ORS 743A.310
Primary care visits

  • rules

(1)

As used in this section, “primary care” means outpatient behavioral health services, nonspecialty medical services or the coordination of health care for the purpose of:

(a)

Promoting or maintaining behavioral and physical health and wellness; and

(b)

Diagnosis, treatment or management of acute or chronic conditions caused by disease, injury or illness.

(2)

An individual or group policy or certificate of health insurance that is not offered on the health insurance exchange and that reimburses the cost of hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases and limited benefit coverage, shall, in each plan year, reimburse the cost of at least three primary care visits for behavioral health or physical health treatment.

(3)

The coverage under subsection (2) of this section:

(a)

May not be subject to copayments, coinsurance or deductibles, except as provided in ORS 742.008 (Health savings account exemption from prohibition on deductible) and subsection (5) of this section; and

(b)

Is in addition to one annual preventive primary care visit that must be covered without cost-sharing.

(4)

An insurer that offers a qualified health plan on the health insurance exchange must offer at least one plan in each metal tier offered by the insurer that provides the coverage described in subsections (2) and (3) of this section.

(5)

The Department of Consumer and Business Services may adopt rules to allow an individual or group policy or certificate of health insurance to impose a copayment of not more than $5 for a primary care visit if necessary to comply with the requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343).

(6)

This section does not apply to health benefit plans offered to public employees by insurers that contract with the Public Employees’ Benefit Board or the Oregon Educators Benefit Board.

(7)

This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance). [2022 c.37 §6; 2023 c.425 §5]
Note: 743A.310 (Primary care visits) 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.

Source: Section 743A.310 — Primary care visits; rules, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html (accessed May 26, 2025).

743A.001
Automatic repeal of certain statutes on individual and group health insurance 743A.010
Services provided by state hospital or state approved program 743A.012
Emergency services 743A.014
Payments for ambulance care and transportation 743A.018
Services provided by osteopathic physician 743A.020
Services provided by acupuncturist 743A.024
Services provided by clinical social worker 743A.028
Services provided by denturist 743A.032
Surgical services provided by dentist 743A.034
Services provided by expanded practice dental hygienist 743A.036
Services provided by licensed nurse practitioner or licensed physician assistant 743A.040
Services provided by optometrist 743A.044
Services provided by physician assistant 743A.048
Services provided by psychologist 743A.051
Services provided by pharmacist 743A.052
Services provided by professional counselor or marriage and family therapist 743A.058
Telemedicine services 743A.060
Definition for ORS 743A.062 743A.062
Prescription drugs 743A.063
Ninety-day supply of prescription drug refills 743A.064
Prescription drugs dispensed at rural health clinics 743A.065
Early refills of prescription eye drops for treatment of glaucoma 743A.066
Contraceptives 743A.067
Reproductive health services 743A.068
Orally administered anticancer medication 743A.069
Insulin 743A.070
Nonprescription enteral formula for home use 743A.078
Newborn nurse home visiting services 743A.080
Pregnancy and childbirth expenses 743A.082
Diabetes management for pregnant women 743A.084
Unmarried women and their children 743A.088
Use by mother of diethylstilbestrol 743A.090
Natural and adopted children 743A.100
Mammograms 743A.101
Supplemental or diagnostic breast examinations 743A.104
Pelvic examinations and Pap smear examinations 743A.105
HPV vaccine 743A.108
Physical examination of breast 743A.110
Mastectomy-related services 743A.111
Consumer education about post-mastectomy services 743A.124
Colorectal cancer screenings and laboratory tests 743A.130
Proton beam therapy 743A.140
Bilateral cochlear implants 743A.141
Hearing aids and assistive listening devices 743A.145
Orthotic and prosthetic devices 743A.148
Maxillofacial prosthetic services 743A.150
Treatment of craniofacial anomaly 743A.160
Alcoholism treatment 743A.168
Behavioral health treatment 743A.169
Behavioral and physical health services provided on same day or in same facility 743A.170
Tobacco use cessation programs 743A.175
Traumatic brain injury 743A.180
Tourette Syndrome 743A.185
Telemedical health services for treatment of diabetes 743A.188
Inborn errors of metabolism 743A.190
Children with pervasive developmental disorder 743A.192
Clinical trials 743A.250
Emergency eye care services 743A.252
Child abuse assessments 743A.260
Inmates 743A.262
Preventive health services 743A.264
Disease outbreaks, epidemics and conditions of public health importance 743A.310
Primary care visits 743A.315
Treatment for pediatric autoimmune neuropsychiatric disorders 743A.325
Gender-affirming treatment

Current through early 2026

§ 743A.310. Primary care visits's source at oregon​.gov