Insurance Policies Generally

ORS 742.424
Requirement for contract with provider

  • contents of contract
  • retention of record


(1)

A discount medical plan organization shall have a written contract or other written agreement with all providers or provider networks that the organization includes or purports to include in a discount medical plan, or with an entity that contracts with or enters into an agreement with a provider network on the organization’s behalf.

(2)

The contract or other agreement between a discount medical plan organization and a provider must include:

(a)

A list of the medical and ancillary services included in the discount medical plan;

(b)

The provider’s discount rate or rates or a schedule that reflects the provider’s fixed or discounted prices for the medical and ancillary services subject to the discount medical plan; and

(c)

A provision in which the provider agrees not to charge plan members more for medical and ancillary services than the amount listed in the provider’s price schedule or an amount that reflects the application of the provider’s discount rate.

(3)

The contract or other agreement between a discount medical plan organization and a provider network, or between an entity and a provider network when the entity contracts with or enters into an agreement with a provider network on the organization’s behalf, shall require the provider network to have written agreements with providers that, in addition to meeting the requirements of subsection (2) of this section:

(a)

Authorize the provider network to contract with or enter into an agreement with the discount medical plan organization or the entity on behalf of the provider; and

(b)

Require the provider network to maintain an up-to-date list of the providers that are part of the provider network and to provide the updated list each month to the discount medical plan organization.

(4)

A discount medical plan organization shall retain copies of the contracts or agreements and other documents described in this section at all times during which the organization operates in this state. [2007 c.272 §4]
Note: See note under 742.420 (Definitions for ORS 742.420 to 742.440).

Source

Last accessed
Jun. 26, 2021