Division 53 - HEALTH BENEFIT PLANS

Section 836-053-0000 - Statutory Authority and Implementation
Section 836-053-0001 - Modification of a Health Benefit Plan
Section 836-053-0002 - Modification of a Health Benefit Plan Subject to Levels of Coverage Requirements
Section 836-053-0003 - Prohibition of Exclusion Period for Pregnancy
Section 836-053-0004 - Compliance with Federal and State Law
Section 836-053-0005 - Prescription drug identification cards
Section 836-053-0006 - Issuance of Group Health Benefit Coverage to Employer Association
Section 836-053-0007 - Approval and Certification of Associations, Trusts, Discretionary Groups and MEWAs
Section 836-053-0008 - Essential Health Benefits for Plan Years 2014, 2015 and 2016
Section 836-053-0009 - Oregon Standard Bronze and Silver Health Benefit Plans for Plan Years 2014, 2015 and 2016
Section 836-053-0010 - Purpose; Statutory Authority; Enforcement
Section 836-053-0011 - Standard Bronze Plan Health Savings Account Eligible Requirement
Section 836-053-0012 - Essential Health Benefits for Plan Years Beginning on and after January 1, 2017
Section 836-053-0013 - Oregon Standard Bronze and Silver Health Benefit Plans
Section 836-053-0014 - Standards and Process for Shortened Period of Market Prohibition
Section 836-053-0015 - Definition of Small Employer
Section 836-053-0017 - Additions to Essential Health Benefits for Plan Years Beginning on and after January 1, 2022
Section 836-053-0021 - Plans Offered to Oregon Small Employers
Section 836-053-0025 - [Repealed effective 1/1/2025] Insulin
Section 836-053-0027 - Copayments for Certain Primary Care Visits
Section 836-053-0028 - Primary Care Provider Assignment Methodology
Section 836-053-0030 - Marketing of a Health Benefit Plan to Small Employers
Section 836-053-0040 - Repealed
Section 836-053-0050 - Trade Practices Relating to Small Employer Health Benefit Plans
Section 836-053-0060 - Repealed
Section 836-053-0063 - Rating for Nongrandfathered Small Group Plans
Section 836-053-0065 - Rating for Grandfathered Small Group Plans
Section 836-053-0066 - Rating for Transitional Health Benefit Plans Offered to Small Employers
Section 836-053-0070 - Multiple Employer Welfare Arrangements
Section 836-053-0081 - Repealed
Section 836-053-0100 - Work Related Injuries or Disease
Section 836-053-0105 - Coordination of Payment for Interim Medical Services
Section 836-053-0210 - Repealed
Section 836-053-0211 - Underwriting, Enrollment and Benefit Design Requirements Applicable to A Group Health Benefit Plan Including A Small Group Health Benefit Plan
Section 836-053-0220 - Repealed
Section 836-053-0221 - Participation, Contribution, and Eligibility Requirements for Group Health Benefit Plans Including Small Group Health Benefit Plans
Section 836-053-0230 - Underwriting
Section 836-053-0250 - Repealed
Section 836-053-0300 - Purpose; Statutory Authority; Applicability of Network Adequacy Requirements
Section 836-053-0310 - Network Adequacy Definitions for OAR 836-053-0300 to 836-053-0350
Section 836-053-0320 - Annual Report Requirements for Network Adequacy
Section 836-053-0330 - Nationally Recognized Standards for Use in Demonstrating Compliance with Network Adequacy Requirements
Section 836-053-0340 - Factor-Based Evidence of Compliance with Network Adequacy Requirements
Section 836-053-0350 - Provider Directory Requirements for Network Adequacy
Section 836-053-0410 - Purpose; Statutory Authority; Enforcement
Section 836-053-0415 - Cancellation of an Individual Health Benefit Plan Coverage
Section 836-053-0418 - Definition of Insurer for Reimbursement of Expenses Related to Disease Outbreak or Epidemic
Section 836-053-0430 - Repealed
Section 836-053-0431 - Underwriting, Enrollment and Benefit Design
Section 836-053-0435 - Health Benefit Plan Coverage of Well-woman Preventive Care Services
Section 836-053-0440 - Repealed
Section 836-053-0460 - Repealed
Section 836-053-0465 - Rating for Individual Health Benefit Plans
Section 836-053-0471 - Repealed
Section 836-053-0472 - Statutory Authority and Implementation
Section 836-053-0473 - Required Materials for Rate Filing for Individual or Small Employer Health Benefit Plans
Section 836-053-0474 - Process For Rate Filing for Individual and Small Employer Health Benefit Plans
Section 836-053-0475 - Approval, Disapproval or Modification of Premium Rates for Individual or Small Employer Health Benefit Plan
Section 836-053-0510 - Evaluating the Health Status of an Applicant for Individual Health Benefit Plan Coverage
Section 836-053-0600 - Purpose; Statutory Authority; Applicability
Section 836-053-0605 - Definitions for OAR 836-053-0600 to 836-053-0615
Section 836-053-0610 - Carrier Response to Request for Confidentiality
Section 836-053-0615 - Carrier Reporting Requirements
Section 836-053-0700 - Repealed
Section 836-053-0710 - Repealed
Section 836-053-0750 - Repealed
Section 836-053-0760 - Repealed
Section 836-053-0780 - Repealed
Section 836-053-0785 - Repealed
Section 836-053-0790 - Repealed
Section 836-053-0800 - Repealed
Section 836-053-0825 - Rescission of a Group Health Benefit Plan
Section 836-053-0830 - Rescission of an Individual Health Benefit Plan or Individual Health Insurance Policy
Section 836-053-0835 - Rescission of an Individual's Coverage under a Group Health Benefit Plan or Group Health Insurance Policy
Section 836-053-0851 - Purpose; Authority; Applicability; and Enforcement
Section 836-053-0857 - Definitions
Section 836-053-0863 - Notifications
Section 836-053-0900 - Purpose; Statutory Authority
Section 836-053-0910 - Rate Filing
Section 836-053-1000 - Statutory Authority and Implementation
Section 836-053-1010 - Insurer Policies
Section 836-053-1020 - Drug Formularies
Section 836-053-1030 - Written Information to Enrollees
Section 836-053-1033 - Cultural and Linguistic Appropriateness
Section 836-053-1035 - Summary of Benefits and Explanation of Coverage
Section 836-053-1040 - Repealed
Section 836-053-1060 - Definitions
Section 836-053-1070 - Reporting of Grievances and Prior Authorization; Format and Contents
Section 836-053-1080 - Tracking Grievances and Prior Authorization Requests
Section 836-053-1090 - Assistance in Filing Grievances
Section 836-053-1100 - Internal Appeals Process
Section 836-053-1110 - Notice of Complaint Filing with Director
Section 836-053-1130 - Annual Summary, Utilization Review
Section 836-053-1140 - Appeal, Utilization Review Determinations
Section 836-053-1170 - Annual Summary, Quality Assessment Activities
Section 836-053-1180 - Format and Instructions for Report Required by ORS 743.818
Section 836-053-1190 - Annual Summary, Uniform Indicators of Network Adequacy
Section 836-053-1200 - Prior Authorization Requirements for Health Benefit Plans
Section 836-053-1203 - Prior Authorization Trade Practices for Health Insurance other than Health Benefit plans
Section 836-053-1205 - Uniform Prescription Drug Prior Authorization Request Form
Section 836-053-1300 - Purpose and Scope; Application
Section 836-053-1305 - Definitions; Authority to Act for Enrollee
Section 836-053-1310 - Contracting Requirements
Section 836-053-1315 - Performance Criteria
Section 836-053-1317 - Professional Qualifications
Section 836-053-1320 - Conflict of Interest
Section 836-053-1325 - Procedures for Conducting External Reviews
Section 836-053-1330 - Criteria and Considerations for External Review Determinations
Section 836-053-1335 - Procedures for Complaint Investigation
Section 836-053-1337 - Preliminary Review by Insurer
Section 836-053-1340 - Timelines and Notice for Dispute That is Not Expedited
Section 836-053-1342 - Timelines and Notice for Expedited Decision-Making
Section 836-053-1345 - Quality Assurance Mechanisms
Section 836-053-1350 - Ongoing Requirements for Independent Review Organizations
Section 836-053-1355 - Synopses
Section 836-053-1360 - External Review Reporting
Section 836-053-1365 - Fees for External Reviews
Section 836-053-1400 - Format and Instructions for Report Required by ORS 743.748
Section 836-053-1401 - Repealed
Section 836-053-1403 - Definitions of Coordinated Care and Case Management for Behavioral Health Care Services
Section 836-053-1404 - Definitions; Noncontracting Providers; Co-Morbidity Disorders
Section 836-053-1405 - General Requirements for Coverage of Behavioral Health Conditions
Section 836-053-1406 - Definitions
Section 836-053-1407 - Prohibited Exclusions
Section 836-053-1408 - Required Disclosures
Section 836-053-1410 - Procedures
Section 836-053-1415 - Instructions
Section 836-053-1420 - Purpose and statutory authority
Section 836-053-1425 - Definitions for behavioral health benefits reporting
Section 836-053-1430 - Form and manner for behavioral health benefits reporting
Section 836-053-1500 - Purpose; Statutory Authority; Applicability
Section 836-053-1505 - Definitions for OAR 836-053-1500 to 836-053-1510
Section 836-053-1510 - Prominent Carrier Reporting Requirements
Section 836-053-1520 - Purpose; Statutory Authority; Applicability
Section 836-053-1525 - Definitions
Section 836-053-1530 - Reporting Requirements
Section 836-053-1600 - [Repealed]
Section 836-053-1605 - [Repealed]
Section 836-053-1610 - [Repealed]
Section 836-053-1615 - [Repealed]
Section 836-053-1630 - Drug Price Transparency Insurer Reporting