Oregon § 743A.250 Emergency eye care services

Oregon Statutes

§ 743A.250 — Emergency eye care services

Oregon § 743A.250

Vol.18

Title 56Insurance

Ch. 743AHealth Insurance: Reimbursement of Claims

This text of Oregon § 743A.250 (Emergency eye care services) is published on Counsel Stack Legal Research, covering Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Or. Rev. Stat. § 743A.250 (2026).

Text

(1)As used in this section:

(a)“Eye care practitioner” means an optometrist or ophthalmologist licensed by the State of Oregon.

(b)“Eye care services” means health care services related to the care of the eye and related structures as specified by a health benefit plan.

(c)“Health benefit plan” has the meaning provided for that term in ORS 743B.005.

(2)Any insurer that offers a health benefit plan that provides coverage of eye care services shall allow any enrollee to receive covered eye care services on an emergency basis without first receiving a referral or prior authorization from a primary care provider. However, an insurer may require the enrollee to receive a referral or prior authorization from a primary care provider for any subsequent surgical procedures. Nothing in this sub

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(1) As used in this section:
(a) “Eye care practitioner” means an optometrist or ophthalmologist licensed by the State of Oregon.
(b) “Eye care services” means health care services related to the care of the eye and related structures as specified by a health benefit plan.
(c) “Health benefit plan” has the meaning provided for that term in ORS 743B.005.
(2) Any insurer that offers a health benefit plan that provides coverage of eye care services shall allow any enrollee to receive covered eye care services on an emergency basis without first receiving a referral or prior authorization from a primary care provider. However, an insurer may require the enrollee to receive a referral or prior authorization from a primary care provider for any subsequent surgical procedures. Nothing in this subsection shall be construed to require that covered eye care services rendered by an eye care practitioner on an emergency basis be furnished in a hospital or similar medical facility.
(3) An insurer described in subsection (2) of this section may not:
(a) Impose a deductible or coinsurance for eye care services that is greater than the deductible or coinsurance imposed for other medical services under the health benefit plan.
(b) Require an eye care practitioner to hold hospital privileges as a condition of participation as a provider in the health benefit plan.
(4) Nothing in this section:
(a) Requires an insurer to provide coverage or reimbursement of eye care services;
(b) Requires an insurer to provide coverage or reimbursement of refractive surgery, ophthalmic materials, lenses, eyeglasses or other appurtenances; or
(c) Prevents an enrollee from receiving eye care or other covered services from the enrollee’s primary care provider in accordance with the terms of the enrollee’s health benefit plan.
(5) This section is exempt from ORS 743A.001.