(1) As used in this section:

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

(a) ‘Detainee’ means an insured who is:

(A) In the custody of a local supervisory authority pending the disposition of charges; or

(B) In a detention facility pending final adjudication by a juvenile court.

(b) ‘Detention facility’ has the meaning given that term in ORS § 419A.004.

(c) ‘Health benefit plan’ has the meaning given that term in ORS § 743B.005.

(d) ‘Supervisory authority’ has the meaning given that term in ORS § 144.087.

(2) Except as provided in subsection (4) of this section, an insurer offering a health benefit plan may not deny reimbursement for any service or supply covered by the plan or cancel the coverage of an insured under the plan on the basis that:

(a) The insured is a detainee;

(b) The insured receives publicly funded medical care while in the custody of a local supervisory authority or in a detention facility; or

(c) The care was provided to the insured by an employee or contractor of a county, a local supervisory authority or a detention facility, if the employee or contractor meets the credentialing criteria of the health benefit plan.

(3) An insurer shall reimburse a county for the costs of covered services or supplies provided to a detainee, in an amount that is no less than 115 percent of the Medicare rate for the service or supply.

(4) An insurer offering a health benefit plan may:

(a) Deny coverage for the treatment of injuries resulting from a violation of law;

(b) Exclude from any requirements for reporting quality outcomes or performance, any covered services provided to a detainee;

(c) Impose utilization controls under the health benefit plan that apply to services provided by in-network providers to insureds who are not in custody or in a detention facility, including a requirement for prior authorization;

(d) Impose the requirements for billing and medical coding for covered services provided to a detainee that the insurer imposes on other providers;

(e) Deny coverage of diagnostic tests or health evaluations required, as a matter of course, for all detainees;

(f) Limit coverage of hospital and ambulatory surgical center services provided to a detainee to services provided by in-network hospitals and ambulatory surgical centers; and

(g) Reimburse an out-of-network renal dialysis facility at either the in-network or the out-of-network rate paid by the insurer for dialysis provided to a detainee.

(5)(a) An insurer may not refuse to credential a health care provider who is an employee or contractor of a county, a local supervisory authority or a detention facility on the basis that the employee or contractor provides the services in a facility operated by the local supervisory authority or in a detention facility.

(b) If an insurer refuses to credential a health care provider who is an employee or contractor of a county, a local supervisory authority or a detention facility, the insurer must give written notice to the provider explaining the reasons for the refusal.

(6) This section does not:

(a) Impair any right of an employer to remove an employee from coverage under a health benefit plan;

(b) Release carriers from the requirement to coordinate benefits for persons who are insured by more than one carrier; or

(c) Limit an insurer’s right to rescind coverage in accordance with ORS § 743B.310.

(7) A public body, as defined in ORS § 174.109, may not pay health benefit plan premiums on behalf of a detainee. [2014 c.97 § 2; 2017 c.329 § 1]

See 743A.001.

743A.260 was added to and made a part of the Insurance Code by legislative action but was not added to ORS Chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.