(1) All insurers offering a health benefit plan shall provide coverage without prior authorization for:
(a) Emergency medical screening exams;
(b) Stabilization of an emergency medical condition; and
(c) Emergency services provided by a nonparticipating provider if a prudent layperson possessing an average knowledge of health and medicine would reasonably believe that the time required to go to a participating provider would place the health of the person, or a fetus in the case of a pregnant woman, in serious jeopardy.
(2) All insurers described in subsection (1) of this section shall provide information to enrollees in plain language regarding:
(a) What constitutes an emergency medical condition;
(b) The coverage provided for emergency services;
(c) How and where to obtain emergency services; and
(d) The appropriate use of 9-1-1.
(3) An insurer offering a health benefit plan may not discourage appropriate use of 9-1-1 and shall not deny coverage for emergency services solely because 9-1-1 was used.
(4) This section is exempt from ORS 743A.001. [Formerly 743.699]
Note: See definitions in 743.801.
Section: Previous 743A.001 743A.010 743A.012 743A.014 743A.020 743A.024 743A.028 743A.032 743A.036 743A.040 743A.044 743A.048 743A.050 743A.060 743A.062 NextLast modified: August 7, 2008