reglab/housing_qa huggingface dataset:
OR Rev Stat § 743A.034 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.034 - Services provided by expanded practice dental hygienist.

(1) If a policy of insurance covering dental health provides for coverage for services performed by a dentist licensed under ORS chapter 679, the policy must also cover the services when they are performed by an expanded practice dental hygienist, as defined in ORS 679.010, who has entered into a provider contract with the insurer. (2) The provisions of ORS 743A.001 do not apply to this section. [2011 c.716 §11] Note: 743A.034 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.036 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.036 - Services provided by licensed nurse practitioner or licensed physician assistant.

(1) Whenever any policy of health insurance provides for reimbursement for a primary care or mental health service provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service if provided by a licensed physician assistant or a licensed nurse practitioner if the service is within the lawful scope of practice of the physician assistant or nurse practitioner. (2)(a) The reimbursement of a service described in subsection (1) of this section that is provided by a licensed physician assistant or a licensed nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served. (b) As used in this subsection, "independent practice" means the licensed physician assistant or the licensed nurse practitioner bills insurers for services provided by the physician assistant or nurse practitioner using the: (A) Diagnosis and procedure codes applicable to the services; (B) Physician assistant’s or nurse practitioner’s own name; and (C) National provider identifier for: (i) The physician assistant or nurse practitioner; and (ii) If required by the insurer, the facility in which the physician assistant or nurse practitioner provides the services. (3) This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act or other insurers that employ physicians, licensed physician assistants or licensed nurse practitioners to provide primary care or mental health services and do not compensate such practitioners on a fee-for-service basis. (4) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply with this section. [Formerly 743.712; 2013 c.430 §§1,4; 2015 c.377 §1; 2016 c.54 §1; 2019 c.358 §42]
OR Rev Stat § 743A.040 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.040 - Services provided by optometrist.

Notwithstanding any provision of any policy of health insurance, whenever the policy provides for payment or reimbursement for a service that is within the lawful scope of practice of a licensed optometrist, the insurer shall provide payment or reimbursement for the service, whether the service is performed by a physician or a licensed optometrist. Unless the policy provides otherwise, there shall be no reimbursement for ophthalmic materials, lenses, spectacles, eyeglasses or appurtenances thereto. [Formerly 743.703]
OR Rev Stat § 743A.044 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.044 - Services provided by physician assistant.

(1) An insurer may not refuse a claim solely on the ground that the claim was submitted by a physician assistant rather than by a supervising physician for the physician assistant. (2) This section is exempt from ORS 743A.001. [Formerly 743.725; 2010 c.43 §9] Note: The amendments to 743A.044 by section 17, chapter 349, Oregon Laws 2021, become operative July 15, 2022, and apply to claims submitted on and after July 15, 2022. See sections 18 and 21, chapter 349, Oregon Laws 2021. The text that is operative on and after July 15, 2022, is set forth for the user’s convenience. (1) An insurer may not refuse a claim solely on the ground that the claim was submitted by a physician assistant rather than by a physician, podiatric physician or employer with whom the physician assistant has entered into a collaboration agreement, as defined in ORS 677.495. (2) This section is exempt from ORS 743A.001.
OR Rev Stat § 743A.048 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.048 - Services provided by psychologist.

Whenever any provision of any individual or group health insurance policy or contract provides for payment or reimbursement for any service which is within the lawful scope of a psychologist licensed under ORS 675.010 to 675.150: (1) The insured under such policy or contract shall be free to select, and shall have direct access to, a psychologist licensed under ORS 675.010 to 675.150, without supervision or referral by a physician or another health practitioner, and wherever such psychologist is authorized to practice. (2) The insured under such policy or contract shall be entitled to have payment or reimbursement made to the insured or on the insured’s behalf for the services performed. Such payment or reimbursement shall be in accordance with the benefits provided in the policy and shall be the same whether performed by a physician or a psychologist licensed under ORS 675.010 to 675.150. [Formerly 743.709]
OR Rev Stat § 743A.051 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.051 - Services provided by pharmacist.

Notwithstanding any provisions of a health benefit plan as defined in ORS 743B.005, whenever the plan provides for payment or reimbursement for a service that is within the lawful scope of practice of a pharmacist, the insurer: (1) May provide payment or reimbursement for the service when the service is provided by a pharmacist; and (2) Shall provide, in the same manner as would be provided for any other health care provider, payment or reimbursement for: (a)(A) The prescription of emergency refills of insulin and associated insulin-related devices and supplies as described in ORS 689.696; and (B) The service provided by the pharmacist; (b)(A) The prescription, dispensation and administration of preexposure and post-exposure prophylactic antiretroviral therapies pursuant to ORS 689.704 and any rules adopted by the State Board of Pharmacy under ORS 689.645 and 689.704; and (B) The service provided by the pharmacist; and (c)(A) The prescription and dispensation of other prescription drugs by a licensed pharmacist if the State Board of Pharmacy or any state law authorizes the drug to be prescribed and dispensed by pharmacists licensed under ORS chapter 689; and (B) The service provided by the pharmacist. (3) This section is exempt from ORS 743A.001. [2015 c.362 §8; 2019 c.95 §5; 2021 c.365 §4] Note: 743A.051 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.052 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.052 - Services provided by professional counselor or marriage and family therapist.

(1) If a group health benefit plan, as described in ORS 743B.005, provides for coverage for services performed by a clinical social worker or nurse practitioner, the plan also must cover services provided by a professional counselor or marriage and family therapist licensed under ORS 675.715 to 675.835 when the counselor or therapist is acting within the counselor’s or therapist’s lawful scope of practice. (2) Health maintenance organizations may limit the receipt of covered services performed by professional counselors and marriage and family therapists to services provided by or upon referral by providers contracting with the health maintenance organization. Health maintenance organizations and health care service contractors may create substantive plan benefit and reimbursement differentials at the same level as, and subject to limitations not more restrictive than, those imposed on coverage or reimbursement of expenses arising out of other medical conditions and apply them to contracting and noncontracting providers. (3) The provisions of ORS 743A.001 do not apply to this section. [2009 c.549 §2] Note: 743A.052 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.060 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.060 - Definition for ORS 743A.062.

As used in ORS 743A.062, "peer-reviewed medical literature" means scientific studies printed in journals or other publications that publish original manuscripts only after the manuscripts have been critically reviewed by unbiased independent experts for scientific accuracy, validity and reliability. "Peer-reviewed medical literature" does not include internal publications of pharmaceutical manufacturers. [Formerly 743.695]
OR Rev Stat § 743A.062 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.062 - Prescription drugs.

(1) As used in this section, "medical assistance program" means the state program that provides medical assistance as defined in ORS 414.025. (2) An insurance policy or contract providing coverage for a prescription drug to a resident of this state may not: (a) Exclude coverage of the drug for a particular indication solely on the grounds that the indication has not been approved by the United States Food and Drug Administration if the Health Evidence Review Commission established under ORS 414.688 or the Pharmacy and Therapeutics Committee established under ORS 414.353 determines that the drug is recognized as effective for the treatment of that indication: (A) In publications that the commission or the committee determines to be equivalent to: (i) The American Hospital Formulary Service drug information; (ii) "Drug Facts and Comparisons" (Lippincott-Raven Publishers); (iii) The United States Pharmacopoeia drug information; or (iv) Other publications that have been identified by the United States Secretary of Health and Human Services as authoritative; (B) In the majority of relevant peer-reviewed medical literature; or (C) By the United States Secretary of Health and Human Services; or (b) For an insured who is enrolled in the medical assistance program: (A) Except as provided in subsection (3) of this section, require a prescription for the drug to be filled or refilled at a mail order pharmacy; or (B) Require a prescription for the drug to be filled or refilled at a pharmacy that is not a local pharmacy enrolled in the medical assistance program. (3) Subsection (2)(b)(A) of this section does not prohibit an insurer from requiring a medical assistance recipient to fill or refill a prescription for a specialty drug at a mail order pharmacy that is a specialty pharmacy. (4) Required coverage of a prescription drug under this section shall include coverage for medically necessary services associated with the administration of that drug. (5) Nothing in this section requires coverage for any prescription drug if the United States Food and Drug Administration has determined use of the drug to be contraindicated. (6) Nothing in this section requires coverage for experimental drugs not approved for any indication by the United States Food and Drug Administration. (7) This section is exempt from ORS 743A.001. [Formerly 743.697; 2011 c.720 §222; 2021 c.339 §1]
OR Rev Stat § 743A.063 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.063 - Ninety-day supply of prescription drug refills.

(1) A prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan as defined in ORS 743B.005, must provide for reimbursement for up to a 90-day supply of a prescription drug dispensed by a pharmacy, as defined in ORS 689.005, if: (a) The prescription drug is covered by the program or plan; (b) An initial 30-day supply of the prescription drug has been previously dispensed to the program or plan member; and (c) The quantity of the prescription drug dispensed does not exceed the total remaining quantity of the prescription drug that the prescribing practitioner authorized to be dispensed through refills. (2) The coverage required by subsection (1) of this section may be limited by the terms and conditions of a pharmacy network contract, or a prescription drug benefit program or health benefit plan, that are related to the reimbursement rate of the prescription drug. (3) The coverage required by subsection (1) of this section may be limited by formulary restrictions that are related to the prescription drug. (4) This section does not apply to the reimbursement of prescription drugs classified as a controlled substance in Schedule II. (5) This section is exempt from ORS 743A.001. [2015 c.661 §2] Note: 743A.063 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.064 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.064 - Prescription drugs dispensed at rural health clinics.

(1) All health insurance policies that provide a prescription drug benefit, except those policies in which coverage is limited to expenses from accidents or specific diseases that are unrelated to the coverage required by this subsection, must include coverage for prescription drugs dispensed by a licensed practitioner at a rural health clinic for an urgent medical condition if there is not a pharmacy within 15 miles of the clinic or if the prescription is dispensed for a patient outside of the normal business hours of any pharmacy within 15 miles of the clinic. (2) The coverage required by subsection (1) of this section is subject to the terms and conditions of the prescription drug benefit provided under the policy. (3) As used in this section, "urgent medical condition" means a medical condition that arises suddenly, is not life-threatening and requires prompt treatment to avoid the development of more serious medical problems. [Formerly 743.793] Note: See 743A.001.
OR Rev Stat § 743A.065 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.065 - Early refills of prescription eye drops for treatment of glaucoma.

An insurer offering a health benefit plan, as defined in ORS 743B.005, that provides coverage of prescription eye drops shall provide coverage for one early refill of a prescription for eye drops to treat glaucoma if all of the following criteria are met: (1) The refill is requested by an insured less than 30 days after the later of: (a) The date the original prescription was dispensed to the insured; or (b) The date that the last refill of the prescription was dispensed to the insured. (2) The prescriber indicates on the original prescription that a specific number of refills will be needed. (3) The refill does not exceed the number of refills that the prescriber indicated under subsection (2) of this section. (4) The prescription has not been refilled more than once during the 30-day period prior to the request for an early refill. [2011 c.660 §25] Note: See 743A.001. Note: 743A.065 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.066 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.066 - Contraceptives.

(1) A prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan as defined in ORS 743B.005 or under a student health insurance policy, must provide payment, coverage or reimbursement for: (a) Prescription contraceptives; and (b) If covered for other drug benefits under the program, plan or policy, outpatient consultations, including pharmacist consultations, examinations, procedures and medical services that are necessary to prescribe, dispense, deliver, distribute, administer or remove a prescription contraceptive. (2) The coverage required by subsection (1) of this section: (a) May be subject to provisions of the program, plan or policy that apply equally to other prescription drugs covered by the program, plan or policy, including but not limited to required copayments, deductibles and coinsurance; and (b) Must reimburse a health care provider or dispensing entity for a dispensing of contraceptives intended to last for a: (A) Three-month period for the first dispensing of the contraceptive to an insured; and (B) Twelve-month period for subsequent dispensings of the same contraceptive to the insured regardless of whether the insured was enrolled in the program, plan or policy at the time of the first dispensing. (3) As used in this section, "prescription contraceptive" means a drug or device that requires a prescription and is approved by the United States Food and Drug Administration to prevent pregnancy. (4) A religious employer is exempt from the requirements of this section with respect to a prescription drug benefit program or a health benefit plan it provides to its employees. A "religious employer" is an employer: (a) Whose purpose is the inculcation of religious values; (b) That primarily employs persons who share the religious tenets of the employer; (c) That primarily serves persons who share the religious tenets of the employer; and (d) That is a nonprofit organization under section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code. (5) This section is exempt from the provisions of ORS 743A.001. [2007 c.182 §3; 2015 c.412 §1; 2017 c.289 §4] Note: 743A.066 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.068 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.068 - Orally administered anticancer medication.

(1) A health benefit plan that provides coverage for cancer chemotherapy treatment must provide coverage for a prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. (2) As used in this section, "health benefit plan" has the meaning given that term in ORS 743B.005. (3) The provisions of ORS 743A.001 do not apply to this section. [2007 c.566 §2] Note: 743A.068 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.069 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.069 - Insulin.

(1) As used in this section: (a) "Health benefit plan" has the meaning given that term in ORS 743B.005. (b) "Insulin" has the meaning given that term in ORS 689.696. (2) A health benefit plan offered in this state may not require an enrollee in the plan to incur cost-sharing or other out-of-pocket costs, as adjusted under subsection (3) of this section, that exceed $75 for each 30-day supply of a type of insulin prescribed for the treatment of diabetes or $225 for each 90-day supply. (3) The Department of Consumer and Business Services shall, by rule, annually adjust the maximum cost specified in subsection (2) of this section by the percentage increase, if any, in the cost of living for the previous calendar year, based on changes in the Consumer Price Index for All Urban Consumers, West Region (All Items), as published by the Bureau of Labor Statistics of the United States Department of Labor. (4) The coverage under this section may not be subject to a deductible imposed by a health benefit plan. (5) This section does not prohibit a health benefit plan from using a drug formulary or other utilization review protocol applicable to prescription drug coverage under the plan. (6) This section is not subject to ORS 743A.001. [2021 c.160 §2] Note: 743A.069 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.070 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 743A - Health Insurance: Reimbursement of Claims|Section 743A.070 - Nonprescription enteral formula for home use.

(1) All policies providing health insurance, as defined in ORS 731.162, 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 a nonprescription elemental enteral formula for home use, if the formula is medically necessary for the treatment of severe intestinal malabsorption and a physician has issued a written order for the formula and the formula comprises the sole source, or an essential source, of nutrition. (2) 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 related to deductibles and coinsurance. Deductibles and coinsurance for elemental enteral formulas shall be no greater than those for any other treatment for the condition under the policy. (3) This section is exempt from ORS 743A.001. [Formerly 743.729; 2009 c.703 §1]