Bill Text: OR SB165 | 2013 | Regular Session | Introduced

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Bill Title: Relating to cost-sharing required by health benefit plan; declaring an emergency.

Spectrum: Committee Bill

Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB165 Detail]

Download: Oregon-2013-SB165-Introduced.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 1312

                         Senate Bill 165

Printed pursuant to Senate Interim Rule 213.28 by order of the
  President of the Senate in conformance with presession filing
  rules, indicating neither advocacy nor opposition on the part
  of the President (at the request of Senate Interim Committee on
  Health Care, Human Services and Rural Health Policy for Oregon
  Diabetes Educators, MS Society of Oregon, Hemophilia Foundation
  of Oregon, Molly's Fund Fighting Lupus, Cascade AIDS Project)

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.

  Adds definitions for 'cost-sharing' and 'essential health
benefits' to Insurance Code. Limits cost-sharing amounts that may
be required under health benefit plans. Applies to policies and
certificates issued or renewed on or after January 1, 2014.
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to cost-sharing required by health benefit plan; and
  declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + Sections 2, 3 and 4 of this 2013 Act are added
to and made a part of the Insurance Code. + }
  SECTION 2.  { + (1) 'Cost-sharing' includes:
  (a) Deductibles, coinsurance, copayments or similar charges;
and
  (b) Any other expenditure required of an insured with respect
to health services covered under a policy or certificate of
health insurance.
  (2) 'Cost-sharing' does not include premiums, balance billing
amounts for non-network providers or costs of services not
covered by the health insurance policy or certificate. + }
  SECTION 3.  { +  ' Essential health benefits' are the items and
services prescribed by the Department of Consumer and Business
Services by rule in collaboration with the Oregon Health Policy
Board and in accordance with federal law, including but not
limited to all of the following:
  (1) Ambulatory patient services.
  (2) Emergency services.
  (3) Hospitalization.
  (4) Maternity and newborn care.
  (5) Mental health and substance use disorder services,
including behavioral health treatment.
  (6) Prescription drugs.
  (7) Rehabilitative and habilitative services and devices.
  (8) Laboratory services.
  (9) Preventive and wellness services and chronic disease
management.
  (10) Pediatric services, including oral and vision care.
  (11) Other items and services prescribed by the department, as
required or permitted by federal law. + }
  SECTION 4.  { + (1) As used in this section, 'health benefit
plan' has the meaning given that term in ORS 743.730.
  (2) A health benefit plan offered to a resident of this state
may not impose annual cost-sharing:
  (a) That exceeds amounts specified in 42 U.S.C. 18022 with
respect to essential health benefits.
  (b) For all health services covered by the plan, amounts that
exceed:
  (A) $5,950 for an individual; or
  (B) $11,950 for a family. + }
  SECTION 5.  { + Section 4 of this 2013 applies to policies and
certificates issued or renewed on or after January 1, 2014. + }
  SECTION 6.  { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
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