Or. Admin. Code § 836-053-1408

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

Section 836-053-1408 - Required Disclosures

(1) Insurers must provide an enrollee or an enrollee's authorized representative reasonable access to and copies of all documents, records, and other information relevant to an enrollee's claim or request for coverage.

(2) Insurers must provide the criteria, guidelines, processes, standards and other factors used to conduct medical necessity, utilization or other clinical reviews for behavioral health conditions. This information must be made available free of charge by the insurer to any current or potential enrollee, beneficiary, or contracting provider upon request, within a reasonable time and in a manner that provides reasonable access to the requestor.

(3) Compliance with these disclosure requirements is not determinative of compliance with any other provisions of applicable federal or state law.

Or. Admin. Code § 836-053-1408

ID 3-2015, f. & cert. ef. 5/12/2015; ID 8-2022, amend filed 12/22/2022, effective 1/1/2023

Statutory/Other Authority: ORS 731.244 & ORS 743A.168

Statutes/Other Implemented: ORS 743A.168