{"data":{"id":"us-or/ors-743b.277","jurisdiction":"us-or","citation":"ORS 743B.277","heading":"Credits to deductibles and out-of-pocket expenses; requirements; process.","body":"(1) An insurer offering a health benefit plan as defined in ORS 743B.005 shall credit any amount an enrollee pays directly to a health care provider to the enrollee’s deductible and annual out-of-pocket expenses if:\n      (a) The health care item or service is medically necessary and covered under the enrollee’s health benefit plan;\n      (b) The enrollee does not submit the claim to the insurer; and\n      (c) The amount paid to the health care provider is less than the average discounted rate for the item or service paid to an in-network health care provider with the same license.\n      (2) An insurer shall:\n      (a) Establish a process for an enrollee to submit a claim for the credit described in subsection (1) of this section, including the necessary documentation the enrollee is required to submit in support of the claim; or\n      (b) Require an enrollee to utilize the system the insurer uses to process and adjudicate claims to submit a claim for the credit described in subsection (1) of this section.\n      (3) Notwithstanding ORS 750.055 (1)(i), this section does not apply to a health maintenance organization as defined in ORS 750.005.","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":"8ee8b6592f649ef4010f050a0325aebd73946a1aad4a6434f6d4c83c19dbee0b","source_id":"us-or","stale":false,"prev":"us-or/ors-743b.275","next":"us-or/ors-743b.280"},"notice":"GroundRules: Original legal text. Not legal advice."}