Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-1415 - Instructions
Universal Citation: OR Admin Rules 836-053-1415
Current through Register Vol. 63, No. 9, September 1, 2024
(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.
Stat. Auth.: ORS 731.244 & 743.893
Stats. Implemented: ORS 743.874 & 743.876
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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