Enrollees covered by workers’ compensation
(1) A health benefit plan may not exclude, and shall expedite preauthorizations required for, work-related injuries or occupational diseases if:
(a) The injured worker is covered by workers’ compensation insurance and the health benefit plan; and
(b) The injured worker has submitted a workers’ compensation claim for the work-related injury or occupational disease that has not been accepted or denied by the workers’ compensation carrier.
(2) A health benefit plan subject to this section shall guarantee payment for preauthorized medical services to the provider of those medical services according to the terms, conditions and benefits of the plan if the claim is found not to be a compensable workers’ compensation claim.
(3) As used in this section, “health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions).
(4) The provisions of ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) do not apply to this section. [2014 c.94 §2; 2017 c.309 §7]
Note: 743B.810 (Enrollees covered by workers’ compensation) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.
Note: Sections 1 and 2, chapter 626, Oregon Laws 2017, provide:
Sec. 1. (1) Notwithstanding any other law, the Department of Consumer and Business Services may, upon the recommendation of the Health Insurance Exchange Advisory Committee created in ORS 741.004 (Health Insurance Exchange Advisory Committee), adopt rules that are not in compliance with the Insurance Code if:
(a)(A) There is a change in federal law on or after September 1, 2017, that:
(i) Is expected to cause premium rates previously approved by the department to no longer meet the requirements of ORS 743.018 (Filing of rates for life and health insurance) (4); or
(ii) Is expected to have a substantial impact on the average out-of-pocket costs for or premiums paid by insureds in this state; or
(B) A decision is made by the United States Department of Health and Human Services, the Internal Revenue Service or the United States Department of Labor to discontinue or reduce federal payments for cost-sharing reductions authorized by 42 U.S.C. 18071; and
(b) The Director of the Department of Consumer and Business Services determines that the change in law or decision by a federal agency described in paragraph (a) of this subsection will cause an imminent destabilization of the insurance market and risk the life or health of residents of this state.
(2) The rules may be adopted as temporary rules, in accordance with ORS 183.335 (Notice) (5), but may not be readopted in whole or in part. Rules adopted as permanent rules may not be in effect for a period longer than six months unless ratified by an action of the Legislative Assembly.
(3) If the Department of Consumer and Business Services adopts any rules pursuant to its authority under this section, the department shall:
(a) Immediately report to the President of the Senate, the Speaker of the House of Representatives and the interim committees of the Legislative Assembly related to health any action taken by the department pursuant to the rules and a full explanation of the reasons for taking the action; and
(b) Each calendar quarter after adopting the rules, report the impact of any actions taken pursuant to the rules on consumers and the insurance market in this state to the committees or interim committees of the Legislative Assembly related to health.
(4) Subsection (1) of this section does not authorize the Department of Consumer and Business Services to adopt any rule that fails to comply with the following provisions of the Insurance Code:
(a) The requirements for the reimbursement of providers, items and services in ORS chapter 743A;
(b) The prohibition on denial of coverage to consumers with preexisting conditions under ORS 735.616 [repealed], 743B.003 (Purposes), 743B.011 (Group health benefit plans subject to provisions of specified laws), 743B.013 (Requirements for small employer health benefit plans), 743B.105 (Requirements for group health benefit plans other than small employer plans) or 743B.125 (Individual health benefit plans); and
(c) The requirement to cover essential health benefits under ORS 741.310 (Requirements for purchase of insurance through exchange and for participation of insurers in exchange), 743B.013 (Requirements for small employer health benefit plans) and 743B.125 (Individual health benefit plans). [2017 c.626 §1]
Sec. 2. Section 1 of this 2017 Act is repealed on July 1, 2019. [2017 c.626 §2]
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.