Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-0310 - Network Adequacy Definitions for OAR 836-053-0300 to 836-053-0350
Universal Citation: OR Admin Rules 836-053-0310
Current through Register Vol. 63, No. 9, September 1, 2024
(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).
Stat. Auth: ORS 731.244 and 743B.505
Stats. Implemented: 743B.505
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