Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
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 - 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- Section 836-053-0040 - Repealed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- Section 836-053-0060 - Repealed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- Section 836-053-0081 - Repealed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 - Purpose; Statutory Authority; Applicability
- Section 836-053-1605 - Definitions for 836-053-1600 to 836-053-1615
- Section 836-053-1610 - Non-anesthesia-related claims
- Section 836-053-1615 - Anesthesia-related claims
- Section 836-053-1630 - Drug Price Transparency Insurer Reporting
Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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