Oregon DFR Reissues Guidance on Health Coverage During Wildfires, Emergencies

Oregon — To all entities transacting health insurance in Oregon: The Oregon Division of Financial Regulation is reminding all health insurers of guidance issued under Bulletin DFR 2023-2. This does not represent new guidance.

Purpose

The purpose of this message is to reiterate the division's past guidance, which encourages all health insurers to take the following active measures to help people and businesses affected by wildfires and other declared emergencies:

• Health insurers should take all practicable steps, consistent with the terms of the policy, to ensure enrollees are covered without delay for replacement durable medical equipment, prescription drugs, or other medical supplies, such as insulin, that were destroyed as a result of the wildfire or declared emergency, or unavailable to enrollees due to evacuation or displacement.

• Health insurers should grant exceptions from network requirements to ensure that enrollees who seek treatment from out-of-network providers or at an out-of-network facility as a result of the wildfire or declared emergency are not subject to greater cost sharing than would apply at an in-network provider or facility. This includes enrollees who seek care out-of-network while evacuated or displaced from their home and any enrollees who are unable to access an in-network provider due to office or road closures.

• Health insurers should allow more flexibility to medical providers whose practices were destroyed, closed, disconnected from telecommunications services, or otherwise adversely affected by wildfire or other declared emergencies. This includes extending deadlines for providers to submit claims and respond to insurer requests related to outstanding claims, medical management, prior authorization, internal appeals, external review, and any related matters.

• Health insurers should make sure replacement copies of insurance policies, membership cards, and other documents are readily available to its members, including making these materials available electronically whenever possible.

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