The New Law
The new Oregon law (Senate Bill 734) amended the Oregon Insurance Code to mandate that each private health plan in Oregon or insurer that covers any Oregonian must provide enrollees a core benefit of at least $500 for access to and coverage for FDA-approved treatment options such as basic treatment programs and available services and therapies. All private plan members, aged 15 years and older in Oregon will now be able to receive at least one tobacco cessation benefit during their enrollment. The benefit was based on U.S. Public Health Service Guidelines. The mandate went into effect January 1, 2010.
Exceptions to the Law
Medicaid, Medicare, disability income, short term health insurance, insurance for students, and other non-traditional “health benefit” plans as defined in ORS 743.730 are not required to cover cessation services under this mandate.
Health benefit plans not required to cover cessation include:
- Accident, specific disease or condition only
- Credit
- Disability income
- Medicare
- CHAMPUS
- Flexible spending arrangements as defined in ORS 743.730
- Student accident and health insurance policies
- Dental only, vision only, hospital indemnity only
- Stop-loss policy coverage that meets the requirements of ORS 742.065
- Coverage issued as a supplement to liability insurance
- Workman’s compensation or similar law
- Automobile medical payment insurance
- Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance