Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-0857 - Definitions
Universal Citation: OR Admin Rules 836-053-0857
Current through Register Vol. 63, No. 9, September 1, 2024
(1) As used in ORS 743.601, "enrollee" has the same meaning as "covered person" as defined in ORS 743.610.
(2) As used in ORS 743.610:
(a) "Claim" means a request for payment of
medical treatment, services, drugs, equipment, or other medical benefit under a
health benefit plan.
(b) "Notice"
means the notice provided by an insurer to a covered person or qualified
beneficiary about continuing group coverage after a qualifying event.
(c) "Qualified beneficiary" does not include:
(A) An individual eligible for Federal
Medicare coverage.
(B) An
individual eligible for any other group health plan. This limitation does not
apply to coverage consisting only of:
(i)
Dental, vision, counseling, or referral services;
(ii) Coverage under a health flexible
spending arrangement as defined in section
106(c)(2) of the
Internal Revenue Code of 1986; or
(iii) Treatment that is furnished in an
on-site medical facility maintained by an employer.
(d) "Similar" means a plan that
provides benefits that are the same or nearly the same as the coverage provided
under the group health benefit plan that is being terminated.
(3) As used in ORS 743.610(7)(a), "coverage" means the benefits provided under a health benefit plan continued by a covered person or qualified beneficiary.
(4) As used in ORS 743.601 and 743.610"dissolution" includes a separation upon a judgment of separation granted pursuant to ORS 107.025.
Stat. Auth.: ORS 731.244, 743.601, & 743.610 & 2009 OL Ch. 73 (HB 2433)
Stats. Implemented: ORS 743.601 & 743.610 & 2009 OL Ch. 73 (HB 2433)
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
