(a) "Carrier" has the meaning given that term in ORS 743B.005.
(b) "Communication" includes:
(A) An explanation of benefits notice;
(B) Information about an appointment;
(C) A notice of an adverse benefit determination;
(D) A carrier’s or third party administrator’s request for additional information regarding a claim;
(E) A notice of a contested claim;
(F) The name and address of a provider, a description of services provided and other visit information; and
(G) Any written, oral or electronic communication described in this paragraph from a carrier or a third party administrator to a policyholder, certificate holder or enrollee that contains protected health information.
(c) "Confidential communications request" means a request from an enrollee to a carrier or third party administrator that communications be sent directly to the enrollee and that the carrier or third party administrator refrain from sending communications concerning the enrollee to the policyholder or certificate holder.
(d) "Protected health information" has the meaning given that term in ORS 192.556.
(2) A carrier and a third party administrator doing business in this state:
(a) Shall permit any enrollee to submit a confidential communications request.
(b) Shall update an enrollee on the status of implementing a confidential communications request upon the enrollee’s inquiry.
(3) The procedure adopted by a carrier or third party administrator for enrollees to make confidential communications requests:
(a) Must allow enrollees to use the form described in subsection (4) of this section and may also allow enrollees to make the request by other means such as telephone or the Internet.
(b) Shall ensure that the confidential communications request remains in effect until the enrollee revokes the request in writing or submits a new confidential communications request.
(c) Shall ensure that the confidential communications request is acted upon and implemented by the carrier or third party administrator not later than seven days after receipt of a request by electronic means or 30 days after receipt of a request in hard copy.
(d) May not require an enrollee to waive any right to limit disclosure under this section as a condition of eligibility for or coverage under a health benefit plan.
(e) Must be easy to understand and to complete.
(4) The Department of Consumer and Business Services shall work with stakeholders to develop and make available to the public a standardized form that an enrollee may submit to a carrier or third party administrator to make a confidential communications request. The department may encourage health care providers to clearly display the form and make it available to patients. At a minimum, the form must:
(a) Inform an enrollee about the enrollee’s right to have protected health information sent to the enrollee and not disclosed to the policyholder or certificate holder;
(b) Allow an enrollee to indicate where to redirect communications containing protected health information, including a specified mail or electronic mail address or specified telephone number;
(c) Allow an enrollee to designate a mail or electronic mail address or telephone number for the carrier or third party administrator to contact the enrollee if additional information or clarification is necessary to process the confidential communications request; and
(d) Include a disclaimer that it may take up to 30 days from the date of receipt for a carrier or third party administrator to process the form.
(5) If an insurer makes an adverse benefit determination regarding a claim concerning health care provided to an enrollee who has made a confidential communications request:
(a) The enrollee has the right to appeal the determination; and
(b) The policyholder or certificate holder may not appeal the adverse benefit determination unless the enrollee has signed an authorization to disclose claims information relevant to the appeal.
(6) As used in this section, "enrollee" does not include an individual who is in the custody of the Department of Corrections.
(7) The department shall interpret this section in a manner that is consistent with federal law. [2015 c.470 §2]
Note: 743B.555 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.