Oregon Statutes 743A.310 – Primary care visits; rules
(1) As used in this section, ‘primary care’ means outpatient behavioral health services, nonspecialty medical services or the coordination of health care for the purpose of:
Terms Used In Oregon Statutes 743A.310
- Contract: A legal written agreement that becomes binding when signed.
(a) Promoting or maintaining behavioral and physical health and wellness; and
(b) Diagnosis, treatment or management of acute or chronic conditions caused by disease, injury or illness.
(2) An individual or group policy or certificate of health insurance that is not offered on the health insurance exchange and that reimburses the cost of hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases and limited benefit coverage, shall, in each plan year, reimburse the cost of at least three primary care visits for behavioral health or physical health treatment.
(3) The coverage under subsection (2) of this section:
(a) May not be subject to copayments, coinsurance or deductibles, except as provided in ORS § 742.008 and subsection (5) of this section; and
(b) Is in addition to one annual preventive primary care visit that must be covered without cost-sharing.
(4) An insurer that offers a qualified health plan on the health insurance exchange must offer at least one plan in each metal tier offered by the insurer that provides the coverage described in subsections (2) and (3) of this section.
(5) The Department of Consumer and Business Services may adopt rules to allow an individual or group policy or certificate of health insurance to impose a copayment of not more than $5 for a primary care visit if necessary to comply with the requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343).
(6) This section does not apply to health benefit plans offered to public employees by insurers that contract with the Public Employees’ Benefit Board or the Oregon Educators Benefit Board.
(7) This section is exempt from ORS § 743A.001. [2022 c.37 § 6; 2023 c.425 § 5]
743A.310 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.