Submission of methodology used to determine insurer’s allowable charges
An insurer offering a health benefit plan as defined in ORS 743B.005 (Definitions) 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 insurer’s 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 743B.281 (Estimate of costs for in-network procedure or service) and 743B.282 (Estimate of costs for out-of-network procedure or service) on the individual and group health insurance markets. [Formerly 743.878]
Note: See note under 743B.280 (Definitions for ORS 743B.280 to 743B.285).
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.