Oregon § 743A.310 Primary care visits; rules

Oregon Statutes

§ 743A.310 — Primary care visits; rules

Oregon § 743A.310

Vol.18

Title 56Insurance

Ch. 743AHealth Insurance: Reimbursement of Claims

This text of Oregon § 743A.310 (Primary care visits; rules) 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.310 (2026).

Text

(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:

(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)T

Free access — add to your briefcase to read the full text and ask questions with AI

(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:
(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.