Or. Admin. Code § 836-053-0310

Current through Register Vol. 63, No. 12, December 1, 2024

Section 836-053-0310 - Network Adequacy Definitions for OAR 836-053-0300 to 836-053-0350

(1) As used in these rules:

(a) "Enrollee" means an employee, dependent of the employee or an individual otherwise eligible for a group or individual health benefit plan who has enrolled for coverage under the terms of the plan.

(b) "Insurer includes a health care service contractor as defined in ORS 750.005.

(c) "Health benefit plan" means any:

(A) Hospital expense, medical expense or hospital or medical expense policy or certificate;

(B) Subscriber contract of a health care service contractor as defined in ORS 750.005; or

(C) Plan provided by a multiple employer welfare arrangement or by another benefit arrangement defined in the federal Employee Retirement Income Security Act of 1974, as amended, to the extent that the plan is subject to state regulation.

(d) "Network plan" means a health benefit plan that either requires an enrollee to use, or creates incentives, including financial incentives, for an enrollee to use health care providers managed, owned, under contract with or employed by the insurer.

(e) "Marketplace" means health insurance exchange as defined in OAR 945-001-002(21).

Or. Admin. Code § 836-053-0310

ID 10-2016, f. & cert. ef. 9/14/2016

Stat. Auth: ORS 731.244 and 743B.505

Stats. Implemented: 743B.505