Chapter 743B Health Benefit Plans: Individual and Group

Definitions and Purposes

§ 743B.001 Definitions
§ 743B.003 Purposes
§ 743B.005 Definitions

Employer Sponsored Health Insurance

§ 743B.010 Issuance of group health benefit plan to affiliated group of employers
§ 743B.011 Group health benefit plans subject to provisions of specified laws
§ 743B.012 Requirement to offer all health benefit plans to small employers
§ 743B.013 Requirements for small employer health benefit plans
§ 743B.020 Eligible employees and small employers

Marketing Requirements

§ 743B.100 Department’s authority to regulate market
§ 743B.102 Certifications and disclosure of coverage
§ 743B.103 Use of health-related information
§ 743B.104 Coverage in group health benefit plans
§ 743B.105 Requirements for group health benefit plans other than small employer plans
§ 743B.110 Implementation of federal laws

Managed Health Insurance

§ 743B.200 Requirements for insurers offering managed health insurance
§ 743B.202 Requirements for insurers offering managed health or preferred provider organization insurance
§ 743B.204 Required managed health insurance contract provision
§ 743B.220 Requirements for insurers that require designation of participating primary care physician
§ 743B.222 Designation of women’s health care provider as primary care provider
§ 743B.225 Continuity of care

Grievances and Appeals

§ 743B.250 Required notices to applicants and enrollees
§ 743B.252 External review
§ 743B.253 Director to contract with independent review organizations to provide external review
§ 743B.254 Notice to enrollee of right to sue if insurer does not follow decision of independent review organization
§ 743B.255 Enrollee application for external review
§ 743B.256 Duties of independent review organizations

Out of Pocket Costs

§ 743B.280 Definitions for ORS 743B.280 to 743B.285
§ 743B.281 Estimate of costs for in-network procedure or service
§ 743B.282 Estimate of costs for out-of-network procedure or service
§ 743B.283 Submission of methodology used to determine insurer’s allowable charges
§ 743B.284 Alternative mechanism for disclosure of costs and charges
§ 743B.285 Rules

Substitution, Rescission, Termination and Continuation

§ 743B.300 Disclosure of differences in replacement health insurance policies
§ 743B.310 Rescinding coverage
§ 743B.320 Minimum grace period
§ 743B.321 Applicability of ORS 743B.320
§ 743B.323 Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium
§ 743B.324 Rules for certain notice requirements

Contracted Health Care Providers

§ 743B.400 Decisions regarding health care facility length of stay, level of care and follow-up care
§ 743B.403 Insurer prohibited practices
§ 743B.405 Medical services contract provisions
§ 743B.406 Vision care providers
§ 743B.407 Naturopathic physicians

Utilization Controls

§ 743B.420 Prior authorization requirements
§ 743B.422 Utilization review requirements for medical services contracts to which insurer not party
§ 743B.423 Utilization review requirements for insurers offering health benefit plan
§ 743B.424 Applicability
§ 743B.425 Prior authorization prohibited for first 30 days of treatment for opioid or opiate withdrawal

Payment of Claims

§ 743B.450 Prompt payment of claims
§ 743B.451 Refund of paid claims
§ 743B.452 Interest on unpaid claims
§ 743B.453 Underpayment of claims
§ 743B.454 Caution-flag-12 Claims submitted during credentialing period
§ 743B.458 Performance-based incentive payments for primary care

Provider Panels

§ 743B.500 Selling and leasing of provider panels by contracting entity
§ 743B.501 Registration of contracting entity
§ 743B.502 Third party contracts for leasing of provider panels
§ 743B.503 Additional requirements for third party contracts
§ 743B.505 Provider networks

Disclosure of Health Information

§ 743B.550 Disclosure of information
§ 743B.555 Confidential communications

Prescription Drug Coverage

§ 743B.601 Synchronization of prescription drug refills
§ 743B.602 Step therapy

Risk Adjustment

§ 743B.800 Risk adjustment procedures


§ 743B.810 Enrollees covered by workers’ compensation
Legislative Counsel Committee, CHAPTER 743B—Health Benefit Plans: Individual and Group, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors743B.­html (2017) (last ac­cessed Mar. 30, 2018).