reglab/housing_qa huggingface dataset:
OR Rev Stat § 743B.281 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.281 - Estimate of costs for in-network procedure or service.

(1) An insurer offering a health benefit plan as defined in ORS 743B.005 must establish a procedure for providing to an enrollee in the plan a reasonable estimate of an enrollee’s costs for an in-network procedure or service covered by the enrollee’s health benefit plan, in advance of the procedure or service, when an enrollee or an enrollee’s authorized representative provides the following information to the insurer: (a) The type of procedure or service; (b) The name of the provider; (c) The enrollee’s member number or policy number; and (d) If requested by the insurer, the site where the procedure or service will be performed. (2) The estimate of costs described in subsection (1) of this section must include an itemization of: (a) The enrollee’s deductible; (b) The amount of the deductible that has been met by processed claims; (c) Coinsurance, copayment or other cost share to be paid by the enrollee for the procedure or service; and (d) Any applicable benefit maximum. (3) Subsections (1) and (2) of this section apply to the insurer’s five most common procedures or services within each of the following categories: (a) Office visits; (b) Diagnostic radiology and imaging; (c) Diagnostic pathology and laboratory procedures; (d) Normal vaginal delivery; (e) Immunizations; (f) Orthopedic-musculoskeletal surgery; and (g) Digestive system endoscopy. (4) In addition to the information specified in subsections (1) and (2) of this section, the insurer’s estimate must include the following disclosures: (a) That other services may be provided to the enrollee that are medically necessary and appropriate as part of the common procedures, of which the insurer or enrollee may not be aware at the time of the inquiry and for which the enrollee may have additional financial responsibility; (b) That the enrollee may be responsible for costs of procedures or services not covered by the plan; (c) How an enrollee may contact the insurer for an explanation, if the estimate differs from the actual cost or if the enrollee has other questions; and (d) The toll-free telephone number of the consumer advocacy unit of the Department of Consumer and Business Services and the address for the department’s consumer information and complaints website. (5) An insurer must make the information required by this section available to enrollees and in-network providers through an interactive website and by toll-free telephone. (6) This section does not prohibit an insurer from providing information in addition to or in more detail than the information required by this section. [Formerly 743.874] Note: See note under 743B.280.
OR Rev Stat § 743B.283 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.283 - Submission of methodology used to determine insurer’s allowable charges.

An insurer offering a health benefit plan as defined in ORS 743B.005 must submit to the Director of the Department of Consumer and Business Services: (1) Upon request by the director, the methodology used to determine the insurer’s allowable charges for out-of-network procedures and services or, if the insurer uses a third party to determine the charges, the methodology used by the third party to determine allowable charges; (2) For approval, a written explanation of the method used by the insurer to determine the allowable charge, that is in plain language and that must be provided upon request to enrollees directly, or, in the case of group coverage, to the employer or other policyholder for distribution to enrollees; and (3) Information prescribed by the director as necessary to assess the effect of the disclosure requirements in ORS 743B.281 and 743B.282 on the individual and group health insurance markets. [Formerly 743.878] Note: See note under 743B.280.
OR Rev Stat § 743B.284 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.284 - Alternative mechanism for disclosure of costs and charges.

The Director of the Department of Consumer and Business Services may waive the requirements of ORS 743B.281 or 743B.282 to allow an insurer to use an alternative disclosure mechanism, provided that the mechanism enables enrollees to access information substantially similar to or more extensive than the information disclosed in ORS 743B.281 or 743B.282. [Formerly 743.883] Note: See note under 743B.280.
OR Rev Stat § 743B.285 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.285 - Rules.

The Director of the Department of Consumer and Business Services shall adopt rules necessary to carry out the purposes of ORS 743B.280 to 743B.285. [Formerly 743.893] Note: See note under 743B.280.
OR Rev Stat § 743B.287 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.287 - Balance billing prohibited for health care facility services.

(1) As used in this section: (a) "Emergency services" has the meaning given that term in ORS 743A.012. (b) "Enrollee" means: (A) An individual who is enrolled in a health benefit plan or a covered dependent or beneficiary of the individual; or (B) A subscriber to a health care service contract or a covered dependent or beneficiary of the subscriber. (c) "Health benefit plan" has the meaning given that term in ORS 743B.005. (d) "Health care facility" has the meaning given that term in ORS 442.015, excluding long term care facilities. (e) "Health care service contractor" has the meaning given that term in ORS 750.005. (f) "In-network" has the meaning given that term in ORS 743B.280. (g) "Out-of-network" means a provider or provider group that has not contracted or has indirectly contracted with the insurer or health care service contractor. (2) A provider who is an out-of-network provider may not bill an enrollee in the health benefit plan or health care service contract for emergency services or other inpatient or outpatient services provided at an in-network health care facility. (3) Subsection (2) of this section does not apply: (a) To applicable coinsurance, copayments or deductible amounts that apply to services provided by an in-network provider; or (b) To services, other than emergency services, provided to enrollees who choose to receive services from an out-of-network provider. (4) If an enrollee chooses to receive services from an out-of-network provider, the provider shall inform the enrollee that the enrollee will be financially responsible for coinsurance, copayments or other out-of-pocket expenses attributable to choosing an out-of-network provider. [2017 c.417 §2; 2018 c.43 §§4,6] Note: 743B.287 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743B.290 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.290 - Hospital payment of copayment or deductible for insured patient.

An insurer offering a policy or certificate of health insurance may not prohibit a hospital, as a condition of reimbursing a claim for hospital services, from paying or waiving all or a portion of a copayment or deductible owed by an insured under the policy or certificate. [2019 c.497 §9] Note: 743B.290 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743B.300 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.300 - Disclosure of differences in replacement health insurance policies; nonduplication for persons 65 and older; rules.

(1) The Director of the Department of Consumer and Business Services shall adopt by rule requirements for disclosure by group and individual health insurers to individual and group health insurance policyholders the difference between coverage under the existing policy and coverage being offered to replace that coverage. (2) The provisions of this section do not apply to disability income insurance. (3) The director shall adopt by rule requirements for nonduplication and replacement of major medical, Medicare supplement, long term care and special illness policies for applicants 65 years of age and older. The insurance producer shall offer to compare for any applicants 65 years of age and older the applicant’s existing policy or policies and coverage being offered to replace or supplement the applicant’s existing coverage. [Formerly 743.013]
OR Rev Stat § 743B.310 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.310 - Rescinding coverage; permissible bases; notice; rules.

(1) As used in this section, "rescind" means to retroactively cancel or discontinue coverage under a health benefit plan or group or individual health insurance policy for reasons other than failure to timely pay required premiums or required contributions toward the cost of coverage. (2) An insurer may not rescind coverage of an individual under a health benefit plan or group or individual health insurance policy unless: (a) The individual or a person seeking coverage on behalf of the individual: (A) Performs an act, practice or omission that constitutes fraud; or (B) Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan or policy; and (b) The insurer provides at least 30 days’ advance written notice, in the form and manner prescribed by the Department of Consumer and Business Services, to the individual. (3) An insurer may not rescind coverage of a group under a health benefit plan unless: (a) The plan sponsor: (A) Performs an act, practice or omission that constitutes fraud; or (B) Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan; and (b) The insurer provides at least 30 days’ advance written notice, in the form and manner prescribed by the department, to each plan enrollee or policy holder who would be affected by the rescission of coverage. (4) An insurer that rescinds a plan or policy must provide notice of the rescission to the department in the form, manner and time frame prescribed by the department by rule. (5) This section does not apply to long term care insurance that is subject to ORS 743.650 to 743.665. [Formerly 743.894] Note: 743B.310 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743B.320 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.320 - Minimum grace period; notice upon termination of policy; effect of failure to notify.

(1) A group health insurance policy shall contain a provision allowing a minimum grace period of 10 days after the premium due date for payment of premium. (2) An insurer of a group health insurance policy providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, that seeks to terminate a policy for nonpayment of premium shall notify the policyholder as described in ORS 743B.323. (3) An insurer of a group health insurance policy providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, shall notify the group policyholder when the policy is terminated and the coverage is not replaced by the group policyholder. The notice required under this subsection: (a) Must be given on a form prescribed by the Department of Consumer and Business Services; (b) Must explain the rights of the certificate holders regarding continuation of coverage provided by federal and state law; and (c) Must be given by mail and must be mailed not later than 10 working days after the date on which the group policy terminates according to the terms of the policy. (4) A group health insurance policy to which subsection (3) of this section applies shall contain a provision requiring the insurer to notify the group policyholder when the policy is terminated and the coverage is not replaced by the group policyholder. Each certificate issued under the policy shall also contain a statement of the provision required under this subsection. (5) If an insurer fails to give notice as required by this section, the insurer shall continue the group health insurance policy of the group policyholder in full force from the date notice should have been provided until the date that the notice is received by the policyholder and shall waive the premiums owing for the period for which the coverage is continued under this subsection. The time period within which the certificate holder may exercise any right to continuation shall commence on the date that the policyholder receives the notice. (6) The insurer shall supply the employer holding the terminated policy with the necessary information for the employer to be able to notify properly the employee of the employee’s right to continuation of coverage under state and federal law. [Formerly 743.560]
OR Rev Stat § 743B.321 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.321 - Applicability of ORS 743B.320.

ORS 743B.320 applies to multiple employer trusts when an employer ceases to participate therein. [Formerly 743.562]
OR Rev Stat § 743B.323 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.323 - Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium; rules.

(1) Before a health insurer selling an individual policy or group health benefit plan may cancel a policy for nonpayment of premium, the insurer must mail a separate notice to the policyholder informing the policyholder that the premium was not received and that the policy will be terminated as of the premium due date if the premium is not received by the end of the applicable grace period required by ORS 743.417 and 743B.320. (2) The notice described in subsection (1) of this section shall be in writing and mailed by first class mail to the last-known address of the policyholder at least: (a) Ten days prior to the end of the grace period specified in ORS 743.417 (1)(a) and 743B.320; or (b) Fifteen days prior to the end of the grace period specified in ORS 743.417 (1)(b). (3) The Department of Consumer and Business Services may prescribe by rule the information that must be contained in the notice required by subsection (1) of this section. [Formerly 743.565; 2021 c.205 §11]
OR Rev Stat § 743B.324 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.324 - Rules for certain notice requirements.

The Director of the Department of Consumer and Business Services shall adopt rules necessary for the implementation and administration of ORS 743B.323 and the amendments to ORS 743.417, 743.420, 743B.013, 743B.105, 743B.125 and 743B.320 by sections 9 to 14, chapter 943, Oregon Laws 2001. [Formerly 743.566] Note: 743B.324 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 743B or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743B.330 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.330 - Notice to policyholder required for cancellation or nonrenewal of health benefit plan; effect of failure to give notice.

(1) As used in this section, "health benefit plan" has the meaning given that term in ORS 743B.005. (2) An insurer shall notify a policyholder in writing if the insurer cancels or does not renew the policyholder’s individual health benefit plan. The notice shall be sent to the policyholder’s last-known mailing address by first class mail in a specially marked envelope or, if the policyholder has elected to receive communications from the insurer electronically, to the policyholder’s last-known electronic mail address using a mechanism that will confirm delivery to the address. (3) If the cancellation or nonrenewal results in a refund to the policyholder of all or part of a premium, the insurer must mail with the refund a written explanation that includes: (a) The effective date of the cancellation; (b) The reason for the cancellation; and (c) The time period to which the refund is applicable. (4) For any cancellation or nonrenewal due to a reported death of the policyholder, the insurer must: (a) Confirm the accuracy of the reported death. (b) If the death is confirmed: (A) Provide any dependents covered by the plan with information about how to continue coverage or obtain alternative coverage; and (B) Issue any refund that is due to the estate of the deceased in accordance with subsection (3) of this section. (5) If an insurer cancels or does not renew an individual health benefit plan and fails to comply with the requirements of this section, the insurer shall continue the coverage under the plan for the policyholder and any dependents covered by the plan until the date that the insurer has complied with the requirements of this section. The insurer shall waive any premiums owed for the period during which the coverage was continued under this subsection and shall process all claims incurred by the policyholder or any covered dependents according to the terms of the plan. (6) This section does not apply: (a) To a cancellation requested by the policyholder if the insurer documents the request and confirms the request with the policyholder; (b) To a cancellation or nonrenewal that results from a policyholder making a change in coverage with the same insurer; or (c) To a cancellation due to nonpayment of premium. [Formerly 743.499] Note: 743B.330 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743B.341 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.341 - Continuation of benefits after termination of group health insurance policy; rules.

(1) Every group health insurance policy that provides coverage for hospital or medical services or expenses shall provide that the insurer shall continue its obligation for benefits under the policy for any person insured under the policy who is hospitalized on the date of termination if the policy is terminated and immediately replaced by a group health insurance policy issued by another insurer. Any payment required under this section is subject to all terms, limitations and conditions of the policy except those relating to termination of benefits. Any obligation by an insurer under this section continues until the hospital confinement ends or hospital benefits under the policy are exhausted, whichever is earlier. (2) The Director of the Department of Consumer and Business Services may adopt rules providing for uninterrupted coverage for individuals insured under a group health insurance policy providing coverage for hospital or medical expenses, when such a policy is replaced by a policy of similar benefits, whether issued by the same insurer or another. [Formerly 743.529]
OR Rev Stat § 743B.342 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.342 - Continuation of benefits after injury or illness covered by workers’ compensation.

Every policy of group health insurance delivered or issued for delivery in this state shall contain a provision applicable to the coverage for hospital or medical services or expenses provided under the policy that if an employee incurs an injury or illness for which a workers’ compensation claim is filed, that policy will continue in effect with respect to that employee upon timely payment by the employee of the premium that includes the individual contribution and the contribution due from the employer under the applicable benefit plan. The employee may maintain such coverage until whichever of the following events first occurs: (1) The employee takes full-time employment with another employer; or (2) Six months from the date that the employee first makes payment under this section. [Formerly 743.530]
OR Rev Stat § 743B.343 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743B - Health Benefit Plans: Individual and Group|Section 743B.343 - Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older.

(1) A group health insurance policy providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, shall contain a provision that: (a) The surviving spouse of a certificate holder may continue coverage under the policy, at the death of the certificate holder, with respect to the spouse and any dependent children whose coverage under the policy otherwise would terminate because of the death of the certificate holder if the surviving spouse is 55 years of age or older at the time of the death; and (b) The divorced or legally separated spouse of a certificate holder may continue coverage under the policy, upon dissolution of marriage with, or legal separation from, the certificate holder, with respect to the divorced or legally separated spouse and any dependent children whose coverage under the policy otherwise would terminate because of the dissolution of marriage or legal separation, if the divorced or legally separated spouse is 55 years of age or older at the time of the dissolution or legal separation. (2) Continued coverage for dental, vision care or prescription drug expenses shall be offered to legally separated, divorced or surviving spouses and any dependent children eligible under subsection (1) of this section if such coverage is or was available to the certificate holder. [Formerly 743.600]