reglab/housing_qa huggingface dataset:
OR Rev Stat § 743A.078 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.078 - Newborn nurse home visiting services.

(1) As used in this section, "carrier," "enrollee" and "health benefit plan" have the meanings given those terms in ORS 743B.005. (2) A health benefit plan offered in this state must reimburse the cost of universal newborn nurse home visiting services as prescribed by the Oregon Health Authority by rule under ORS 433.301 (7). (3) The coverage must be provided without any cost-sharing, coinsurance or deductible applicable to the services. (4) Carriers must offer the services in their health benefit plans but enrollees are not required to receive the services as a condition of coverage and may not be penalized or in any way discouraged from declining the services. (5) A carrier must notify an enrollee about the services whenever an enrollee adds a newborn to coverage. (6) A carrier may use in-network providers or may contract with local public health authorities to provide the services. (7) This section does not require a carrier to reimburse the cost of the services in any specific manner. The services may be reimbursed using: (a) A value-based payment methodology; (b) A claim invoicing process; (c) Capitated payments; (d) A payment methodology that takes into account the need for a community-based entity providing the services to expand its capacity to provide the services and address health disparities; or (e) Any other methodology agreed to by the carrier and the provider of the services. (8) Carriers shall report to the authority, in the form and manner prescribed by the authority, data regarding claims submitted for services covered under this section to monitor the provision of the services. [2019 c.552 §3] Note: See 743A.001. Note: 743A.078 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.080 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.080 - Pregnancy and childbirth expenses.

(1) As used in this section, "pregnancy care" means the care necessary to support a healthy pregnancy and care related to labor and delivery. (2) All health benefit plans as defined in ORS 743B.005 must provide payment or reimbursement for expenses associated with pregnancy care and childbirth. Benefits provided under this section shall be extended to all enrollees, enrolled spouses and enrolled dependents. [Formerly 743.693; 2011 c.500 §39]
OR Rev Stat § 743A.082 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.082 - Diabetes management for pregnant women.

(1) Except as provided in subsections (2) and (3) of this section, a health benefit plan, as defined in ORS 743B.005, may not require a copayment or impose a coinsurance requirement or a deductible on the covered health services, medications and supplies that are medically necessary for a woman to manage her diabetes during the period of each pregnancy, beginning with conception and ending six weeks postpartum. (2) Subsection (1) of this section does not apply to a high deductible health plan described in 26 U.S.C. 223. (3) The coverage required by subsection (1) of this section may be limited by network and formulary restrictions that apply to other benefits under the plan. Subsection (1) of this section does not apply to services, medications, test strips and syringes that are not covered due to the network or formulary restrictions. (4) An insurer may require an enrollee or the enrollee’s health care provider to notify the insurer orally, in a timely manner, that the enrollee is diabetic and is pregnant or has given birth and is within six weeks postpartum. [2013 c.682 §2; 2014 c.74 §1] Note: 743A.082 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.084 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.084 - Unmarried women and their children.

Each policy of health insurance shall provide: (1) The same payments for costs of maternity to unmarried women that it provides to married women, including the spouses in marriages of insured persons choosing family coverage; and (2) The same coverage for the child of an unmarried woman that the child of an insured married person choosing family coverage receives. [Formerly 743.721; 2015 c.629 §61]
OR Rev Stat § 743A.088 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.088 - Use by mother of diethylstilbestrol.

No policy of health insurance may be denied or canceled by the insurer solely because the mother of the insured used drugs containing diethylstilbestrol prior to the insured’s birth. [Formerly 743.710]
OR Rev Stat § 743A.100 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.100 - Mammograms.

(1) Every health insurance policy that covers hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases, shall provide coverage of mammograms as follows: (a) Mammograms for the purpose of diagnosis in symptomatic or high-risk individuals at any time upon referral of an individual’s health care provider; and (b) An annual mammogram for the purpose of early detection for an individual 40 years of age or older, with or without referral from the individual’s health care provider. (2) An insurance policy described in subsection (1) of this section must not limit coverage of mammograms to the schedule provided in subsection (1) of this section if the individual is determined by the individual’s health care provider to be at high risk for breast cancer. [Formerly 743.727; 2017 c.152 §4]
OR Rev Stat § 743A.104 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.104 - Pelvic examinations and Pap smear examinations.

All policies providing health insurance, except those policies whose coverage is limited to expenses from accidents or specific diseases that are unrelated to the coverage required by this section, shall include coverage for pelvic examinations and Pap smear examinations as follows: (1) Annually for individuals 18 to 64 years of age; and (2) At any time upon referral of an individual’s health care provider. [Formerly 743.728; 2017 c.152 §5]
OR Rev Stat § 743A.105 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.105 - HPV vaccine.

(1) All health benefit plans, as defined in ORS 743B.005, shall include coverage of the human papillomavirus vaccine for beneficiaries under the health benefit plan who are at least 11 years of age but no older than 26 years of age. (2) ORS 743A.001 does not apply to this section. [2009 c.630 §2; 2017 c.152 §6] Note: 743A.105 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.108 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.108 - Physical examination of breast.

(1) A health insurance policy that covers hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases, shall provide coverage for a complete and thorough physical examination of the breast, including but not limited to a clinical breast examination, performed by a health care provider to check for lumps and other changes for the purpose of early detection and prevention of breast cancer as follows: (a) Annually for individuals 18 years of age and older; and (b) At any time at the recommendation of an individual’s health care provider. (2) An insurance policy must provide coverage of physical examinations of the breast as described in subsection (1) of this section regardless of whether a health care provider performs other preventative health examinations or makes a referral for other preventative health examinations at the same time the health care provider performs the breast examination. (3) This section applies to health care service contractors, as defined in ORS 750.005, and trusts carrying out a multiple employer welfare arrangement, as defined in ORS 750.301. [Formerly 743.791; 2017 c.152 §7] Note: 743A.108 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.110 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.110 - Mastectomy-related services; expedited external review required.

(1) As used in this section, "mastectomy" means the surgical removal of all or part of a breast or a breast tumor suspected to be malignant. (2) All insurers offering a health benefit plan as defined in ORS 743B.005 shall provide payment, coverage or reimbursement for mastectomy and for the following services related to a mastectomy as determined by the attending physician and enrollee to be part of the enrollee’s course or plan of treatment: (a) All stages of reconstruction of the breast on which a mastectomy was performed, including but not limited to nipple reconstruction, skin grafts and stippling of the nipple and areola; (b) Surgery and reconstruction of the other breast to produce a symmetrical appearance; (c) Prostheses; (d) Treatment of physical complications of the mastectomy, including lymphedemas; and (e) Inpatient care related to the mastectomy and post-mastectomy services. (3) An insurer providing coverage under subsection (2) of this section shall provide written notice describing the coverage to the enrollee at the time of enrollment in the health benefit plan and annually thereafter. (4) A health benefit plan must provide a single determination of prior authorization for all services related to a mastectomy covered under subsection (2) of this section that are part of the enrollee’s course or plan of treatment. (5) When an enrollee requests an external review of an adverse benefit determination as defined in ORS 743B.001 by the insurer regarding services described in subsection (2) of this section, the insurer or the Director of the Department of Consumer and Business Services must expedite the enrollee’s case pursuant to ORS 743B.252 (5). (6) The coverage required under subsection (2) of this section is subject to the same terms and conditions in the plan that apply to other benefits under the plan. (7) This section is exempt from ORS 743A.001. [Formerly 743.691; 2011 c.208 §1; 2011 c.500 §41]
OR Rev Stat § 743A.111 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.111 - Consumer education about post-mastectomy services.

(1) The Department of Consumer and Business Services shall make written materials available on the department’s website to educate breast cancer patients about the availability of insurance coverage for breast reconstruction surgery and breast prostheses following a mastectomy. The department shall update the materials at least annually. (2) The department shall place a link to the educational materials described in subsection (1) of this section close to links on the website to information for consumers about health insurance and under a tab designated "Breast Reconstruction Education." The materials must include links to information about breast reconstruction surgery published by governmental entities with a nexus to this state or nonprofit organizations with expertise in breast reconstruction surgery, including but not limited to information about: (a) The availability of the option to have breast reconstruction surgery following a mastectomy including that the breast reconstruction surgery may be performed at the time of a mastectomy or may be delayed until a later date. (b) Prostheses or breast forms as alternatives to breast reconstruction surgery. (c) The requirements of the Women’s Health and Cancer Rights Act of 1998 (P.L. 105-277) including the right to breast reconstruction surgery following a mastectomy even if the surgery is delayed until a later date. (3) The department may include educational information about breast reconstruction surgery in newsletters or similar publications that the department sends to consumers or carriers on a weekly or monthly basis. [2017 c.163 §2] Note: 743A.111 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 743A or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.124 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.124 - Colorectal cancer screenings and laboratory tests.

(1) A health benefit plan, as defined in ORS 743B.005, shall provide coverage for all colorectal cancer screening examinations and laboratory tests assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. (2) If an insured is 50 years of age or older, an insurer may not impose cost sharing on the coverage required by subsection (1) of this section and the coverage shall include, at a minimum: (a)(A) Fecal occult blood tests; (B) Colonoscopies, including the removal of polyps during a screening procedure; or (C) Double contrast barium enemas; and (b) A colonoscopy, including the removal of polyps during the procedure, if the insured has a positive result on any fecal test assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. (3) If an insured is at high risk for colorectal cancer, the coverage required by subsection (1) of this section shall include colorectal cancer screening examinations and laboratory tests as recommended by the treating physician. (4) For the purposes of subsection (3) of this section, an individual is at high risk for colorectal cancer if the individual has: (a) A family medical history of colorectal cancer; (b) A prior occurrence of cancer or precursor neoplastic polyps; (c) A prior occurrence of a chronic digestive disease condition such as inflammatory bowel disease, Crohn’s disease or ulcerative colitis; or (d) Other predisposing factors. (5) Subsection (2)(b) of this section does not apply to a high deductible health plan described in 26 U.S.C. 223. [Formerly 743.799; 2014 c.9 §1; 2015 c.206 §1] Note: See 743A.001. Note: 743A.124 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.130 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.130 - Proton beam therapy.

(1) A health benefit plan, as defined in ORS 743B.005, that provides coverage of radiation therapy for the treatment of prostate cancer must provide coverage for proton beam therapy for the treatment of prostate cancer on a basis no less favorable than the coverage of radiation therapy. (2) The coverage of proton beam therapy under subsection (1) of this section may be subject to prior authorization, as defined in ORS 743B.001, or other utilization review, as defined in ORS 743B.001, if the prior authorization or utilization review applied to proton beam therapy is no more restrictive than the prior authorization or utilization review applied to radiation therapy. (3) This section is exempt from ORS 743A.001. [2019 c.466 §2; 2021 c.384 §1] Note: 743A.130 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.140 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.140 - Bilateral cochlear implants.

(1) A health benefit plan, as defined in ORS 743B.005, shall reimburse the cost of: (a) Bilateral cochlear implants if medically appropriate for the treatment of hearing loss; and (b) Programming and reprogramming cochlear implants. (2) For purposes of ORS 746.230, a reasonable investigation of a claim for bilateral cochlear implants must include a request to the treating surgeon for a written recommendation based on peer-reviewed medical literature and for the medical findings that support the recommendation. (3) A health benefit plan shall reimburse the cost of repair and replacement parts for a cochlear implant if the repair or parts are not covered by a warranty and are necessary for the device to be functional for the user. (4) The provisions of this section are exempt from ORS 743A.001. [2007 c.504 §2; 2018 c.9 §1] Note: 743A.140 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.148 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.148 - Maxillofacial prosthetic services.

(1) The Legislative Assembly declares that all group health insurance policies providing hospital, medical or surgical expense benefits, other than limited benefit coverage, include coverage for maxillofacial prosthetic services considered necessary for adjunctive treatment. (2) As used in this section, "maxillofacial prosthetic services considered necessary for adjunctive treatment" means restoration and management of head and facial structures that cannot be replaced with living tissue and that are defective because of disease, trauma or birth and developmental deformities when such restoration and management are performed for the purpose of: (a) Controlling or eliminating infection; (b) Controlling or eliminating pain; or (c) Restoring facial configuration or functions such as speech, swallowing or chewing but not including cosmetic procedures rendered to improve on the normal range of conditions. (3) The coverage required by subsection (1) of this section may be made subject to provisions of the policy that apply to other benefits under the policy including, but not limited to, provisions relating to deductibles and coinsurance. (4) The services described in this section shall apply to individual health policies entered into or renewed on or after January 1, 1982. [Formerly 743.706; 2016 c.11 §5]
OR Rev Stat § 743A.150 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.150 - Treatment of craniofacial anomaly.

(1) As used in this section, "craniofacial anomaly" means a physical disorder identifiable at birth that affects the bony structures of the face or head, including but not limited to cleft palate, cleft lip, craniosynostosis, craniofacial microsomia and Treacher Collins syndrome. (2) All health benefit plans, as defined in ORS 743B.005, providing coverage of hospital, surgical or dental services, shall provide coverage for dental and orthodontic services for the treatment of craniofacial anomalies if the services are medically necessary to restore function. (3) This section does not require coverage for the treatment of: (a) Developmental maxillofacial conditions that result in overbite, crossbite, malocclusion or similar developmental irregularities of the teeth; or (b) Temporomandibular joint disorder. (4) Coverage required by this section may be subject to copayments, deductibles and coinsurance imposed on similar services by the terms of the plan. (5) This section does not limit or supersede any coverage required by ORS 743A.028, 743A.032 or 743A.148. (6) This section is exempt from ORS 743A.001. [2012 c.21 §2] Note: 743A.150 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.160 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.160 - Alcoholism treatment.

A health insurance policy providing coverage for hospital or medical expenses, other than limited benefit coverage, shall provide, at the request of the applicant, coverage for expenses arising from treatment for alcoholism. The following conditions apply to the requirement for such coverage: (1) The applicant shall be informed of the applicant’s option to request this coverage. (2) The inclusion of the coverage may be made subject to the insurer’s usual underwriting requirements. (3) The coverage may be made subject to provisions of the policy that apply to other benefits under the policy, including but not limited to provisions relating to deductibles and coinsurance. (4) The policy may limit hospital expense coverage to treatment provided by the following facilities: (a) A health care facility licensed as required by ORS 441.015. (b) A health care facility accredited by the Joint Commission. (5) Except as permitted by subsection (3) of this section, the policy may not limit payments thereunder for alcoholism to an amount less than $4,500 in any 24-consecutive month period and the policy shall provide coverage, within the limits of this subsection, of not less than 80 percent of the hospital and medical expenses for treatment for alcoholism. [Formerly 743.412; 2016 c.11 §6; 2017 c.17 §56] Note: See 743.402.
OR Rev Stat § 743A.170 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.170 - Tobacco use cessation programs.

(1) A health benefit plan as defined in ORS 743B.005 must provide payment, coverage or reimbursement of at least $500 for a tobacco use cessation program for a person enrolled in the plan who is 15 years of age or older. (2) As used in this section, "tobacco use cessation program" means a program recommended by a physician that follows the United States Public Health Service guidelines for tobacco use cessation. "Tobacco use cessation program" includes education and medical treatment components designed to assist a person in ceasing the use of tobacco products. (3) This section is exempt from ORS 743A.001. [2009 c.503 §2] Note: 743A.170 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 743A.175 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.175 - Traumatic brain injury.

(1) A health benefit plan, as defined in ORS 743B.005, shall provide coverage of medically necessary therapy and services for the treatment of traumatic brain injury. (2) This section is exempt from ORS 743A.001. [2009 c.423 §2]