Title 56, Insurance

A health insurance policy providing coverage for hospital or medical expenses, other than limited benefit coverage, shall provide, at the request of the applicant, coverage for expenses arising from treatment for alcoholism. The following conditions apply to the requirement for s…

(1) As used in this section: (a) “Behavioral health assessment” means an evaluation by a provider, in person or using telemedicine, to determine a patient’s need for behavioral health treatment. (b) “Behavioral health condition” has the meaning prescribed by rule by the Departmen…

(1) As used in this section: (a) “Behavioral health home” means an entity providing behavioral health services that the Oregon Health Authority has found to meet the core attributes established under ORS 413.259 for a behavioral health home. (b) “Patient centered primary care hom…

(1) A health benefit plan as defined in ORS 743B.005 must provide payment, coverage or reimbursement of at least $500 for a tobacco use cessation program for a person enrolled in the plan who is 15 years of age or older. (2) As used in this section, “tobacco use cessation program…

(1) As used in this section: (a) “Group health insurance” has the meaning given that term in ORS 731.098. (b) “Health benefit plan” has the meaning given that term in ORS 743B.005. (c) “Substance use disorder” has the meaning given that term in the fifth edition of the Diagnostic…

(1) A health benefit plan, as defined in ORS 743B.005, shall provide coverage of medically necessary therapy and services for the treatment of traumatic brain injury. (2) This section is exempt from ORS 743A.001. [2009 c.423 §2]

For purpose of coverage by group health insurers, health care service contractors and health maintenance organizations, reimbursement for treatment of Tourette Syndrome shall be made on the basis of the diagnosis and treatment modality employed. [Formerly 743.717] Note: See 743A.…

(1) As used in this section: (a) “Health benefit plan” has the meaning given that term in ORS 743B.005. (b) “Originating site” means a location where health services are provided or where the patient is receiving a telemedical health service. (c) “Telemedical” means delivered thr…

(1) All individual and group health insurance policies providing coverage for hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases, shall include coverage for treatment of inborn errors of metabolism that involve amin…

(1) A health benefit plan, as defined in ORS 743B.005, must cover for a child enrolled in the plan who is under 18 years of age and who has been diagnosed with a pervasive developmental disorder all medical services, including rehabilitation services, that are medically necessary…

(1) A health benefit plan, as defined in ORS 743B.005: (a) Shall provide coverage for the routine costs of the care of patients enrolled in and participating in approved clinical trials; (b) May not exclude, limit or impose additional conditions on the coverage of the routine cos…

(1) As used in this section: (a) “Eye care practitioner” means an optometrist or ophthalmologist licensed by the State of Oregon. (b) “Eye care services” means health care services related to the care of the eye and related structures as specified by a health benefit plan. (c) “H…

(1) As used in this section: (a) “Child abuse assessment” has the meaning given that term in ORS 418.782. (b) “Children’s advocacy center” has the meaning given that term in ORS 418.782. (c) “Forensic interview” has the meaning given that term in ORS 418.782. (d) “Health benefit …

(1) As used in this section: (a) “Detainee” means an insured who is: (A) In the custody of a local supervisory authority pending the disposition of charges; or (B) In a detention facility pending final adjudication by a juvenile court. (b) “Detention facility” has the meaning giv…

Notwithstanding any other provision of law, a health benefit plan that is not a grandfathered health plan: (1) Must provide coverage of preventive health services as prescribed by the United States Department of Health and Human Services pursuant to 42 U.S.C. 300gg-13 in rules ad…

(1) As used in this section: (a) “Condition of public health importance” has the meaning given that term in ORS 431A.005. (b) “Disease outbreak” has the meaning given that term in ORS 431A.005. (c) “Enrollee” means an individual residing in this state who: (A) Is enrolled in a he…

(1) As used in this section, “primary care” means outpatient behavioral health services, nonspecialty medical services or the coordination of health care for the purpose of: (a) Promoting or maintaining behavioral and physical health and wellness; and (b) Diagnosis, treatment or …

(1) A health benefit plan, as defined in ORS 743B.005, must cover the cost of up to three monthly immunomodulatory courses of intravenous immunoglobulin therapy for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pedia…

(1) As used in this section: (a) “Carrier” has the meaning given that term in ORS 743B.005. (b) “Gender-affirming treatment” means a procedure, service, drug, device or product that a physical or behavioral health care provider prescribes to treat an individual for incongruence b…

(1) An insurer that offers a health benefit plan, as defined in ORS 743B.005, that reimburses the cost of counseling, prevention services or screening for sexually transmitted infections, shall provide coverage for: (a) Drugs that have been approved by the United States Food and …