislative Assembly specifically provides otherwise.
(2)This section governs any statute that applies to individual or group healthinsurance policies and does any of the following:
(a)Requires the insurer to include coverage for specific physical or mentalconditions or specific hospital, medical, surgical or dental health services.
(b)Requires the insurer to include coverage for specified persons.
(c)Requires the insurer to provide payment or reimbursement to specified providersof services if the services are within the lawful scope of practice of theprovider and the insurance policy provides payment or reimbursement for thoseservices.
(d)Requires the insurer to provide any specific coverage on a nondiscriminatorybasis.
(e)Forbids the insurer to exclude from payment or reimbursement any coveredservices.
(f)Forbids the insurer to exclude coverage of a person because of that person’smedical history.
(3)A repeal of a statute under subsection (1) of this section does not apply toany insurance policy in effect on the effective date of the repeal. However,the repeal of the statute applies to a renewal or extension of an existinginsurance policy on or after the effective date of the repealer as well as to anew policy issued on or after the effective date of the repealer.
(4)This section does not apply to ORS 743A.020, 743A.080, 743A.100, 743A.104 and743A.108. [Formerly 743.700]
743A.010Services provided by state hospital or state approved program. No policy ofhealth insurance shall exclude from payment or reimbursement losses incurred byan insured for any covered service because the service was rendered at anyhospital owned or operated by the State of Oregon or any state approvedcommunity mental health and developmental disabilities program. [Formerly743.701]
743A.012Emergency services.(1) All insurers offering a health benefit plan shall provide coverage withoutprior authorization for:
(a)Emergency medical screening exams;
(b)Stabilization of an emergency medical condition; and
(c)Emergency services provided by a nonparticipating provider if a prudentlayperson possessing an average knowledge of health and medicine wouldreasonably believe that the time required to go to a participating providerwould place the health of the person, or a fetus in the case of a pregnantwoman, in serious jeopardy.
(2)All insurers described in subsection (1) of this section shall provideinformation to enrollees in plain language regarding:
(a)What constitutes an emergency medical condition;
(b)The coverage provided for emergency services;
(c)How and where to obtain emergency services; and
(d)The appropriate use of 9-1-1.
(3)An insurer offering a health benefit plan may not discourage appropriate use of9-1-1 and shall not deny coverage for emergency services solely because 9-1-1was used.
(4)This section is exempt from ORS 743A.001. [Formerly 743.699]
Note: See definitionsin 743.801.
743A.014Payments for ambulance care and transportation. Any insurancepolicy issued or issued for delivery in this state that provides coverage forambulance care and transportation shall provide that payments will be madejointly to the provider of the ambulance care and transportation and to theinsured, unless the policy provides for direct payment to the provider. [Formerly743.718]
Note: See 743A.001.
743A.020Services provided by acupuncturist. (1) An individual or group healthinsurance policy that provides coverage for acupuncture services performed by aphysician shall provide coverage for acupuncture services performed by anacupuncturist licensed under ORS 677.757 to 677.770.
(2)The coverage required by subsection (1) of this section may be made subject toprovisions of the policy that apply to other benefits under the policy,including, but not limited to, provisions related to deductibles andcoinsurance and shall be computed in the same manner whether performed by aphysician or an acupuncturist.
(3)Subsection (1) of this section does not require group practice healthmaintenance organizations that are federally qualified pursuant to Title XIIIsubchapter XI of the Public Health Service Act (42 U.S.C. 300e et seq.) toemploy acupuncturists licensed under ORS 677.757 to 677.770.
(4)This section also applies to health care service contractors, as defined in ORS750.005, and trusts carrying out multiple employer welfare arrangements, asdefined in ORS 750.301. [2007 c.313 §2]
Note: 743A.020 wasadded to and made a part of the Insurance Code by legislative action but wasnot added to ORS chapter 743A or any series therein. See Preface to OregonRevised Statutes for further explanation.
743A.024Services provided by clinical social worker. Whenever any individual or grouphealth insurance policy or blanket health insurance policy described in ORS743.534 (3) provides for payment or reimbursement for any service within thelawful scope of service of a clinical social worker licensed under ORS 675.530:
(1)The insured under the policy shall be entitled to the services of a clinicalsocial worker licensed under ORS 675.530, upon referral by a physician orpsychologist.
(2)The insured under the policy shall be entitled to have payment or reimbursementmade to the insured or on behalf of the insured for the services performed. Thepayment or reimbursement shall be in accordance with the benefits provided inthe policy and shall be computed in the same manner whether performed by aphysician, by a psychologist or by a clinical social worker, according to thecustomary and usual fee of clinical social workers in the area served. [Formerly743.714; 2009 c.442 §46]
743A.028Services provided by denturist. Notwithstanding any provisions of anypolicy of insurance covering dental health, whenever such policy provides forreimbursement for any service that is within the lawful scope of practice of adenturist, the insured under such policy shall be entitled to reimbursement forsuch service, whether the service is performed by a licensed dentist or alicensed denturist as defined in ORS 680.500. [Formerly 743.713]
Note: 743A.028 wasadded to and made a part of the Insurance Code by the people in the exercise oftheir initiative power but was not added to ORS chapter 743A or any seriestherein. See Preface to Oregon Revised Statutes for further explanation.
743A.032Surgical services provided by dentist. Notwithstanding any provision of apolicy of health insurance, whenever the policy provides for payment of asurgical service, the performance for the insured of such surgical service byany dentist acting within the scope of the dentist’s license is compensable ifperformance of that service by a physician acting within the scope of thephysician’s license would be compensable. [Formerly 743.719]
743A.036Services provided by nurse practitioner. (1) Whenever any policy of healthinsurance provides for reimbursement for any service which is within the lawfulscope of practice of a duly licensed and certified nurse practitioner,including prescribing or dispensing drugs, the insured under the policy isentitled to reimbursement for such service whether it is performed by aphysician licensed by the Oregon Medical Board or by a duly licensed nursepractitioner.
(2)This section does not apply to group practice health maintenance organizationsthat are federally qualified pursuant to Title XIII of the Health MaintenanceOrganization Act. [Formerly 743.712]
743A.040Services provided by optometrist. Notwithstanding any provision of anypolicy of health insurance, whenever the policy provides for payment orreimbursement for a service that is within the lawful scope of practice of alicensed optometrist, the insurer shall provide payment or reimbursement forthe service, whether the service is performed by a physician or a licensedoptometrist. Unless the policy provides otherwise, there shall be noreimbursement for ophthalmic materials, lenses, spectacles, eyeglasses orappurtenances thereto. [Formerly 743.703]
743A.044Services provided by physician assistant. (1) An insurer may not refuse aclaim solely on the ground that the claim was submitted by a physicianassistant rather than by the supervising physician for the physician assistant.
(2)This section is exempt from ORS 743A.001. [Formerly 743.725]
743A.048Services provided by psychologist. Whenever any provision of anyindividual or group health insurance policy or contract provides for payment orreimbursement for any service which is within the lawful scope of apsychologist licensed under ORS 675.010 to 675.150:
(1)The insured under such policy or contract shall be free to select, and shallhave direct access to, a psychologist licensed under ORS 675.010 to 675.150,without supervision or referral by a physician or another health practitioner,and wherever such psychologist is authorized to practice.
(2)The insured under such policy or contract shall be entitled to have payment orreimbursement made to the insured or on the insured’s behalf for the servicesperformed. Such payment or reimbursement shall be in accordance with thebenefits provided in the policy and shall be the same whether performed by aphysician or a psychologist licensed under ORS 675.010 to 675.150. [Formerly743.709]
743A.050Services provided by registered nurse first assistant. (1) An insureroffering a health insurance policy that provides coverage for hospital, medicalor surgical expenses, other than coverage limited to expenses from accidents orspecific diseases, shall provide payment or reimbursement for professionalservices performed by a registered nurse whose certification as a registerednurse first assistant has been recognized by the Oregon State Board of Nursingunder ORS 678.366.
(2)This section also applies to health care service contractors, as defined in ORS750.005, and trusts carrying out multiple employer welfare arrangements, asdefined in ORS 750.301. [Formerly 743.798]
Note: See 743A.001.
743A.052Services provided by professional counselor or marriage and family therapist. (1) If a grouphealth benefit plan, as described in ORS 743.730, provides for coverage forservices performed by a clinical social worker or nurse practitioner, the planalso must cover services provided by a professional counselor or marriage andfamily therapist licensed under ORS 675.715 to 675.835 when the counselor ortherapist is acting within the counselor’s or therapist’s lawful scope ofpractice.
(2)Health maintenance organizations may limit the receipt of covered servicesperformed by professional counselors and marriage and family therapists toservices provided by or upon referral by providers contracting with the healthmaintenance organization. Health maintenance organizations and health careservice contractors may create substantive plan benefit and reimbursementdifferentials at the same level as, and subject to limitations not morerestrictive than, those imposed on coverage or reimbursement of expensesarising out of other medical conditions and apply them to contracting andnoncontracting providers.
(3)The provisions of ORS 743A.001 do not apply to this section. [2009 c.549 §2]
Note: 743A.052 wasadded to and made a part of ORS chapter 743 by legislative action but was notadded to ORS chapter 743A or any smaller series therein. See Preface to OregonRevised Statutes for further explanation.
743A.058Telemedical services.(1) As used in this section:
(a)“Health benefit plan” has the meaning given that term in ORS 743.730.
(b)“Originating site” means the physical location of the patient receiving atelemedical health service.
(c)“Telemedical” means delivered through a two-way video communication that allowsa health professional to interact with a patient who is at an originating site.
(2)A health benefit plan must provide coverage of a telemedical health service if:
(a)The plan provides coverage of the health service when provided in person by thehealth professional;
(b)The health service is medically necessary; and
(c)The health service does not duplicate or supplant a health service that isavailable to the patient in person.
(3)An originating site for a telemedical health service subject to subsection (2)of this section includes but is not limited to a:
