2017 ORS 743A.148¹
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]

(formerly 743.119, then 743.706)

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)

1 Legislative Counsel Committee, CHAPTER 743A—Health Insurance: Reimbursement of Claims, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors743A.­html (2017) (last ac­cessed Mar. 30, 2018).
 
2 Legislative Counsel Committee, Annotations to the Oregon Revised Stat­utes, Cumulative Supplement - 2017, Chapter 743A, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ano743A.­html (2017) (last ac­cessed Mar. 30, 2018).
 
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.