(a) "Health benefit plan" has the meaning given that term in ORS 743B.005.
(b) "Originating site" means a location where health services are provided or where the patient is receiving a telemedical health service.
(c) "Telemedical" means delivered through a two-way electronic communication, including but not limited to video, audio, Voice over Internet Protocol or transmission of telemetry, that allows a health professional to interact with a patient, a parent or guardian of a patient or another health professional on a patient’s behalf, who is at an originating site.
(2) A health benefit plan must provide coverage of a telemedical health service provided in connection with the treatment of diabetes if:
(a) The plan provides coverage of the health service when provided in person by the health professional;
(b) The health service is medically necessary;
(c) The telemedical health service relates to a specific patient; and
(d) One of the participants in the telemedical health service is a representative of an academic health center.
(3) A health benefit plan may not distinguish between rural and urban originating sites in providing coverage under subsection (2) of this section.
(4) A health benefit plan may subject coverage of a telemedical health service under subsection (2) of this section to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in person.
(5) This section does not require a health benefit plan to reimburse a provider for a health service that is not a covered benefit under the plan. [2011 c.312 §2]
Note: See 743A.001.
Note: 743A.185 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.