70th OREGON LEGISLATIVE ASSEMBLY--1999 Regular Session
Enrolled
Senate Bill 16
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 Joint Interim Committee on
Human Resources for the Oregon Optometric Association)
CHAPTER ................
AN ACT
Relating to coverage of eye care services; creating new
provisions; and amending ORS 750.055 and 750.333.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 1999 Act is added to and made
a part of ORS chapter 743. + }
SECTION 2. { + (1) As used in this section:
(a) 'Eye care practitioner' means an optometrist or
ophthalmologist licensed by the State of Oregon.
(b) 'Eye care services' means health care services related to
the care of the eye and related structures as specified by a
health benefit plan.
(c) 'Health benefit plan' has the meaning provided for that
term in ORS 743.730.
(2) Any insurer that offers a health benefit plan that provides
coverage of eye care services shall allow any enrollee to receive
covered eye care services on an emergency basis without first
receiving a referral or prior authorization from a primary care
provider. However, an insurer may require the enrollee to receive
a referral or prior authorization from a primary care provider
for any subsequent surgical procedures. Nothing in this
subsection shall be construed to require that covered eye care
services rendered by an eye care practitioner on an emergency
basis be furnished in a hospital or similar medical facility.
(3) An insurer described in subsection (2) of this section may
not:
(a) Impose a deductible or coinsurance for eye care services
that is greater than the deductible or coinsurance imposed for
other medical services under the health benefit plan.
(b) Require an eye care practitioner to hold hospital
privileges as a condition of participation as a provider in the
health benefit plan.
(4) Nothing in this section:
(a) Requires an insurer to provide coverage or reimbursement of
eye care services;
(b) Requires an insurer to provide coverage or reimbursement of
refractive surgery, ophthalmic materials, lenses, eyeglasses or
other appurtenances; or
Enrolled Senate Bill 16 (SB 16-A) Page 1
(c) Prevents an enrollee from receiving eye care or other
covered services from the enrollee's primary care provider in
accordance with the terms of the enrollee's health benefit plan.
(5) This section is exempt from ORS 743.700. + }
SECTION 3. ORS 750.055 is amended to read:
750.055. (1) The following provisions of the Insurance Code
shall apply to health care service contractors to the extent so
applicable and not inconsistent with the express provisions of
ORS 750.005 to 750.095:
(a) ORS 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, 731.450,
731.454, 731.488, 731.504, 731.508, 731.509, 731.510, 731.511,
731.512, 731.574 to 731.620, 731.640 to 731.652, 731.730,
731.731, 731.735, 731.737, 731.740, 731.750, 731.804 and 731.844
to 731.992.
(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 732.549 and
732.574 to 732.592.
(c)(A) ORS 733.010 to 733.050, 733.080, 733.140 to 733.170,
733.210, 733.510 to 733.620, 733.635 to 733.680 and 733.695 to
733.780 apply to not-for-profit health care service contractors.
(B) ORS chapter 733, not including ORS 733.630, applies to
for-profit health care service contractors.
(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,
743.412, 743.472, 743.492, 743.495, 743.498, 743.523 to 743.527,
743.529, 743.549 to 743.555, 743.556, 743.560, 743.600 to
743.610, 743.650 to 743.656, 743.697, 743.699, 743.701, 743.704,
743.706 to 743.712, 743.721, 743.722, 743.726, 743.727, 743.728,
743.729, 743.804, 743.807, 743.808, 743.809, 743.814 to 743.839,
743.845 and 743.847 { + and section 2 of this 1999 Act + }.
(f) ORS 743.522 and 743.528, except that individual policies
may be issued to the persons or families insured in lieu of
issuance of a single group policy as referred to in ORS 743.522.
An individual policy issued under this paragraph shall be
considered the statement of the essential features of the
insurance coverage required under ORS 743.528 (2).
(g) The provisions of ORS chapter 744 relating to the
regulation of agents.
(h) ORS 746.005 to 746.140, 746.160, 746.180, 746.220 to
746.370 and 746.600 to 746.690.
(i) ORS 743.714, 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.
(j) ORS 735.600 to 735.650.
(k) ORS 743.680 to 743.689.
(L) ORS 744.700 to 744.740.
(m) ORS 743.730 to 743.773.
(n) 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 only, health care service
contractors shall be deemed insurers.
(3) Any for-profit health care service contractor organized
under the laws of any other state which is not governed by the
Enrolled Senate Bill 16 (SB 16-A) Page 2
insurance laws of such state, will be 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 4. ORS 750.055, as amended by section 5, chapter 759,
Oregon Laws 1997, is amended to read:
750.055. (1) The following provisions of the Insurance Code
shall apply to health care service contractors to the extent so
applicable and not inconsistent with the express provisions of
ORS 750.005 to 750.095:
(a) ORS 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, 731.450,
731.454, 731.488, 731.504, 731.508, 731.509, 731.510, 731.511,
731.512, 731.574 to 731.620, 731.640 to 731.652, 731.730,
731.731, 731.735, 731.737, 731.740, 731.750, 731.804 and 731.844
to 731.992.
(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 732.549 and
732.574 to 732.592.
(c)(A) ORS 733.010 to 733.050, 733.080, 733.140 to 733.170,
733.210, 733.510 to 733.620, 733.635 to 733.680 and 733.695 to
733.780 apply to not-for-profit health care service contractors.
(B) ORS chapter 733, not including ORS 733.630, applies to
for-profit health care service contractors.
(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,
743.412, 743.472, 743.492, 743.495, 743.498, 743.523 to 743.527,
743.529, 743.549 to 743.555, 743.556, 743.560, 743.600 to
743.610, 743.650 to 743.656, 743.697, 743.699, 743.701, 743.704,
743.706 to 743.712, 743.721, 743.722, 743.726, 743.727, 743.728,
743.729, 743.804, 743.807, 743.808, 743.809, 743.814 to 743.839,
743.845 and 743.847 and section 2, chapter 759, Oregon Laws
1997 { + , and section 2 of this 1999 Act + }.
(f) ORS 743.522 and 743.528, except that individual policies
may be issued to the persons or families insured in lieu of
issuance of a single group policy as referred to in ORS 743.522.
An individual policy issued under this paragraph shall be
considered the statement of the essential features of the
insurance coverage required under ORS 743.528 (2).
(g) The provisions of ORS chapter 744 relating to the
regulation of agents.
(h) ORS 746.005 to 746.140, 746.160, 746.180, 746.220 to
746.370 and 746.600 to 746.690.
(i) ORS 743.714, 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.
(j) ORS 735.600 to 735.650.
(k) ORS 743.680 to 743.689.
(L) ORS 744.700 to 744.740.
(m) ORS 743.730 to 743.773.
(n) ORS 731.485, except in the case of a group practice health
maintenance organization that is federally qualified pursuant to
Enrolled Senate Bill 16 (SB 16-A) Page 3
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 only, health care service
contractors shall be deemed insurers.
(3) Any for-profit health care service contractor organized
under the laws of any other state which is not governed by the
insurance laws of such state, will be 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 5. { + Nothing in the amendments to ORS 750.055 by
section 3 or 4 of this 1999 Act affects the repealing or
operative date provisions of section 7, chapter 759, Oregon Laws
1997. + }
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, 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, 743.699, 743.730 to 743.773 (except 743.760 to 743.773),
743.804, 743.807, 743.808, 743.809, 743.814 to 743.839, 743.845
and 743.847 { + and section 2 of this 1999 Act + }.
(f) ORS 743.556, 743.701, 743.703, 743.704, 743.706, 743.707,
743.709, 743.710, 743.712, 743.713, 743.714, 743.717, 743.718,
743.719, 743.721, 743.722, 743.725 and 743.726. 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
agents and insurance consultants, and ORS 744.700 to 744.740.
(h) ORS 746.005 to 746.140, 746.160, 746.180 and 746.220 to
746.370.
(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. ORS 750.333, as amended by section 6, chapter 759,
Oregon Laws 1997, is amended to read:
750.333. (1) The following provisions of the Insurance Code
apply to trusts carrying out a multiple employer welfare
arrangement:
Enrolled Senate Bill 16 (SB 16-A) Page 4
(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, 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, 743.699, 743.730 to 743.773 (except 743.760 to 743.773),
743.804, 743.807, 743.808, 743.809, 743.814 to 743.839, 743.845
and 743.847 and section 2, chapter 759, Oregon Laws 1997 { + ,
and section 2 of this 1999 Act + }.
(f) ORS 743.556, 743.701, 743.703, 743.704, 743.706, 743.707,
743.709, 743.710, 743.712, 743.713, 743.714, 743.717, 743.718,
743.719, 743.721, 743.722, 743.725 and 743.726. 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
agents and insurance consultants, and ORS 744.700 to 744.740.
(h) ORS 746.005 to 746.140, 746.160, 746.180 and 746.220 to
746.370.
(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 8. { + Nothing in the amendments to ORS 750.333 by
section 6 or 7 of this 1999 Act affects the repealing or
operative date provisions of section 7, chapter 759, Oregon Laws
1997. + }
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Passed by Senate May 14, 1999
...........................................................
Secretary of Senate
...........................................................
President of Senate
Passed by House June 25, 1999
...........................................................
Speaker of House
Enrolled Senate Bill 16 (SB 16-A) Page 5
Received by Governor:
......M.,............., 1999
Approved:
......M.,............., 1999
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 1999
...........................................................
Secretary of State
Enrolled Senate Bill 16 (SB 16-A) Page 6