Division 53 - HEALTH BENEFIT PLANS

  1. § 836-053-0000 - Statutory Authority and Implementation
  2. § 836-053-0001 - Modification of a Health Benefit Plan
  3. § 836-053-0002 - Modification of a Health Benefit Plan Subject to Levels of Coverage Requirements
  4. § 836-053-0003 - Prohibition of Exclusion Period for Pregnancy
  5. § 836-053-0004 - Compliance with Federal and State Law
  6. § 836-053-0005 - Prescription drug identification cards
  7. § 836-053-0007 - Approval and Certification of Associations, Trusts, Discretionary Groups and MEWAs
  8. § 836-053-0008 - Essential Health Benefits for Plan Years 2014, 2015 and 2016
  9. § 836-053-0009 - Oregon Standard Bronze and Silver Health Benefit Plans for Plan Years 2014, 2015 and 2016
  10. § 836-053-0010 - Purpose; Statutory Authority; Enforcement
  11. § 836-053-0011 - Standard Bronze Plan Health Savings Account Eligible Requirement
  12. § 836-053-0012 - Essential Health Benefits for Plan Years Beginning on and after January 1, 2017
  13. § 836-053-0013 - [Effective until 11/23/2021]Oregon Standard Bronze and Silver Health Benefit Plans
  14. § 836-053-0013 - [Effective 11/23/2021]Oregon Standard Bronze and Silver Health Benefit Plans, version 2
  15. § 836-053-0014 - Standards and Process for Shortened Period of Market Prohibition
  16. § 836-053-0015 - Definition of Small Employer
  17. § 836-053-0017 - Additions to Essential Health Benefits for Plan Years Beginning on and after January 1, 2022
  18. § 836-053-0021 - Plans Offered to Oregon Small Employers
  19. § 836-053-0030 - Marketing of a Health Benefit Plan to Small Employers
  20. § 836-053-0040 - Repealed
  21. § 836-053-0050 - Trade Practices Relating to Small Employer Health Benefit Plans
  22. § 836-053-0060 - Repealed
  23. § 836-053-0063 - Rating for Nongrandfathered Small Group Plans
  24. § 836-053-0065 - Rating for Grandfathered Small Group Plans
  25. § 836-053-0066 - Rating for Transitional Health Benefit Plans Offered to Small Employers
  26. § 836-053-0070 - Multiple Employer Welfare Arrangements
  27. § 836-053-0081 - Repealed
  28. § 836-053-0100 - Work Related Injuries or Disease
  29. § 836-053-0105 - Coordination of Payment for Interim Medical Services
  30. § 836-053-0210 - Repealed
  31. § 836-053-0211 - Underwriting, Enrollment and Benefit Design Requirements Applicable to A Group Health Benefit Plan Including A Small Group Health Benefit Plan
  32. § 836-053-0220 - Repealed
  33. § 836-053-0221 - Participation, Contribution, and Eligibility Requirements for Group Health Benefit Plans Including Small Group Health Benefit Plans
  34. § 836-053-0230 - Underwriting
  35. § 836-053-0250 - Repealed
  36. § 836-053-0300 - Purpose; Statutory Authority; Applicability of Network Adequacy Requirements
  37. § 836-053-0310 - Network Adequacy Definitions for OAR 836-053-0300 to 836-053-0350
  38. § 836-053-0320 - Annual Report Requirements for Network Adequacy
  39. § 836-053-0330 - Nationally Recognized Standards for Use in Demonstrating Compliance with Network Adequacy Requirements
  40. § 836-053-0340 - Factor-Based Evidence of Compliance with Network Adequacy Requirements
  41. § 836-053-0350 - Provider Directory Requirements for Network Adequacy
  42. § 836-053-0410 - Purpose; Statutory Authority; Enforcement
  43. § 836-053-0415 - Cancellation of an Individual Health Benefit Plan Coverage
  44. § 836-053-0418 - Definition of Insurer for Reimbursement of Expenses Related to Disease Outbreak or Epidemic
  45. § 836-053-0430 - Repealed
  46. § 836-053-0431 - Underwriting, Enrollment and Benefit Design
  47. § 836-053-0435 - Health Benefit Plan Coverage of Well-woman Preventive Care Services
  48. § 836-053-0440 - Repealed
  49. § 836-053-0460 - Repealed
  50. § 836-053-0465 - Rating for Individual Health Benefit Plans
  51. § 836-053-0471 - Repealed
  52. § 836-053-0472 - Statutory Authority and Implementation
  53. § 836-053-0473 - Required Materials for Rate Filing for Individual or Small Employer Health Benefit Plans
  54. § 836-053-0474 - Process For Rate Filing for Individual and Small Employer Health Benefit Plans
  55. § 836-053-0475 - Approval, Disapproval or Modification of Premium Rates for Individual or Small Employer Health Benefit Plan
  56. § 836-053-0510 - Evaluating the Health Status of an Applicant for Individual Health Benefit Plan Coverage
  57. § 836-053-0600 - Purpose; Statutory Authority; Applicability
  58. § 836-053-0605 - Definitions for OAR 836-053-0600 to 836-053-0615
  59. § 836-053-0610 - Carrier Response to Request for Confidentiality
  60. § 836-053-0615 - Carrier Reporting Requirements
  61. § 836-053-0700 - Repealed
  62. § 836-053-0710 - Repealed
  63. § 836-053-0750 - Repealed
  64. § 836-053-0760 - Repealed
  65. § 836-053-0780 - Repealed
  66. § 836-053-0785 - Repealed
  67. § 836-053-0790 - Repealed
  68. § 836-053-0800 - Repealed
  69. § 836-053-0825 - Rescission of a Group Health Benefit Plan
  70. § 836-053-0830 - Rescission of an Individual Health Benefit Plan or Individual Health Insurance Policy
  71. § 836-053-0835 - Rescission of an Individual's Coverage under a Group Health Benefit Plan or Group Health Insurance Policy
  72. § 836-053-0851 - Purpose; Authority; Applicability; and Enforcement
  73. § 836-053-0857 - Definitions
  74. § 836-053-0863 - Notifications
  75. § 836-053-0900 - Purpose; Statutory Authority
  76. § 836-053-0910 - Rate Filing
  77. § 836-053-1000 - Statutory Authority and Implementation
  78. § 836-053-1010 - Insurer Policies
  79. § 836-053-1020 - Drug Formularies
  80. § 836-053-1030 - Written Information to Enrollees
  81. § 836-053-1033 - Cultural and Linguistic Appropriateness
  82. § 836-053-1035 - Summary of Benefits and Explanation of Coverage
  83. § 836-053-1040 - Repealed
  84. § 836-053-1060 - Definitions
  85. § 836-053-1070 - Reporting of Grievances; Format and Contents
  86. § 836-053-1080 - Tracking Grievances
  87. § 836-053-1090 - Assistance in Filing Grievances
  88. § 836-053-1100 - Internal Appeals Process
  89. § 836-053-1110 - Notice of Complaint Filing with Director
  90. § 836-053-1130 - Annual Summary, Utilization Review
  91. § 836-053-1140 - Appeal, Utilization Review Determinations
  92. § 836-053-1170 - Annual Summary, Quality Assessment Activities
  93. § 836-053-1180 - Format and Instructions for Report Required by ORS 743.818
  94. § 836-053-1190 - Annual Summary, Uniform Indicators of Network Adequacy
  95. § 836-053-1200 - Prior Authorization Requirements for Health Benefit Plans
  96. § 836-053-1203 - Prior Authorization Trade Practices for Health Insurance other than Health Benefit plans
  97. § 836-053-1205 - Uniform Prescription Drug Prior Authorization Request Form
  98. § 836-053-1300 - Purpose and Scope; Application
  99. § 836-053-1305 - Definitions; Authority to Act for Enrollee
  100. § 836-053-1310 - Contracting Requirements
  101. § 836-053-1315 - Performance Criteria
  102. § 836-053-1317 - Professional Qualifications
  103. § 836-053-1320 - Conflict of Interest
  104. § 836-053-1325 - Procedures for Conducting External Reviews
  105. § 836-053-1330 - Criteria and Considerations for External Review Determinations
  106. § 836-053-1335 - Procedures for Complaint Investigation
  107. § 836-053-1337 - Preliminary Review by Insurer
  108. § 836-053-1340 - Timelines and Notice for Dispute That is Not Expedited
  109. § 836-053-1342 - Timelines and Notice for Expedited Decision-Making
  110. § 836-053-1345 - Quality Assurance Mechanisms
  111. § 836-053-1350 - Ongoing Requirements for Independent Review Organizations
  112. § 836-053-1355 - Synopses
  113. § 836-053-1360 - External Review Reporting
  114. § 836-053-1365 - Fees for External Reviews
  115. § 836-053-1400 - Format and Instructions for Report Required by ORS 743.748
  116. § 836-053-1401 - Repealed
  117. § 836-053-1403 - Definitions of Coordinated Care and Case Management for Behavioral Health Care Services
  118. § 836-053-1404 - Definitions; Noncontracting Providers; Co-Morbidity Disorders
  119. § 836-053-1405 - General Requirements for Coverage of Mental or Nervous Conditions and Chemical Dependency
  120. § 836-053-1406 - Definitions
  121. § 836-053-1407 - Prohibited Exclusions
  122. § 836-053-1408 - Required Disclosures
  123. § 836-053-1410 - Procedures
  124. § 836-053-1415 - Instructions
  125. § 836-053-1500 - Purpose; Statutory Authority; Applicability
  126. § 836-053-1505 - Definitions for OAR 836-053-1500 to 836-053-1510
  127. § 836-053-1510 - Prominent Carrier Reporting Requirements
  128. § 836-053-1520 - Purpose; Statutory Authority; Applicability
  129. § 836-053-1525 - Definitions
  130. § 836-053-1530 - Reporting Requirements
  131. § 836-053-1600 - Purpose; Statutory Authority; Applicability
  132. § 836-053-1605 - Definitions for 836-053-1600 to 836-053-1615
  133. § 836-053-1610 - Non-anesthesia-related claims
  134. § 836-053-1615 - Anesthesia-related claims

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