Bill Text: OR HB2484 | 2011 | Regular Session | Introduced

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Bill Title: Relating to coordination of health insurance benefits.

Spectrum: Unknown

Status: (Failed) 2011-06-30 - In committee upon adjournment. [HB2484 Detail]

Download: Oregon-2011-HB2484-Introduced.html

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     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 1741

                         House Bill 2484

Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
  Presession filed (at the request of House Interim Committee on
  Consumer Protection and Government Accountability)

                             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.

  Requires insurers to comply with coordination of benefits
guidelines adopted by Director of Department of Consumer and
Business Services by rule. Expands procedures covered under
guidelines to include determination by insurers of amount of
benefits payable and notification of amount determined to insured
and provider. Requires director to resolve disputes between
insurers regarding amount of benefits payable.

                        A BILL FOR AN ACT
Relating to coordination of health insurance benefits; amending
  ORS 743.549 and 743.552; and repealing ORS 743.459 and 743.462.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 743.549 is amended to read:
  743.549.  { + (1) + }   { - No group or blanket health
insurance policy providing hospital, medical or surgical expense
benefits, and which contains a provision for the reduction of
benefits otherwise payable thereunder on the basis of other
existing coverages, shall provide that such reduction operates to
reduce total benefits payable below an amount equal to 100
percent of total allowable expenses, except as provided for in a
collective bargaining agreement. - }   { + A group or blanket
health insurance policy providing hospital, medical or surgical
expense benefits and that contains a provision for the reduction
of benefits otherwise payable under the policy on the basis of
other existing coverages may not operate to reduce total benefits
payable below an amount equal to 100 percent of total allowable
expenses, except as provided for in a collective bargaining
agreement.
  (2) An insurer offering a policy containing a provision
described in this section shall comply with rules adopted by the
Director of the Department of Consumer and Business Services
under ORS 743.552. + }
  SECTION 2. ORS 743.552 is amended to read:
  743.552. The Director of the Department of Consumer and
Business Services shall by rule establish guidelines for the
application of ORS 743.549, including:
  (1) The procedures by which persons insured under such policies
are to be made aware of the existence of such a provision  { +

and of the procedures described in subsection (5) of this
section + };
  (2) The benefits which may be subject to such a provision;
  (3) The effect of such a provision on the benefits provided;
  (4) Establishment of the order of benefit determination; and
  (5) Reasonable claim administration procedures to expedite
 { +  and ensure the accuracy of + } claim payments under such a
provision { + , + } which shall include { + :
  (a) Steps that insurers must take in carrying out such a
provision to ensure that the requirements of ORS 743.459 are met;
  (b) Resolution by the director of any disputes arising between
the primary insurer and other insurers providing coverage subject
to such a provision;
  (c) Notification to the insured and to a provider of the amount
determined by the primary insurer to be payable to the provider;
and
  (d) + } A time limit of 14 days beyond which   { - the - }
 { +  an + } insurer shall not delay payment of a claim by reason
of the application of coordination of benefits provision.
  SECTION 3.  { + ORS 743.459 and 743.462 are repealed. + }
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