(a) "Emergency services" has the meaning given that term in ORS 743A.012.
(b) "Enrollee" means:
(A) An individual who is enrolled in a health benefit plan or a covered dependent or beneficiary of the individual; or
(B) A subscriber to a health care service contract or a covered dependent or beneficiary of the subscriber.
(c) "Health benefit plan" has the meaning given that term in ORS 743B.005.
(d) "Health care facility" has the meaning given that term in ORS 442.015, excluding long term care facilities.
(e) "Health care service contractor" has the meaning given that term in ORS 750.005.
(f) "In-network" has the meaning given that term in ORS 743B.280.
(g) "Out-of-network" means a provider or provider group that has not contracted or has indirectly contracted with the insurer or health care service contractor.
(2) A provider who is an out-of-network provider may not bill an enrollee in the health benefit plan or health care service contract for emergency services or other inpatient or outpatient services provided at an in-network health care facility.
(3) Subsection (2) of this section does not apply:
(a) To applicable coinsurance, copayments or deductible amounts that apply to services provided by an in-network provider; or
(b) To services, other than emergency services, provided to enrollees who choose to receive services from an out-of-network provider.
(4) If an enrollee chooses to receive services from an out-of-network provider, the provider shall inform the enrollee that the enrollee will be financially responsible for coinsurance, copayments or other out-of-pocket expenses attributable to choosing an out-of-network provider. [2017 c.417 §2; 2018 c.43 §§4,6]
Note: 743B.287 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.