ORS 743A.148
Maxillofacial prosthetic services


(1)

The Legislative Assembly declares that all group health insurance policies providing hospital, medical or surgical expense benefits, other than limited benefit coverage, include coverage for maxillofacial prosthetic services considered necessary for adjunctive treatment.

(2)

As used in this section, “maxillofacial prosthetic services considered necessary for adjunctive treatment” means restoration and management of head and facial structures that cannot be replaced with living tissue and that are defective because of disease, trauma or birth and developmental deformities when such restoration and management are performed for the purpose of:

(a)

Controlling or eliminating infection;

(b)

Controlling or eliminating pain; or

(c)

Restoring facial configuration or functions such as speech, swallowing or chewing but not including cosmetic procedures rendered to improve on the normal range of conditions.

(3)

The coverage required by subsection (1) of this section may be made subject to provisions of the policy that apply to other benefits under the policy including, but not limited to, provisions relating to deductibles and coinsurance.

(4)

The services described in this section shall apply to individual health policies entered into or renewed on or after January 1, 1982. [Formerly 743.706; 2016 c.11 §5]

Source: Section 743A.148 — Maxillofacial prosthetic services, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html.

Notes of Decisions

Under circumstances, insurance contract provision limiting coverage for dental services to expenses incurred within 90 days of accidental injury was not contrary to public policy and void but trial court erred in striking plaintiff’s allegation that 90-day limitation negated statutorily required coverage of maxillofacial prosthetic services allegedly received. Allen v. Pacific Hospital Assoc., 91 Or App 356, 757 P2d 428 (1988)

Maxillofacial prosthetic services performed for described purpose are not required to be adjunctive to independent medical condition. Blanchard v. Kaiser Foundation Health Plan, 136 Or App 466, 901 P2d 943 (1995)

743A.001
Automatic repeal of certain statutes on individual and group health insurance
743A.010
Services provided by state hospital or state approved program
743A.012
Emergency services
743A.014
Payments for ambulance care and transportation
743A.018
Services provided by osteopathic physician
743A.020
Services provided by acupuncturist
743A.024
Services provided by clinical social worker
743A.028
Services provided by denturist
743A.032
Surgical services provided by dentist
743A.034
Services provided by expanded practice dental hygienist
743A.036
Services provided by licensed nurse practitioner or licensed physician assistant
743A.040
Services provided by optometrist
743A.044
Services provided by physician assistant
743A.048
Services provided by psychologist
743A.051
Services provided by pharmacist
743A.052
Services provided by professional counselor or marriage and family therapist
743A.058
Telemedicine services
743A.060
Definition for ORS 743A.062
743A.062
Prescription drugs
743A.063
Ninety-day supply of prescription drug refills
743A.064
Prescription drugs dispensed at rural health clinics
743A.065
Early refills of prescription eye drops for treatment of glaucoma
743A.066
Contraceptives
743A.067
Reproductive health services
743A.068
Orally administered anticancer medication
743A.069
Insulin
743A.070
Nonprescription enteral formula for home use
743A.078
Newborn nurse home visiting services
743A.080
Pregnancy and childbirth expenses
743A.082
Diabetes management for pregnant women
743A.084
Unmarried women and their children
743A.088
Use by mother of diethylstilbestrol
743A.090
Natural and adopted children
743A.100
Mammograms
743A.104
Pelvic examinations and Pap smear examinations
743A.105
HPV vaccine
743A.108
Physical examination of breast
743A.110
Mastectomy-related services
743A.111
Consumer education about post-mastectomy services
743A.124
Colorectal cancer screenings and laboratory tests
743A.130
Proton beam therapy
743A.140
Bilateral cochlear implants
743A.141
Hearing aids and hearing assistive technology systems
743A.148
Maxillofacial prosthetic services
743A.150
Treatment of craniofacial anomaly
743A.160
Alcoholism treatment
743A.168
Behavioral health treatment
743A.170
Tobacco use cessation programs
743A.175
Traumatic brain injury
743A.180
Tourette Syndrome
743A.185
Telemedical health services for treatment of diabetes
743A.188
Inborn errors of metabolism
743A.190
Children with pervasive developmental disorder
743A.192
Clinical trials
743A.250
Emergency eye care services
743A.252
Child abuse assessments
743A.260
Inmates
743A.262
Preventive health services
743A.264
Disease outbreaks, epidemics and conditions of public health importance
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