750.005
Definitions. As
used in ORS 750.005 to 750.095:
(1) “Claims”
means any amount incurred by the insurer covering contracted benefits.
(2) “Complementary
health services” means the following health care services:
(a) Chiropractic
as defined in ORS 684.010;
(b) Naturopathic
medicine as defined in ORS 685.010;
(c) Massage
therapy as defined in ORS 687.011; or
(d) Acupuncture
as defined in ORS 677.757.
(3) “Doctor”
means any person lawfully licensed or authorized by statute to render any
health care services.
(4) “Health care
service contractor” means:
(a) Any
corporation that is sponsored by or otherwise intimately connected with a group
of doctors licensed by this state, or by a group of hospitals licensed by this
state, or both, under contracts with groups of doctors or hospitals that
include conditions holding the subscriber harmless in the event of nonpayment
by the health care service contract as provided in ORS 750.095, and that
accepts prepayment for health care services; or
(b) Any person
referred to in ORS 750.035.
(5) “Health care
services” means the furnishing of medicine, medical or surgical treatment,
nursing, hospital service, dental service, optometrical service, complementary
health services or any or all of the enumerated services or any other necessary
services of like character, whether or not contingent upon sickness or personal
injury, as well as the furnishing to any person of any and all other services
and goods for the purpose of preventing, alleviating, curing or healing human
illness, physical disability or injury.
(6) “Health
maintenance organization” means any health care service contractor operated on
a for-profit or not for-profit basis which:
(a) Qualifies
under Title XIII of the Public Health Service Act; or
(b)(A) Provides
or otherwise makes available to enrolled participants health care services,
including at least the following basic health care services:
(i) Usual
physician services;
(ii)
Hospitalization;
(iii) Laboratory;
(iv) X-ray;
(v) Emergency and
preventive services; and
(vi) Out-of-area
coverage;
(B) Is
compensated, except for copayments, for the provision of basic health care
services listed in subparagraph (A) of this paragraph to enrolled participants
on a predetermined periodic rate basis;
(C) Provides
physicians’ services primarily directly through physicians who are either
employees or partners of such organization, or through arrangements with
individual physicians or one or more groups of physicians organized on a group
practice or individual practice basis; and
(D) Employs the
terms “health maintenance organization” or “HMO” in its name, contracts,
literature or advertising media on or before July 13, 1985. [Formerly 742.010;
1973 c.515 §5; 1979 c.799 §1; 1985 c.747 §65; 1989 c.783 §4; 1991 c.958 §3;
2003 c.33 §1]
750.010 [Amended by 1957 c.301 §1; 1961
c.116 §1; 1967 c.359 §548; renumbered 744.305]
Notes of Decisions
Hahn v. Oregon Physicians' Serv., 508 F. Supp. 970 (D. Or. 1981).
· cites it 4× “Present defendants are: Oregon Physicians’ Service (OPS), Physicians’ Association of Clackamas County (PACC), Rogue Valley Physicians’ Service (RVPS), Klamath Medical Service Bureau (KMSB), and Greater Oregon Health Service (GOHS), all health care contractors under ORS § 750.005…”
Mitchell v. Mt. Hood Meadows Oreg., 99 P.3d 748 (Or. Ct. App. 2004).
· cites it 2× “550, a health care service contractor as defined in ORS 750.005, a home health agency licensed under ORS chapter 443 or a hospice program licensed, certified or accredited under ORS chapter 443.”
Rowen v. Gonenne, 362 P.3d 694 (Or. Ct. App. 2015).
“675 provides, in full: “(1) As used in this section, ‘peer review body’ includes tissue committees, governing bodies or committees including medical staff committees of a health care facility licensed under ORS chapter 441, medical staff committees of the Department of…”
Providence Health Plan v. Winchester, 288 P.3d 13 (Or. Ct. App. 2012).
· cites it 2× “Plaintiff Providence Health Plan is a health care service contractor under ORS 750.005(4). Thus, technically, Providence is a plan to which defendant subscribes, not an insurer that insures defendant.”
Oregon Psychological Ass'n v. Physicians Ass'n, 816 P.2d 686 (Or. Ct. App. 1991).
“* * * * * “(23) Health maintenance organizations, as defined in ORS 750.005(3), shall be subject to the following conditions and requirements in their provision of benefits for chemical dependency or mental or nervous conditions to enrollees: * * * * “(c) Health maintenance…”
— Or. Rev. Stat. § 750.005(2)(a) — 1 case
Hahn v. Oregon Physicians' Serv., 508 F. Supp. 970 (D. Or. 1981).
“Present defendants are: Oregon Physicians’ Service (OPS), Physicians’ Association of Clackamas County (PACC), Rogue Valley Physicians’ Service (RVPS), Klamath Medical Service Bureau (KMSB), and Greater Oregon Health Service (GOHS), all health care contractors under ORS § 750.005…”
— Or. Rev. Stat. § 750.005(3) — 1 case
Oregon Psychological Ass'n v. Physicians Ass'n, 816 P.2d 686 (Or. Ct. App. 1991).
“* * * * * “(23) Health maintenance organizations, as defined in ORS 750.005(3), shall be subject to the following conditions and requirements in their provision of benefits for chemical dependency or mental or nervous conditions to enrollees: * * * * “(c) Health maintenance…”
— Or. Rev. Stat. § 750.005(4) — 1 case
Providence Health Plan v. Winchester, 288 P.3d 13 (Or. Ct. App. 2012).
“Plaintiff Providence Health Plan is a health care service contractor under ORS 750.005(4). Thus, technically, Providence is a plan to which defendant subscribes, not an insurer that insures defendant.”
— Or. Rev. Stat. § 750.005(4)(a) — 1 case
Providence Health Plan v. Winchester, 288 P.3d 13 (Or. Ct. App. 2012).
“Plaintiff Providence Health Plan is a health care service contractor under ORS 750.005(4). Thus, technically, Providence is a plan to which defendant subscribes, not an insurer that insures defendant.”
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