{"data":{"id":"us-or/ors-743b.220","jurisdiction":"us-or","citation":"ORS 743B.220","heading":"Requirements for insurers that require designation of participating primary care physician; exceptions.","body":"(1) All insurers offering a health benefit plan in this state that requires an enrollee to designate a participating primary care physician shall:\n      (a) Permit the enrollee to change participating primary care physicians at will, except that the enrollee may be restricted to making changes no more frequently than two times in any 12-month period and may be limited to designating only those participating primary care physicians accepting new patients.\n      (b) Have available for employer purchasers of group health plans a point-of-service benefit plan providing for payment for the services of a provider on a fee-for-service or discounted fee-for-service basis with reasonable access to a broad array of licensed providers in the insurer’s geographic service area. Any higher premium for the point-of-service benefit plan may not exceed true actuarial cost, including administrative costs, to the insurer.\n      (2) A health maintenance organization that is exempt from federal income tax under Internal Revenue Code section 501(c)(3) or (4) shall not be required to offer a point-of-service benefit plan as required by subsection (1)(b) of this section if offering such a plan could result in loss of federal tax-exempt status. Until such time as the federal government establishes guidelines for health maintenance organizations exempt from federal income tax that offer point-of-service benefit plans, such a health maintenance organization shall not be required to offer a point-of-service benefit plan if:\n      (a) Enrollment in Internal Revenue Code section 501(m) coverages exceeds five percent of its business; or\n      (b) Revenue from Internal Revenue Code section 501(m) coverages exceeds five percent of its revenue.\n      (3) A health maintenance organization that is federally qualified under 42 U.S.C. 300e et seq. shall not be required to offer a point-of-service benefit plan in a manner or to an extent that is inconsistent with federal law and regulation.","path":["18 - Financial Institutions, Insurance","56. Insurance","Chapter 743B — Health Benefit Plans: Individual and Group"],"source_url":"https://www.oregonlegislature.gov/bills_laws/ors/ors743B.html","current_through":"2025 Edition","vintage":"","retrieved_at":"2026-09-03T23:50:17Z","sha256":"7697daefa7a64b4b0aa8f0137fa934cef9cacfdfbed0da72016088f08599e4ac","source_id":"us-or","stale":false,"prev":"us-or/ors-743b.206","next":"us-or/ors-743b.221"},"notice":"GroundRules: Original legal text. Not legal advice."}