Or. Admin. Code § 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.
Notes
Stat. Auth.: ORS 731.244 & 743.893
Stats. Implemented: ORS 743.874 & 743.876
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