Or. Admin. Code § 836-053-1415

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

Section 836-053-1415 - Instructions

(1) An insurer shall make available to enrollees, by online access and by telephone, detailed instructions for obtaining estimates and benefit information under ORS 743.874 and 743.876. The instructions must do at least the following:

(a) Specify the information needed by the insurer to provide the estimate, including but not limited to information for identifying the procedure or service and the provider.

(b) Describe how an enrollee may obtain an estimate and find benefit information for an in-network procedure, and inform the enrollee that an estimate is not required by law to be provided for a procedure or service that is not included in the insurer's categories; and

(c) Must provide a general explanation for obtaining an estimate for an out-of-network procedure or service and must specify what information is needed for the most accurate estimates.

(2) An insurer may include in the instructions a statement that accuracy of an estimate depends on the specificity and accuracy of the information provided by the enrollee.

Or. Admin. Code § 836-053-1415

ID 16-2008, f. & cert. ef. 9-24-08

Stat. Auth.: ORS 731.244 & 743.893

Stats. Implemented: ORS 743.874 & 743.876