2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743B - Health Benefit Plans: Individual and Group › Section 743B.221 - Assignment of beneficiaries to primary care providers; rules.

(1) As used in this section, "primary care provider" means an individual 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. [2022 c.37 §8]
Note:
The amendments to 743B.221 by section 14, chapter 37, Oregon Laws 2022, become operative December 31, 2027. See section 5, chapter 575, Oregon Laws 2015, as amended by section 8, chapter 26, Oregon Laws 2016, section 19, chapter 489, Oregon Laws 2017, and section 15, chapter 37, Oregon Laws 2022. The text that is operative on and after December 31, 2027, is set forth for the user’s convenience.
(1) As used in this section, "primary care provider" means an individual 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 and ensure collaboration between insurers and providers.
Note:
743B.221 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.