2013 ORS § 743.878¹
Submission of methodology used to determine insurers allowable charges

An insurer offering a health benefit plan as defined in ORS 743.730 (Definitions for ORS 743.730 to 743.773) must submit to the Director of the Department of Consumer and Business Services:

(1) Upon request by the director, the methodology used to determine the insurers allowable charges for out-of-network procedures and services or, if the insurer uses a third party to determine the charges, the methodology used by the third party to determine allowable charges;

(2) For approval, a written explanation of the method used by the insurer to determine the allowable charge, that is in plain language and that must be provided upon request to enrollees directly, or, in the case of group coverage, to the employer or other policyholder for distribution to enrollees; and

(3) Information prescribed by the director as necessary to assess the effect of the disclosure requirements in ORS 743.874 (Estimate of costs for in-network procedure or service) and 743.876 (Estimate of costs for out-of-network procedure or service) on the individual and group health insurance markets. [2007 c.390 §4; 2011 c.500 §37]

Note: See note under 743.871 (Definitions for ORS 743.871 to 743.893).