Oregon § 743B.277 Credits to deductibles and out-of-pocket expenses; requirements; process

Oregon Statutes

§ 743B.277 — Credits to deductibles and out-of-pocket expenses; requirements; process

Oregon § 743B.277

Vol.18

Title 56Insurance

Ch. 743BHealth Benefit Plans: Individual and Group

This text of Oregon § 743B.277 (Credits to deductibles and out-of-pocket expenses; requirements; process) 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.277 (2026).

Text

(1)An insurer offering a health benefit plan as defined in ORS 743B.005 shall credit any amount an enrollee pays directly to a health care provider to the enrollee’s deductible and annual out-of-pocket expenses if:

(a)The health care item or service is medically necessary and covered under the enrollee’s health benefit plan;

(b)The enrollee does not submit the claim to the insurer; and

(c)The amount paid to the health care provider is less than the average discounted rate for the item or service paid to an in-network health care provider with the same license.

(2)An insurer shall:

(a)Establish a process for an enrollee to submit a claim for the credit described in subsection (1) of this section, including the necessary documentation the enrollee is required to submit in support of th

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

(1) An insurer offering a health benefit plan as defined in ORS 743B.005 shall credit any amount an enrollee pays directly to a health care provider to the enrollee’s deductible and annual out-of-pocket expenses if:
(a) The health care item or service is medically necessary and covered under the enrollee’s health benefit plan;
(b) The enrollee does not submit the claim to the insurer; and
(c) The amount paid to the health care provider is less than the average discounted rate for the item or service paid to an in-network health care provider with the same license.
(2) An insurer shall:
(a) Establish a process for an enrollee to submit a claim for the credit described in subsection (1) of this section, including the necessary documentation the enrollee is required to submit in support of the claim; or
(b) Require an enrollee to utilize the system the insurer uses to process and adjudicate claims to submit a claim for the credit described in subsection (1) of this section.
(3) Notwithstanding ORS 750.055 (1)(i), this section does not apply to a health maintenance organization as defined in ORS 750.005.