(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
(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 743A.001. [1999 c.749 §2]Section: Previous 743.831 743.833 743.834 743.835 743.837 743.839 743.840 743.842 743.845 743.847 743.850 743.851 743.852 743.853 743.854 Next
Last modified: August 7, 2008