Oregon § 743B.221 Assignment of beneficiaries to primary care providers; rules

Oregon Statutes

§ 743B.221 — Assignment of beneficiaries to primary care providers; rules

Oregon § 743B.221

Vol.18

Title 56Insurance

Ch. 743BHealth Benefit Plans: Individual and Group

This text of Oregon § 743B.221 (Assignment of beneficiaries to primary care providers; 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. § 743B.221 (2026).

Text

(1)As used in this section, “primary care provider” means an individual, clinic or team of health care providers licensed or certified in this state to provide outpatient, nonspecialty medical services or the coordination of health care for the purpose of:

(a)Promoting or maintaining mental and physical health and wellness; and

(b)Diagnosis, treatment or management of acute or chronic conditions caused by disease, injury or illness.

(2)An insurer offering an individual or group policy or certificate of health insurance 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, must assign a beneficiary under the policy or certificate to a primary care provider if the benef

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(1) As used in this section, “primary care provider” means an individual, clinic or team of health care providers licensed or certified in this state to provide outpatient, nonspecialty medical services or the coordination of health care for the purpose of:
(a) Promoting or maintaining mental and physical health and wellness; and
(b) Diagnosis, treatment or management of acute or chronic conditions caused by disease, injury or illness.
(2) An insurer offering an individual or group policy or certificate of health insurance 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, must assign a beneficiary under the policy or certificate to a primary care provider if the beneficiary or a parent of a minor beneficiary has not selected a primary care provider by the 90th day of the plan year. If the insurer assigns the beneficiary to a primary care provider, the insurer shall provide notice of the assignment to the beneficiary or parent and to the primary care provider.
(3) A beneficiary may select a different primary care provider at any time.
(4) The Department of Consumer and Business Services shall adopt rules prescribing a methodology for assignment and attribution of beneficiaries, to ensure accuracy and agreement between insurers and providers. The rules must prioritize consumer choice, ensure collaboration between insurers and providers and be consistent with recommendations of the primary care payment reform collaborative described in section 2, chapter 575, Oregon Laws 2015.