Bill Text: OR HB4128 | 2012 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relating to treatment for craniofacial anomalies.

Spectrum: Strong Partisan Bill (Democrat 18-1)

Status: (Passed) 2012-03-05 - Chapter 21, (2012 Laws): Effective date January 1, 2013. [HB4128 Detail]

Download: Oregon-2012-HB4128-Introduced.html

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     76th OREGON LEGISLATIVE ASSEMBLY--2012 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 25

                         House Bill 4128

Sponsored by Representatives HOYLE, WEIDNER; Representatives
  BARNHART, DEMBROW, DOHERTY, GARRETT, GELSER, HOLVEY, MATTHEWS,
  SCHAUFLER, TOMEI (Presession filed.)

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.

  Requires health benefit plans to cover medically necessary
dental or orthodontic services for treatment of craniofacial
anomalies.

                        A BILL FOR AN ACT
Relating to treatment for craniofacial anomalies; creating new
  provisions; and amending ORS 750.055 and 750.333.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + Section 2 of this 2012 Act is added to and made
a part of the Insurance Code. + }
  SECTION 2.  { + (1) As used in this section, 'craniofacial
anomaly' includes any congenital anomaly affecting the face or
head, including but not limited to cleft palate, cleft lip,
craniosynostosis, craniofacial microsomia and Treacher Collins
syndrome.
  (2) All health benefit plans, as defined in ORS 743.730,
providing coverage of hospital, surgical or dental services,
shall provide coverage for dental and orthodontic services for
the treatment of craniofacial anomalies if the services are
medically necessary to improve or restore function.
  (3) Coverage required by this section may be subject to
copayments, deductibles and coinsurance imposed on similar
services by the terms of the plan.
  (4) This section does not limit or supersede any coverage
required by ORS 743A.028, 743A.032 or 743A.148.
  (5) This section is exempt from ORS 743A.001. + }
  SECTION 3. ORS 750.055 is amended to read:
  750.055. (1) The following provisions of the Insurance Code
apply to health care service contractors to the extent not
inconsistent with the express provisions of ORS 750.005 to
750.095:
  (a) ORS 705.137, 705.139, 731.004 to 731.150, 731.162, 731.216
to 731.362, 731.382, 731.385, 731.386, 731.390, 731.398 to
731.430, 731.428, 731.450, 731.454, 731.488, 731.504, 731.508,
731.509, 731.510, 731.511, 731.512, 731.574 to 731.620, 731.592,
731.594, 731.640 to 731.652, 731.730, 731.731, 731.735, 731.737,
731.750, 731.752, 731.804, 731.844 to 731.992, 731.870 and
743.061.

  (b) ORS 732.215, 732.220, 732.230, 732.245, 732.250, 732.320,
732.325 and 732.517 to 732.592, not including ORS 732.582.
  (c) ORS 733.010 to 733.050, 733.080, 733.140 to 733.170,
733.210, 733.510 to 733.680 and 733.695 to 733.780.
  (d) ORS chapter 734.
  (e) ORS 742.001 to 742.009, 742.013, 742.061, 742.065, 742.150
to 742.162, 742.400, 742.520 to 742.540, 743.010, 743.013,
743.018 to 743.030, 743.050, 743.100 to 743.109, 743.402,
743.472, 743.492, 743.495, 743.498, 743.499, 743.522, 743.523,
743.524, 743.526, 743.527, 743.528, 743.529, 743.549 to 743.552,
743.560, 743.600 to 743.610, 743.650 to 743.656, 743.764,
743.804, 743.807, 743.808, 743.814 to 743.839, 743.842, 743.845,
743.847, 743.854, 743.856, 743.857, 743.858, 743.859, 743.861,
743.862, 743.863, 743.864, 743.894, 743.911, 743.912, 743.913,
743.917, 743A.010, 743A.012, 743A.020, 743A.034, 743A.036,
743A.048, 743A.058, 743A.062, 743A.064, 743A.065, 743A.066,
743A.068, 743A.070, 743A.080, 743A.084, 743A.088, 743A.090,
743A.100, 743A.104, 743A.105, 743A.110, 743A.140, 743A.141,
743A.144, 743A.148, 743A.160, 743A.164, 743A.168, 743A.170,
743A.175, 743A.184, 743A.185, 743A.188, 743A.190 and
743A.192 { +  and section 2 of this 2012 Act + }.
  (f) The provisions of ORS chapter 744 relating to the
regulation of insurance producers.
  (g) ORS 746.005 to 746.140, 746.160, 746.220 to 746.370,
746.600, 746.605, 746.607, 746.608, 746.610, 746.615, 746.625,
746.635, 746.650, 746.655, 746.660, 746.668, 746.670, 746.675,
746.680 and 746.690.
  (h) ORS 743A.024, except in the case of group practice health
maintenance organizations that are federally qualified pursuant
to Title XIII of the Public Health Service Act unless the patient
is referred by a physician associated with a group practice
health maintenance organization.
  (i) ORS 735.600 to 735.650.
  (j) ORS 743.680 to 743.689.
  (k) ORS 744.700 to 744.740.
  (L) ORS 743.730 to 743.773.
  (m) ORS 731.485, except in the case of a group practice health
maintenance organization that is federally qualified pursuant to
Title XIII of the Public Health Service Act and that wholly owns
and operates an in-house drug outlet.
  (2) For the purposes of this section, health care service
contractors shall be deemed insurers.
  (3) Any for-profit health care service contractor organized
under the laws of any other state that is not governed by the
insurance laws of the other state is subject to all requirements
of ORS chapter 732.
  (4) The Director of the Department of Consumer and Business
Services may, after notice and hearing, adopt reasonable rules
not inconsistent with this section and ORS 750.003, 750.005,
750.025 and 750.045 that are deemed necessary for the proper
administration of these provisions.
  SECTION 4. ORS 750.333 is amended to read:
  750.333. (1) The following provisions of the Insurance Code
apply to trusts carrying out a multiple employer welfare
arrangement:
  (a) ORS 731.004 to 731.150, 731.162, 731.216 to 731.268,
731.296 to 731.316, 731.324, 731.328, 731.378, 731.386, 731.390,
731.398, 731.406, 731.410, 731.414, 731.418 to 731.434, 731.454,
731.484, 731.486, 731.488, 731.512, 731.574 to 731.620, 731.640
to 731.652, 731.804 to 731.992 and 743.061.
  (b) ORS 733.010 to 733.050, 733.140 to 733.170, 733.210,
733.510 to 733.680 and 733.695 to 733.780.
  (c) ORS chapter 734.
  (d) ORS 742.001 to 742.009, 742.013, 742.061 and 742.400.
  (e) ORS 743.028, 743.053, 743.499, 743.524, 743.526, 743.527,
743.528, 743.529, 743.530, 743.560, 743.562, 743.600, 743.601,
743.602, 743.610, 743.730 to 743.773 (except 743.760 to 743.773),
743.801, 743.804, 743.807, 743.808, 743.814 to 743.839, 743.842,
743.845, 743.847, 743.854, 743.856, 743.857, 743.858, 743.859,
743.861, 743.862, 743.863, 743.864, 743.894, 743.912, 743.917,
743A.012, 743A.020, 743A.034, 743A.052, 743A.064, 743A.065,
743A.080, 743A.100, 743A.104, 743A.110, 743A.144, 743A.170,
743A.175, 743A.184 and 743A.192 { +  and section 2 of this 2012
Act + }.
  (f) ORS 743A.010, 743A.014, 743A.024, 743A.028, 743A.032,
743A.036, 743A.040, 743A.048, 743A.058, 743A.066, 743A.068,
743A.070, 743A.084, 743A.088, 743A.090, 743A.105, 743A.140,
743A.141, 743A.148, 743A.168, 743A.180, 743A.185, 743A.188 and
743A.190. Multiple employer welfare arrangements to which ORS
743.730 to 743.773 apply are subject to the sections referred to
in this paragraph only as provided in ORS 743.730 to 743.773.
  (g) Provisions of ORS chapter 744 relating to the regulation of
insurance producers and insurance consultants, and ORS 744.700 to
744.740.
  (h) ORS 746.005 to 746.140, 746.160 and 746.220 to 746.370.
  (i) ORS 731.592 and 731.594.
  (j) ORS 731.870.
  (2) For the purposes of this section:
  (a) A trust carrying out a multiple employer welfare
arrangement shall be considered an insurer.
  (b) References to certificates of authority shall be considered
references to certificates of multiple employer welfare
arrangement.
  (c) Contributions shall be considered premiums.
  (3) The provision of health benefits under ORS 750.301 to
750.341 shall be considered to be the transaction of health
insurance.
  SECTION 5.  { + Section 2 of this 2012 Act applies to policies
or certificates issued or renewed on or after the effective date
of this 2012 Act. + }
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