Chapter 743A — Chapter 743A

ORS 743A.001 Automatic repeal of certain statutes on individual and group health insurance. (1) Except as provided in subsection (4) of this section, any statute described in subsection (2) of this section that becomes effective on or after July 13, 1985, is repealed on the sixth anniversary of the effective date of the statute, unless the Legislative Assembly specifically provides otherwise

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ORS 743A.010 Services provided by state hospital or state approved program. No policy of health insurance shall exclude from payment or reimbursement losses incurred by an insured for any covered service because the service was rendered at any hospital owned or operated by the State of Oregon or any state approved community mental health program or community developmental disabilities program. [Formerly 743.701; 2011 c.720 §221]

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ORS 743A.012 Emergency services. (1) As used in this section

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ORS 743A.014 Payments for ambulance care and transportation. (1) As used in this section, “health benefit plan” has the meaning given that term in ORS 743B.005

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ORS 743A.018 Services provided by osteopathic physician. (1) As used in this section

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ORS 743A.020 Services provided by acupuncturist. (1) An individual or group health insurance policy that provides coverage for acupuncture services performed by a physician shall provide coverage for acupuncture services performed by an acupuncturist licensed under ORS 677.757 to 677.770

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ORS 743A.024 Services provided by clinical social worker. Whenever any individual or group health insurance policy or blanket health insurance policy described in ORS 743.536 (3) provides for payment or reimbursement for any service within the lawful scope of service of a clinical social worker licensed under ORS 675.530

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ORS 743A.028 Services provided by denturist. Notwithstanding any provisions of any policy of insurance covering dental health, whenever such policy provides for reimbursement for any service that is within the lawful scope of practice of a denturist, the insured under such policy shall be entitled to reimbursement for such service, whether the service is performed by a licensed dentist or a licensed denturist as defined in ORS 680.500. [Formerly 743.713]

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ORS 743A.032 Surgical services provided by dentist. Notwithstanding any provision of a policy of health insurance, whenever the policy provides for payment of a surgical service, the performance for the insured of such surgical service by any dentist acting within the scope of the dentist’s license is compensable if performance of that service by a physician acting within the scope of the physician’s license would be compensable. [Formerly 743.719]

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ORS 743A.034 Services provided by expanded practice dental hygienist. (1) If a policy of insurance covering dental health provides for coverage for services performed by a dentist licensed under ORS chapter 679, the policy must also cover the services when they are performed by an expanded practice dental hygienist, as defined in ORS 679.010, who has entered into a provider contract with the insurer

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ORS 743A.036 Services provided by licensed nurse practitioner or licensed physician associate. (1) Whenever any policy of health insurance provides for reimbursement for a primary care or mental health service provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service if provided by a licensed physician associate or a licensed nurse practitioner if the service is within the lawful scope of practice of the physician associate or nurse practitioner

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ORS 743A.040 Services provided by optometrist. Notwithstanding any provision of any policy of health insurance, whenever the policy provides for payment or reimbursement for a service that is within the lawful scope of practice of a licensed optometrist, the insurer shall provide payment or reimbursement for the service, whether the service is performed by a physician or a licensed optometrist. Unless the policy provides otherwise, there shall be no reimbursement for ophthalmic materials, lenses, spectacles, eyeglasses or appurtenances thereto. [Formerly 743.703]

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ORS 743A.044 Services provided by physician associate. (1) An insurer may not refuse a claim solely on the ground that the claim was submitted by a physician associate rather than by a physician, podiatric physician or employer with whom the physician associate has entered into a collaboration agreement, as defined in ORS 677.495

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ORS 743A.048 Services provided by psychologist. Whenever any provision of any individual or group health insurance policy or contract provides for payment or reimbursement for any service which is within the lawful scope of a psychologist licensed under ORS 675.010 to 675.150

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ORS 743A.050 [Formerly 743.798; repealed by 2017 c.206 §16]

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ORS 743A.051 (1) Notwithstanding any provisions of a health benefit plan as defined in ORS 743B.005, whenever the plan provides for payment or reimbursement for a service that is within the lawful scope of practice of a pharmacist, the insurer

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ORS 743A.052 Services provided by professional counselor or marriage and family therapist. (1) If a group health benefit plan, as described in ORS 743B.005, provides for coverage for services performed by a clinical social worker or nurse practitioner, the plan also must cover services provided by a professional counselor or marriage and family therapist licensed under ORS 675.715 to 675.835 when the counselor or therapist is acting within the counselor’s or therapist’s lawful scope of practice

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ORS 743A.058 Telemedicine services; rules. (1) As used in this section

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ORS 743A.060 Definition for ORS 743A.062. As used in ORS 743A.062, “peer-reviewed medical literature” means scientific studies printed in journals or other publications that publish original manuscripts only after the manuscripts have been critically reviewed by unbiased independent experts for scientific accuracy, validity and reliability. “Peer-reviewed medical literature” does not include internal publications of pharmaceutical manufacturers. [Formerly 743.695]

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ORS 743A.062 Prescription drugs. (1) As used in this section

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ORS 743A.063 Ninety-day supply of prescription drug refills. (1) A prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan as defined in ORS 743B.005, must provide for reimbursement for up to a 90-day supply of a prescription drug dispensed by a pharmacy, as defined in ORS 689.005, if

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ORS 743A.064 Prescription drugs dispensed at rural health clinics. (1) All health insurance policies that provide a prescription drug benefit, except those policies in which coverage is limited to expenses from accidents or specific diseases that are unrelated to the coverage required by this subsection, must include coverage for prescription drugs dispensed by a licensed practitioner at a rural health clinic for an urgent medical condition if there is not a pharmacy within 15 miles of the clinic or if the prescription is dispensed for a patient outside of the normal business hours of any pharmacy within 15 miles of the clinic

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ORS 743A.065 Early refills of prescription eye drops for treatment of glaucoma. An insurer offering a health benefit plan, as defined in ORS 743B.005, that provides coverage of prescription eye drops shall provide coverage for one early refill of a prescription for eye drops to treat glaucoma if all of the following criteria are met

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ORS 743A.066 Contraceptives. (1) A prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan as defined in ORS 743B.005 or under a student health insurance policy, must provide payment, coverage or reimbursement for

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ORS 743A.067 Reproductive health services. (1) As used in this section

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ORS 743A.068 Orally administered anticancer medication. (1) A health benefit plan that provides coverage for cancer chemotherapy treatment must provide coverage for a prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits

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ORS 743A.069 Insulin. (1) As used in this section

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ORS 743A.070 Nonprescription enteral formula for home use. (1) All policies providing health insurance, as defined in ORS 731.162, except those policies whose coverage is limited to expenses from accidents or specific diseases that are unrelated to the coverage required by this section, shall include coverage for a nonprescription elemental enteral formula for home use, if the formula is medically necessary for the treatment of severe intestinal malabsorption and a physician has issued a written order for the formula and the formula comprises the sole source, or an essential source, of nutrition

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ORS 743A.078 Newborn nurse home visiting services. (1) As used in this section, “carrier,” “enrollee” and “health benefit plan” have the meanings given those terms in ORS 743B.005

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ORS 743A.080 Pregnancy and childbirth expenses. (1) As used in this section, “pregnancy care” means the care necessary to support a healthy pregnancy and care related to labor and delivery

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ORS 743A.081 Doulas, lactation counselors and lactation educators. (1) As used in this section

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ORS 743A.082 Diabetes management for pregnant women. (1) Except as provided in subsections (2) and (3) of this section, a health benefit plan, as defined in ORS 743B.005, may not require a copayment or impose a coinsurance requirement or a deductible on the covered health services, medications and supplies that are medically necessary for a woman to manage her diabetes during the period of each pregnancy, beginning with conception and ending six weeks postpartum

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ORS 743A.084 Unmarried women and their children. Each policy of health insurance shall provide

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ORS 743A.088 Use by mother of diethylstilbestrol. No policy of health insurance may be denied or canceled by the insurer solely because the mother of the insured used drugs containing diethylstilbestrol prior to the insured’s birth. [Formerly 743.710]

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ORS 743A.090 Natural and adopted children. (1)(a) All individual and group health benefit plans, as defined in ORS 743B.005, that include coverage for a family member of the insured shall also provide that the health insurance benefits applicable for children in the family shall be payable with respect to

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ORS 743A.100 Mammograms. (1) Every health insurance policy that covers hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases, shall provide coverage of mammograms as follows

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ORS 743A.101 Supplemental or diagnostic breast examinations. (1) As used in this section

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ORS 743A.104 Pelvic examinations and Pap smear examinations. All policies providing health insurance, except those policies whose coverage is limited to expenses from accidents or specific diseases that are unrelated to the coverage required by this section, shall include coverage for pelvic examinations and Pap smear examinations as follows

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ORS 743A.105 HPV vaccine. (1) All health benefit plans, as defined in ORS 743B.005, shall include coverage of the human papillomavirus vaccine for beneficiaries under the health benefit plan who are at least 11 years of age but no older than 26 years of age

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ORS 743A.108 Physical examination of breast. (1) A health insurance policy that covers hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases, shall provide coverage for a complete and thorough physical examination of the breast, including but not limited to a clinical breast examination, performed by a health care provider to check for lumps and other changes for the purpose of early detection and prevention of breast cancer as follows

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ORS 743A.110 Mastectomy-related services; expedited external review required. (1) As used in this section, “mastectomy” means the surgical removal of all or part of a breast or a breast tumor suspected to be malignant

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ORS 743A.111 Consumer education about post-mastectomy services. (1) The Department of Consumer and Business Services shall make written materials available on the department’s website to educate breast cancer patients about the availability of insurance coverage for breast reconstruction surgery and breast prostheses following a mastectomy. The department shall update the materials at least annually

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ORS 743A.112 Autologous breast reconstruction procedures. (1) As used in this section

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ORS 743A.114 Perimenopause, menopause and postmenopause. (1) All health benefit plans, as defined in ORS 743B.005, shall include coverage of the treatment of perimenopause, menopause and postmenopause, including but not limited to the following

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ORS 743A.120 [Formerly 743.794; repealed by 2017 c.206 §16]

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ORS 743A.124 Colorectal cancer screenings and laboratory tests. (1) A health benefit plan, as defined in ORS 743B.005, shall provide coverage for all colorectal cancer screening examinations and laboratory tests assigned either a grade of A or a grade of B by the United States Preventive Services Task Force

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ORS 743A.130 Proton beam therapy. (1) A health benefit plan, as defined in ORS 743B.005, that provides coverage of radiation therapy for the treatment of prostate cancer must provide coverage for proton beam therapy for the treatment of prostate cancer on a basis no less favorable than the coverage of radiation therapy including with respect to prior authorization or other utilization review requirements

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ORS 743A.140 Bilateral cochlear implants. (1) A health benefit plan, as defined in ORS 743B.005, shall reimburse the cost of

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ORS 743A.141 Hearing aids and assistive listening devices. (1) As used in this section

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ORS 743A.144 [2007 c.374 §2; 2016 c.11 §4; repealed by 2017 c.206 §16]

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