Student health insurance
(1) Student health insurance is subject to ORS 743.537 (Required provisions for blanket health insurance policies), 743.540 (Application and certificates not required for blanket health insurance policies), 743.543 (Payment of benefits under blanket health insurance policies), 743.546 (Exemption of policy form approval for blanket health insurance policies) and 743B.475 (Guidelines for coordination of benefits), except as provided in this section.
(2) Coverage under a student health insurance policy may be mandatory for all students at the institution, voluntary for all students at the institution, or mandatory for defined classes of students and voluntary for other classes of students. As used in this subsection, “classes” refers to undergraduates, graduate students, domestic students, international students or other like classifications. Any differences based on a student’s nationality may be established only for the purpose of complying with federal law in effect when the policy is issued.
(3) When coverage under a student health insurance policy is mandatory, the policyholder may allow any student subject to the policy to decline coverage if the student provides evidence acceptable to the policyholder that the student has similar health coverage.
(4) A student health insurance policy may provide for any student to purchase optional supplemental coverage.
(5) Student health insurance coverage for athletic injuries may:
(a) Exclude coverage for injuries of students who have not obtained medical release for a similar injury; and
(b) Be provided in excess of or in addition to any other coverage under any other health insurance policy, including a student health insurance policy.
(6) A student health insurance policy may provide that coverage under the policy is secondary to any other health insurance for purposes of guidelines established under ORS 743B.475 (Guidelines for coordination of benefits).
(7) A student health insurance policy may provide, on request by the policyholder, that all or any portion of any indemnities provided by such policy on account of hospital, nursing, medical or surgical services may, at the insurer’s option, be paid directly to the hospital or person rendering such services. However, the amount of any such payment shall not exceed the amount of benefit provided by the policy with respect to the service or billing of the provider of aid. The amount of such payments pursuant to one or more assignments shall not exceed the amount of expenses incurred on account of such hospitalization or medical or surgical aid.
(8) An insurer providing student health insurance as primary coverage may negotiate and enter into contracts for alternative rates of payment with providers and offer the benefit of such alternative rates to insureds who select such providers. An insurer may utilize such contracts by offering a choice of plans at the time an insured enrolls, one of which provides benefits only for services by members of a particular provider organization with whom the insurer has an agreement. If an insured chooses such a plan, benefits are payable only for services rendered by a member of that provider organization, unless such services were requested by a member of such organization or are rendered as the result of an emergency.
(9) Payments made under subsection (8) of this section shall discharge the insurer’s obligation with respect to the amount of insurance paid.
(10) An insurer shall provide each student health insurance policyholder with a current roster of institutional and professional providers under contract to provide services at alternative rates under the group policy and shall also make such lists available for public inspection during regular business hours at the insurer’s principal office within this state.
(11) As used in this section, “student health insurance”:
(a) Means that form of health insurance under a policy issued to a college, school or other institution of learning, a school district or districts, or school jurisdictional unit, or recognized student government at a public university listed in ORS 352.002 (Public universities), or to the head, principal or governing board of any such educational unit, who or which shall be deemed the policyholder, that is available exclusively to students at the college, school or other institution.
(b) Does not include a student health benefit plan as defined in ORS 743.551 (Student health benefit plans). [1995 c.623 §2; 2011 c.637 §289; 2013 c.681 §15]
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