Bill Text: OR SB684 | 2011 | Regular Session | Introduced
Bill Title: Relating to health insurance.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2011-06-30 - In committee upon adjournment. [SB684 Detail]
Download: Oregon-2011-SB684-Introduced.html
76th OREGON LEGISLATIVE ASSEMBLY--2011 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 3138
Senate Bill 684
Sponsored by Senator ATKINSON
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.
Prohibits insurers from denying cancer treatment provided by
specified medical facilities on basis that treatment is
experimental or investigational. Requires health insurance
policies to contain list of medical procedures excluded from
coverage.
A BILL FOR AN ACT
Relating to health insurance; creating new provisions; and
amending ORS 743.405, 743.528, 750.055 and 750.333.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2011 Act is added to and made
a part of the Insurance Code. + }
SECTION 2. { + A health benefit plan that covers treatment for
cancer may not deny coverage of treatment for cancer provided by
an Oregon Health and Science University medical facility, the
City of Hope cancer center, the Fred Hutchinson Cancer Research
Center or the Burzynski Clinic on the basis that the treatment is
experimental or investigational. + }
SECTION 3. ORS 743.405 is amended to read:
743.405. An individual health insurance policy must meet the
following requirements:
(1) The entire money and other considerations therefor shall be
expressed therein.
(2) The time at which the insurance takes effect and terminates
shall be expressed therein.
(3) It shall purport to insure only one person, except that a
policy may insure, originally or by subsequent amendment, upon
the application of an adult member of a family who shall be
deemed the policyholder, any two or more eligible members of that
family, including husband, wife, dependent children or any
children under a specified age, which shall not exceed 19 years,
and any other person dependent upon the policyholder.
(4) The policy may not be issued individually to an individual
in a group of persons as described in ORS 743.522 for the purpose
of separating the individual from health insurance benefits
offered or provided in connection with a group health benefit
plan.
(5) Except as provided in ORS 743.498, the style, arrangement
and overall appearance of the policy may not give undue
prominence to any portion of the text, and every printed portion
of the text of the policy and of any indorsements or attached
papers shall be plainly printed in lightfaced type of a style in
general use, the size of which shall be uniform and not less than
10 point with a lower case unspaced alphabet length not less than
120 point. Captions shall be printed in not less than 12-point
type. As used in this subsection, 'text' includes all printed
matter except the name and address of the insurer, name or title
of the policy, the brief description if any, and captions and
subcaptions.
(6) The exceptions and reductions of indemnity must be set
forth in the policy. Except those required by ORS 743.411 to
743.477 and 743A.160, exceptions and reductions shall be printed
at the insurer's option either included with the applicable
benefit provision or under an appropriate caption such as
EXCEPTIONS, or EXCEPTIONS AND REDUCTIONS. However, if an
exception or reduction specifically applies only to a particular
benefit of the policy, a statement of the exception or reduction
must be included with the applicable benefit provision. { + The
policy must also set forth a complete list of medical procedures
that are specifically excluded from coverage under the
policy. + }
(7) Each form constituting the policy, including riders and
indorsements, must be identified by a form number in the lower
left-hand corner of the first page of the policy.
(8) The policy may not contain provisions purporting to make
any portion of the charter, rules, constitution or bylaws of the
insurer a part of the policy unless such portion is set forth in
full in the policy, except in the case of the incorporation of or
reference to a statement of rates or classification of risks, or
short rate table filed with the Director of the Department of
Consumer and Business Services.
SECTION 4. ORS 743.528 is amended to read:
743.528. A group health insurance policy shall contain in
substance the following provisions:
(1) A provision that, in the absence of fraud, all statements
made by applicants, the policyholder or an insured person shall
be deemed representations and not warranties, and that no
statement made for the purpose of effecting insurance shall avoid
the insurance or reduce benefits unless contained in a written
instrument signed by the policyholder or the insured person, a
copy of which has been furnished to the policyholder or to the
person or the beneficiary of the person.
(2) A provision that the insurer will furnish to the
policyholder for delivery to each employee or member of the
insured group a statement in summary form of the essential
features of the insurance coverage of the employee or member, to
whom the insurance benefits are payable, { - and - } the
applicable rights and conditions set forth in ORS 743.527,
743.529, 743.600 to 743.610 and 743.760 { + and a complete list
of medical procedures that are excluded from coverage under the
policy + }. If dependents are included in the coverage, only one
statement need be issued for each family unit.
(3) A provision that to the group originally insured may be
added from time to time eligible new employees or members or
dependents, as the case may be, in accordance with the terms of
the policy.
SECTION 5. ORS 750.055 is amended to read:
750.055. (1) The following provisions of the Insurance Code
apply to health care service contractors to the extent not
inconsistent with the express provisions of ORS 750.005 to
750.095:
(a) ORS 705.137, 705.139, 731.004 to 731.150, 731.162, 731.216
to 731.362, 731.382, 731.385, 731.386, 731.390, 731.398 to
731.430, 731.428, 731.450, 731.454, 731.488, 731.504, 731.508,
731.509, 731.510, 731.511, 731.512, 731.574 to 731.620, 731.592,
731.594, 731.640 to 731.652, 731.730, 731.731, 731.735, 731.737,
731.750, 731.752, 731.804, 731.844 to 731.992 and 731.870.
(b) ORS 732.215, 732.220, 732.230, 732.245, 732.250, 732.320,
732.325 and 732.517 to 732.592, not including ORS 732.582.
(c) ORS 733.010 to 733.050, 733.080, 733.140 to 733.170,
733.210, 733.510 to 733.680 and 733.695 to 733.780.
(d) ORS chapter 734.
(e) ORS 742.001 to 742.009, 742.013, 742.061, 742.065, 742.150
to 742.162, 742.400, 742.520 to 742.540, 743.010, 743.013,
743.018 to 743.030, 743.050, 743.100 to 743.109, 743.402,
743.472, 743.492, 743.495, 743.498, 743.522, 743.523, 743.524,
743.526, 743.527, 743.528, 743.529, 743.549 to 743.552, 743.560,
743.600 to 743.610, 743.650 to 743.656, 743.804, 743.807,
743.808, 743.814 to 743.839, 743.842, 743.845, 743.847, 743.854,
743.856, 743.857, 743.858, 743.859, 743.861, 743.862, 743.863,
743.864, 743.911, 743.912, 743.913, 743.917, 743A.010, 743A.012,
743A.020, 743A.036, 743A.048, 743A.058, 743A.062, 743A.064,
743A.066, 743A.068, 743A.070, 743A.080, 743A.084, 743A.088,
743A.090, 743A.100, 743A.104, 743A.105, 743A.110, 743A.140,
743A.141, 743A.144, 743A.148, 743A.160, 743A.164, 743A.168,
743A.170, 743A.175, 743A.184, 743A.188, 743A.190 and
743A.192 { + and section 2 of this 2011 Act + }.
(f) The provisions of ORS chapter 744 relating to the
regulation of insurance producers.
(g) ORS 746.005 to 746.140, 746.160, 746.220 to 746.370,
746.600, 746.605, 746.607, 746.608, 746.610, 746.615, 746.625,
746.635, 746.650, 746.655, 746.660, 746.668, 746.670, 746.675,
746.680 and 746.690.
(h) ORS 743A.024, except in the case of group practice health
maintenance organizations that are federally qualified pursuant
to Title XIII of the Public Health Service Act unless the patient
is referred by a physician associated with a group practice
health maintenance organization.
(i) ORS 735.600 to 735.650.
(j) ORS 743.680 to 743.689.
(k) ORS 744.700 to 744.740.
(L) ORS 743.730 to 743.773.
(m) ORS 731.485, except in the case of a group practice health
maintenance organization that is federally qualified pursuant to
Title XIII of the Public Health Service Act and that wholly owns
and operates an in-house drug outlet.
(2) For the purposes of this section, health care service
contractors shall be deemed insurers.
(3) Any for-profit health care service contractor organized
under the laws of any other state that is not governed by the
insurance laws of the other state is subject to all requirements
of ORS chapter 732.
(4) The Director of the Department of Consumer and Business
Services may, after notice and hearing, adopt reasonable rules
not inconsistent with this section and ORS 750.003, 750.005,
750.025 and 750.045 that are deemed necessary for the proper
administration of these provisions.
SECTION 6. ORS 750.333 is amended to read:
750.333. (1) The following provisions of the Insurance Code
apply to trusts carrying out a multiple employer welfare
arrangement:
(a) ORS 731.004 to 731.150, 731.162, 731.216 to 731.268,
731.296 to 731.316, 731.324, 731.328, 731.378, 731.386, 731.390,
731.398, 731.406, 731.410, 731.414, 731.418 to 731.434, 731.454,
731.484, 731.486, 731.488, 731.512, 731.574 to 731.620, 731.640
to 731.652 and 731.804 to 731.992.
(b) ORS 733.010 to 733.050, 733.140 to 733.170, 733.210,
733.510 to 733.680 and 733.695 to 733.780.
(c) ORS chapter 734.
(d) ORS 742.001 to 742.009, 742.013, 742.061 and 742.400.
(e) ORS 743.028, 743.053, 743.524, 743.526, 743.527, 743.528,
743.529, 743.530, 743.560, 743.562, 743.600, 743.601, 743.602,
743.610, 743.730 to 743.773 (except 743.760 to 743.773), 743.801,
743.804, 743.807, 743.808, 743.814 to 743.839, 743.842, 743.845,
743.847, 743.854, 743.856, 743.857, 743.858, 743.859, 743.861,
743.862, 743.863, 743.864, 743.912, 743.917, 743A.012, 743A.020,
743A.052, 743A.064, 743A.080, 743A.100, 743A.104, 743A.110,
743A.144, 743A.170, 743A.175, 743A.184 and 743A.192 { + and
section 2 of this 2011 Act + }.
(f) ORS 743A.010, 743A.014, 743A.024, 743A.028, 743A.032,
743A.036, 743A.040, 743A.048, 743A.058, 743A.066, 743A.068,
743A.070, 743A.084, 743A.088, 743A.090, 743A.105, 743A.140,
743A.141, 743A.148, 743A.168, 743A.180, 743A.188 and 743A.190.
Multiple employer welfare arrangements to which ORS 743.730 to
743.773 apply are subject to the sections referred to in this
paragraph only as provided in ORS 743.730 to 743.773.
(g) Provisions of ORS chapter 744 relating to the regulation of
insurance producers and insurance consultants, and ORS 744.700 to
744.740.
(h) ORS 746.005 to 746.140, 746.160 and 746.220 to 746.370.
(i) ORS 731.592 and 731.594.
(j) ORS 731.870.
(2) For the purposes of this section:
(a) A trust carrying out a multiple employer welfare
arrangement shall be considered an insurer.
(b) References to certificates of authority shall be considered
references to certificates of multiple employer welfare
arrangement.
(c) Contributions shall be considered premiums.
(3) The provision of health benefits under ORS 750.301 to
750.341 shall be considered to be the transaction of health
insurance.
SECTION 7. { + Section 2 of this 2011 Act and the amendments
to ORS 743.405, 743.528, 750.055 and 750.333 by sections 3 to 6
of this 2011 Act apply to health benefit plan policies or
certificates issued or renewed on or after the effective date of
this 2011 Act. + }
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