Oregon Statutes - Chapter 743A - Health Insurance: Required Reimbursements - Section 743A.012 - Emergency services.

(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.

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Last modified: August 7, 2008