2007 ORS 750.055¹
Other provisions applicable to health care service contractors
  • rules

(1) The following provisions of the Insurance Code apply to health care service contractors to the extent not inconsistent with the express provisions of ORS 750.005 (Definitions) to 750.095 (Requirements of contract between provider and subscriber):

(a) ORS 705.137 (Information that is confidential or not subject to disclosure), 705.139 (Agreements with other agencies regarding sharing and use of confidential information), 731.004 (Short title) to 731.150 (Definitions of classes of insurance not mutually exclusive), 731.162 ("Health insurance"), 731.216 (Administrative power of director) to 731.362 (Requirements of foreign or alien insurers generally), 731.382 (General eligibility for certificate of authority), 731.385 (Standards for determining whether continued operation of insurer is hazardous), 731.386 (Management of insurers), 731.390 (Government insurers not to be authorized), 731.398 (Amendment of certificate of authority) to 731.430 (Name of insurer), 731.428 (Written consent to engage or participate in business of insurance), 731.450 (Unrelated business prohibited), 731.454 (Domestic insurers not to transact business in jurisdiction where not authorized), 731.488 (Annual audit of insurer), 731.504 (Limit of risk), 731.508 (Approved reinsurance), 731.509 (Legislative intent), 731.510 (Criteria for allowing reduction from liability for reinsurance), 731.511 (Criteria to be met by assuming insurer in order to be accredited as reinsurer), 731.512 (Withdrawal of insurer), 731.574 (Annual financial statement) to 731.620 (Assignment of deposited securities), 731.592 (Reporting criminal conduct involving insurance), 731.594 (Immunity from civil liability), 731.640 (Eligible deposits) to 731.652 (Proofs for release of deposit to insurers), 731.730 (Insurer filings with National Association of Insurance Commissioners), 731.731 (Immunity for certain persons dealing with information collected from filings under ORS 731.730), 731.735 (Certain information confidential), 731.737 (Immunity from liability for certain persons filing reports or furnishing information about specified activities to specified persons), 731.750 (Confidentiality of report of material acquisitions or dispositions of assets, material nonrenewals, cancellations and revisions of ceded reinsurance agreements), 731.752 (Confidentiality of report used for determination of required amount of capital or surplus), 731.804 (Assessments) and 731.844 (No personal liability for paying invalid tax) to 731.992 (Criminal penalty).

(b) ORS 732.215 (Management contracts prohibited), 732.220 (Exclusive agency contracts), 732.230 (Order to cure impairment), 732.245 (Home office), 732.250 (Continuity of management in event of national emergency), 732.320 (Supporting documents for expenditures), 732.325 (Certain transactions and compensation between insurers and directors, trustees, officers, agents or employees prohibited) and 732.517 (Purpose of ORS 732.517 to 732.546) to 732.592 (Recovery from parent corporation or holding company if domestic insurer ordered into liquidation or rehabilitation), not including ORS 732.582 (Determination of reasonableness and adequacy of capital and surplus).

(c) ORS 733.010 (Assets allowed) to 733.050 (Increase of inadequate reserves), 733.080 (Reserves for health insurance), 733.140 (Disallowance of "wash" transactions) to 733.170 (Accounts and records), 733.210 (Director's determinations), 733.510 (Investments of insurers) to 733.680 (Acquisition and retention of personal property generally) and 733.695 (Investment of funds in obligations that are not investment quality) to 733.780 (Prohibited investments).

(d) ORS chapter 734.

(e) ORS 742.001 (Scope of ORS chapters 742, 743 and 743A) to 742.009 (Regulation of sales material), 742.013 (Representations in applications), 742.061 (Recovery of attorney fees in action on policy or contractor's bond), 742.065 (Insurance against risk of loss assumed under less than fully insured employee health benefit plan), 742.150 (Approval by director) to 742.162 (Transfer and novation of policy effected by director), 742.400 (Duty to report claim of professional negligence to licensing board), 742.520 (Personal injury protection benefits for motor vehicle liability policies) to 742.540 (Rules), 743.010 (Health insurance policy and health benefit plan forms), 743.013 (Disclosure of differences in replacement health insurance policies), 743.018 (Filing of rates for life and health insurance) to 743.030 (Life insurance for benefit of charity), 743.050 (Exemption of proceeds of health insurance), 743.100 (Short title) to 743.109 (Approval of certain policy forms containing specified provisions), 743.402 (Exceptions to individual health insurance policy requirements), 743.472 (Permissible reasons for cancellation or refusal to renew), 743.492 (Policy return and premium refund provision), 743.495 (Use of terms "noncancelable" or "guaranteed renewable"), 743.498 (Statement in policy of cancelability or renewability), 743.522 ("Group health insurance" described), 743.523 (Certain sales practices prohibited), 743.524 (Eligibility of association to be group health policyholder), 743.526 (Determination of whether trustees are policyholders), 743.527 (When group health insurance policies to continue in effect upon payment of premium by insured individual), 743.528 (Required provisions in group health insurance policies), 743.529 (Continuation of benefits after termination of group health insurance policy), 743.549 (Restriction on reduction of benefits provisions in group and blanket health insurance policies) to 743.552 (Guidelines for application of ORS 743.549), 743.560 (Minimum grace period), 743.600 (Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older) to 743.610 (Continuation of coverage under group policy upon termination of employment or membership or dissolution of marriage), 743.650 (Long Term Care Insurance Act) to 743.664 (Offer of nonforfeiture benefit), 743.804 (Requirements for insurer offering health benefit plan), 743.807 (Utilization review requirements for insurers offering health benefit plan), 743.808 (Requirements for insurers that require designation of participating primary care physician), 743.814 (Requirements for insurers offering managed health insurance) to 743.839 (Disclosure of information), 743.842 (Emergency eye care services without referral from primary care provider), 743.845 (Designation of women's health care provider as primary care provider), 743.847 (Medicaid not considered in coverage eligibility determination), 743.854 (Continuity of care), 743.856 (Referrals to specialists), 743.857 (External review), 743.858 (Director to contract with independent review organizations to provide external review), 743.859 (Inclusion of statements regarding external review in health benefit plans), 743.861 (Enrollee application for external review), 743.862 (Duties of independent review organizations), 743.863 (Civil penalty for failure to comply by insurer that agreed to be bound by decision), 743.864 (Private right of action), 743.911 (Payment or denial of health benefit plan claims), 743.913 (Interest on unpaid claims), 743A.010 (Services provided by state hospital or state approved program), 743A.012 (Emergency services), 743A.036 (Services provided by nurse practitioner), 743A.048 (Services provided by psychologist), 743A.062 (Prescription drugs), 743A.064 (Prescription drugs dispensed at rural health clinics), 743A.066 (Contraceptives), 743A.068 (Orally administered anticancer medication), 743A.070 (Nonprescription enteral formula for home use), 743A.080 (Pregnancy and childbirth expenses), 743A.084 (Unmarried women and their children), 743A.088 (Use by mother of diethylstilbestrol), 743A.090 (Newly born and adopted children), 743A.100 (Mammogram), 743A.104 (Pelvic examinations and Pap smear examinations), 743A.110 (Mastectomy-related services), 743A.140 (Bilateral cochlear implants), 743A.148 (Maxillofacial prosthetic services), 743A.160 (Alcoholism treatment), 743A.164 (Injuries resulting from alcohol and controlled substances), 743A.168 (Treatment of chemical dependency, including alcoholism, and mental or nervous conditions), 743A.184 (Diabetes self-management programs), 743A.188 (Inborn errors of metabolism) and 743A.190 (Children with pervasive developmental disorder).

(f) The provisions of ORS chapter 744 relating to the regulation of insurance producers.

(g) ORS 746.005 (Trade practices exempted from prohibitions) to 746.140 (Sale of life insurance with securities), 746.160 (Practices injurious to free competition), 746.220 (Debtor's option in furnishing credit life or credit health insurance) to 746.370 (Records of insureds), 746.600 (Definitions for ORS 746.600 to 746.690), 746.605 (Purpose), 746.607 (Use and disclosure of personal information), 746.608 (Rules), 746.610 (Application of ORS 746.600 to 746.690), 746.615 (Pretext interviews prohibited), 746.625 (Marketing and research surveys), 746.635 (Investigative consumer reports), 746.650 (Reasons for adverse underwriting decisions), 746.655 (Information concerning previous adverse underwriting decisions), 746.660 (Basing adverse underwriting decision on previous adverse decision), 746.668 (Relationship of ORS 746.620, 746.630 and 746.665 to federal Fair Credit Reporting Act), 746.670 (Investigatory powers), 746.675 (Service of process on out-of-state insurance-support organizations), 746.680 (Remedies) and 746.690 (Obtaining information under false pretenses prohibited).

(h) ORS 743A.024 (Services provided by clinical social worker), except in the case of group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Public Health Service Act unless the patient is referred by a physician associated with a group practice health maintenance organization.

(i) ORS 735.600 (Legislative intent) to 735.650 (Application of provisions of Insurance Code).

(j) ORS 743.680 (Definitions for ORS 743.680 to 743.689) to 743.689 (Director's authority upon violation of ORS 743.680 to 743.689).

(k) ORS 744.700 (Definitions for ORS 744.700 to 744.740) to 744.740 (Responsibility of insurer using third party administrator).

(L) ORS 743.730 (Definitions for ORS 743.730 to 743.773) to 743.773 (Rules for ORS 743.766 to 743.769).

(m) ORS 731.485 (Conditions under which insurer may limit insured's choice of drug outlets and pharmacies), except in the case of a group practice health maintenance organization that is federally qualified pursuant to Title XIII of the Public Health Service Act and that wholly owns and operates an in-house drug outlet.

(2) For the purposes of this section, health care service contractors shall be deemed insurers.

(3) Any for-profit health care service contractor organized under the laws of any other state that is not governed by the insurance laws of the other state is subject to all requirements of ORS chapter 732.

(4) The Director of the Department of Consumer and Business Services may, after notice and hearing, adopt reasonable rules not inconsistent with this section and ORS 750.003 (Purpose), 750.005 (Definitions), 750.025 (Restricting distribution of income) and 750.045 (Required capitalization) that are deemed necessary for the proper administration of these provisions. [1967 c.359 §659; 1969 c.336 §18; 1971 c.231 §41; 1973 c.143 §5; 1973 c.515 §6; 1973 c.613 §4a; 1975 c.135 §3; 1975 c.338 §4a; 1975 c.689 §4; 1975 c.784 §13c; 1977 c.402 §6; 1979 c.268 §7; 1979 c.708 §11; 1979 c.785 §22a; 1979 c.797 §3a; 1981 c.254 §3; 1981 c.319 §3; 1981 c.422 §6; 1981 c.649 §22; 1981 c.752 §14; 1983 c.601 §9; 1985 c.747 §68; 1985 c.827 §3; 1987 c.411 §3; 1987 c.720 §3; 1987 c.739 §5; 1987 c.774 §62; 1987 c.838 §16; 1989 c.255 §13; 1989 c.425 §15; 1989 c.474 §4; 1989 c.701 §76; 1989 c.784 §14; 1989 c.832 §3; 1989 c.1022 §11; 1991 c.182 §18; 1991 c.401 §33; 1991 c.673 §8; 1991 c.812 §24; 1991 c.875 §3; 1991 c.916 §19; 1993 c.391 §3; 1993 c.447 §118; 1993 c.649 §14; 1995 c.30 §13; 1995 c.506 §3; 1995 c.623 §3; 1995 c.638 §9; 1995 c.669 §3; 1995 c.672 §8; 1997 c.343 §22; 1997 c.496 §4; 1997 c.573 §4; 1997 c.759 §5; 1999 c.428 §§4,5; 1999 c.633 §§7,8; 1999 c.749 §§3,4; 1999 c.987 §§22,23; 2001 c.191 §60; 2001 c.266 §16; 2001 c.377 §20; 2001 c.742 §4; 2001 c.747 §6; 2003 c.87 §19; 2003 c.91 §5; 2003 c.363 §14; 2003 c.364 §169; 2003 c.748 §3; 2003 c.802 §172; 2005 c.22 §500; 2005 c.255 §4; 2007 c.128 §2; 2007 c.182 §8; 2007 c.313 §5; 2007 c.504 §3; 2007 c.566 §3; 2007 c.872 §3]

Note: The amendments to 750.055 (Other provisions applicable to health care service contractors) by section 3, chapter 263, Oregon Laws 2003, section 501, chapter 22, Oregon Laws 2005, and section 5, chapter 255, Oregon Laws 2005, become operative July 3, 2009. See section 5, chapter 263, Oregon Laws 2003. The amendments to 750.055 (Other provisions applicable to health care service contractors) by section 7, chapter 137, Oregon Laws 2003, section 502, chapter 22, Oregon Laws 2005, section 6, chapter 255, Oregon Laws 2005, and section 5, chapter 418, Oregon Laws 2005, become operative October 4, 2009. See section 9, chapter 137, Oregon Laws 2003. The text that is operative July 3, 2009, is identical to the text that is operative October 4, 2009. 750.055 (Other provisions applicable to health care service contractors), as amended by section 7, chapter 137, Oregon Laws 2003, section 3, chapter 263, Oregon Laws 2003, sections 501 and 502, chapter 22, Oregon Laws 2005, sections 5 and 6, chapter 255, Oregon Laws 2005, and section 5, chapter 418, Oregon Laws 2005, and including amendments by section 3, chapter 128, Oregon Laws 2007, section 9, chapter 182, Oregon Laws 2007, section 6, chapter 313, Oregon Laws 2007, section 4, chapter 504, Oregon Laws 2007, section 4, chapter 566, Oregon Laws 2007, and section 4, chapter 872, Oregon Laws 2007, is set forth for the user’s convenience.

750.055 (Other provisions applicable to health care service contractors). (1) The following provisions of the Insurance Code apply to health care service contractors to the extent not inconsistent with the express provisions of ORS 750.005 (Definitions) to 750.095 (Requirements of contract between provider and subscriber):

(a) ORS 705.137 (Information that is confidential or not subject to disclosure), 705.139 (Agreements with other agencies regarding sharing and use of confidential information), 731.004 (Short title) to 731.150 (Definitions of classes of insurance not mutually exclusive), 731.162 ("Health insurance"), 731.216 (Administrative power of director) to 731.362 (Requirements of foreign or alien insurers generally), 731.382 (General eligibility for certificate of authority), 731.385 (Standards for determining whether continued operation of insurer is hazardous), 731.386 (Management of insurers), 731.390 (Government insurers not to be authorized), 731.398 (Amendment of certificate of authority) to 731.430 (Name of insurer), 731.428 (Written consent to engage or participate in business of insurance), 731.450 (Unrelated business prohibited), 731.454 (Domestic insurers not to transact business in jurisdiction where not authorized), 731.488 (Annual audit of insurer), 731.504 (Limit of risk), 731.508 (Approved reinsurance), 731.509 (Legislative intent), 731.510 (Criteria for allowing reduction from liability for reinsurance), 731.511 (Criteria to be met by assuming insurer in order to be accredited as reinsurer), 731.512 (Withdrawal of insurer), 731.574 (Annual financial statement) to 731.620 (Assignment of deposited securities), 731.592 (Reporting criminal conduct involving insurance), 731.594 (Immunity from civil liability), 731.640 (Eligible deposits) to 731.652 (Proofs for release of deposit to insurers), 731.730 (Insurer filings with National Association of Insurance Commissioners), 731.731 (Immunity for certain persons dealing with information collected from filings under ORS 731.730), 731.735 (Certain information confidential), 731.737 (Immunity from liability for certain persons filing reports or furnishing information about specified activities to specified persons), 731.750 (Confidentiality of report of material acquisitions or dispositions of assets, material nonrenewals, cancellations and revisions of ceded reinsurance agreements), 731.752 (Confidentiality of report used for determination of required amount of capital or surplus), 731.804 (Assessments) and 731.844 (No personal liability for paying invalid tax) to 731.992 (Criminal penalty).

(b) ORS 732.215 (Management contracts prohibited), 732.220 (Exclusive agency contracts), 732.230 (Order to cure impairment), 732.245 (Home office), 732.250 (Continuity of management in event of national emergency), 732.320 (Supporting documents for expenditures), 732.325 (Certain transactions and compensation between insurers and directors, trustees, officers, agents or employees prohibited) and 732.517 (Purpose of ORS 732.517 to 732.546) to 732.592 (Recovery from parent corporation or holding company if domestic insurer ordered into liquidation or rehabilitation), not including ORS 732.582 (Determination of reasonableness and adequacy of capital and surplus).

(c) ORS 733.010 (Assets allowed) to 733.050 (Increase of inadequate reserves), 733.080 (Reserves for health insurance), 733.140 (Disallowance of "wash" transactions) to 733.170 (Accounts and records), 733.210 (Director's determinations), 733.510 (Investments of insurers) to 733.680 (Acquisition and retention of personal property generally) and 733.695 (Investment of funds in obligations that are not investment quality) to 733.780 (Prohibited investments).

(d) ORS chapter 734.

(e) ORS 742.001 (Scope of ORS chapters 742, 743 and 743A) to 742.009 (Regulation of sales material), 742.013 (Representations in applications), 742.061 (Recovery of attorney fees in action on policy or contractor's bond), 742.065 (Insurance against risk of loss assumed under less than fully insured employee health benefit plan), 742.150 (Approval by director) to 742.162 (Transfer and novation of policy effected by director), 742.400 (Duty to report claim of professional negligence to licensing board), 742.520 (Personal injury protection benefits for motor vehicle liability policies) to 742.540 (Rules), 743.010 (Health insurance policy and health benefit plan forms), 743.013 (Disclosure of differences in replacement health insurance policies), 743.018 (Filing of rates for life and health insurance) to 743.030 (Life insurance for benefit of charity), 743.050 (Exemption of proceeds of health insurance), 743.100 (Short title) to 743.109 (Approval of certain policy forms containing specified provisions), 743.402 (Exceptions to individual health insurance policy requirements), 743.472 (Permissible reasons for cancellation or refusal to renew), 743.492 (Policy return and premium refund provision), 743.495 (Use of terms "noncancelable" or "guaranteed renewable"), 743.498 (Statement in policy of cancelability or renewability), 743.522 ("Group health insurance" described), 743.523 (Certain sales practices prohibited), 743.524 (Eligibility of association to be group health policyholder), 743.526 (Determination of whether trustees are policyholders), 743.527 (When group health insurance policies to continue in effect upon payment of premium by insured individual), 743.528 (Required provisions in group health insurance policies), 743.529 (Continuation of benefits after termination of group health insurance policy), 743.549 (Restriction on reduction of benefits provisions in group and blanket health insurance policies) to 743.552 (Guidelines for application of ORS 743.549), 743.560 (Minimum grace period), 743.600 (Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older) to 743.610 (Continuation of coverage under group policy upon termination of employment or membership or dissolution of marriage), 743.650 (Long Term Care Insurance Act) to 743.656 (Eligibility for benefits), 743.804 (Requirements for insurer offering health benefit plan), 743.807 (Utilization review requirements for insurers offering health benefit plan), 743.808 (Requirements for insurers that require designation of participating primary care physician), 743.814 (Requirements for insurers offering managed health insurance) to 743.839 (Disclosure of information), 743.842 (Emergency eye care services without referral from primary care provider), 743.845 (Designation of women's health care provider as primary care provider), 743.847 (Medicaid not considered in coverage eligibility determination), 743.854 (Continuity of care), 743.856 (Referrals to specialists), 743.857 (External review), 743.858 (Director to contract with independent review organizations to provide external review), 743.859 (Inclusion of statements regarding external review in health benefit plans), 743.861 (Enrollee application for external review), 743.862 (Duties of independent review organizations), 743.863 (Civil penalty for failure to comply by insurer that agreed to be bound by decision), 743.864 (Private right of action), 743.911 (Payment or denial of health benefit plan claims), 743.913 (Interest on unpaid claims), 743A.010 (Services provided by state hospital or state approved program), 743A.012 (Emergency services), 743A.036 (Services provided by nurse practitioner), 743A.048 (Services provided by psychologist), 743A.062 (Prescription drugs), 743A.064 (Prescription drugs dispensed at rural health clinics), 743A.066 (Contraceptives), 743A.068 (Orally administered anticancer medication), 743A.070 (Nonprescription enteral formula for home use), 743A.080 (Pregnancy and childbirth expenses), 743A.084 (Unmarried women and their children), 743A.088 (Use by mother of diethylstilbestrol), 743A.090 (Newly born and adopted children), 743A.100 (Mammogram), 743A.104 (Pelvic examinations and Pap smear examinations), 743A.110 (Mastectomy-related services), 743A.140 (Bilateral cochlear implants), 743A.148 (Maxillofacial prosthetic services), 743A.160 (Alcoholism treatment), 743A.164 (Injuries resulting from alcohol and controlled substances), 743A.168 (Treatment of chemical dependency, including alcoholism, and mental or nervous conditions), 743A.184 (Diabetes self-management programs) and 743A.190 (Children with pervasive developmental disorder).

(f) The provisions of ORS chapter 744 relating to the regulation of insurance producers.

(g) ORS 746.005 (Trade practices exempted from prohibitions) to 746.140 (Sale of life insurance with securities), 746.160 (Practices injurious to free competition), 746.220 (Debtor's option in furnishing credit life or credit health insurance) to 746.370 (Records of insureds), 746.600 (Definitions for ORS 746.600 to 746.690), 746.605 (Purpose), 746.607 (Use and disclosure of personal information), 746.608 (Rules), 746.610 (Application of ORS 746.600 to 746.690), 746.615 (Pretext interviews prohibited), 746.625 (Marketing and research surveys), 746.635 (Investigative consumer reports), 746.650 (Reasons for adverse underwriting decisions), 746.655 (Information concerning previous adverse underwriting decisions), 746.660 (Basing adverse underwriting decision on previous adverse decision), 746.668 (Relationship of ORS 746.620, 746.630 and 746.665 to federal Fair Credit Reporting Act), 746.670 (Investigatory powers), 746.675 (Service of process on out-of-state insurance-support organizations), 746.680 (Remedies) and 746.690 (Obtaining information under false pretenses prohibited).

(h) ORS 743A.024 (Services provided by clinical social worker), except in the case of group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Public Health Service Act unless the patient is referred by a physician associated with a group practice health maintenance organization.

(i) ORS 735.600 (Legislative intent) to 735.650 (Application of provisions of Insurance Code).

(j) ORS 743.680 (Definitions for ORS 743.680 to 743.689) to 743.689 (Director's authority upon violation of ORS 743.680 to 743.689).

(k) ORS 744.700 (Definitions for ORS 744.700 to 744.740) to 744.740 (Responsibility of insurer using third party administrator).

(L) ORS 743.730 (Definitions for ORS 743.730 to 743.773) to 743.773 (Rules for ORS 743.766 to 743.769).

(m) ORS 731.485 (Conditions under which insurer may limit insured's choice of drug outlets and pharmacies), except in the case of a group practice health maintenance organization that is federally qualified pursuant to Title XIII of the Public Health Service Act and that wholly owns and operates an in-house drug outlet.

(2) For the purposes of this section, health care service contractors shall be deemed insurers.

(3) Any for-profit health care service contractor organized under the laws of any other state that is not governed by the insurance laws of the other state is subject to all requirements of ORS chapter 732.

(4) The Director of the Department of Consumer and Business Services may, after notice and hearing, adopt reasonable rules not inconsistent with this section and ORS 750.003 (Purpose), 750.005 (Definitions), 750.025 (Restricting distribution of income) and 750.045 (Required capitalization) that are deemed necessary for the proper administration of these provisions.

Chapter 750

Notes of Decisions

These sec­tions, covering health care contractors, made applicable to defendant, nonprofit provider of health care services, regula­tion by state law, as re­quired by McCarran-Ferguson Act, 15 U.S.C. 1011 et seq. Klamath Lake Pharm. Assn. v. Klamath Medical Service Bureau, 507 F Supp 980 (1981)

1 Legislative Counsel Committee, CHAPTER 750—Health Care Service Contractors; Multiple Employer Welfare Arrangements; Legal Expense Organizations, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­750.­html (2007) (last ac­cessed Feb. 12, 2009).
 
2 Legislative Counsel Committee, Annotations to the Oregon Revised Stat­utes, Cumulative Supplement - 2007, Chapter 750, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­750ano.­htm (2007) (last ac­cessed Feb. 12, 2009).
 
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.