(1) A health benefit plan, as defined in ORS § 743B.005, shall reimburse the cost of:

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

(a) Bilateral cochlear implants if medically appropriate for the treatment of hearing loss; and

(b) The fitting, programming and reprogramming of bilateral or unilateral cochlear implants or other assistive listening devices performed by licensed audiologists.

(2) For purposes of ORS § 746.230, a reasonable investigation of a claim for bilateral cochlear implants must include a request to the treating surgeon for a written recommendation based on peer-reviewed medical literature and for the medical findings that support the recommendation.

(3) A health benefit plan shall reimburse the cost of repair and replacement parts for a cochlear implant if the repair or parts are not covered by a warranty and are necessary for the device to be functional for the user.

(4) A health benefit plan shall reimburse the costs described in this section when prescribed by a licensed health professional even if over-the-counter items and services are available without a prescription.

(5) An adverse determination on a claim for coverage under this section must include a prominent notice to the enrollee of the enrollee’s rights to file grievances and request appeals and reviews under ORS § 743B.250 and must provide a toll-free telephone number or chat line for enrollees to seek assistance in contesting the denial of or limitation on coverage.

(6) Coverage under this section may not be subject to a deductible, except as provided in ORS § 742.008.

(7) The provisions of this section are exempt from ORS § 743A.001. [2007 c.504 § 2; 2018 c.9 § 1; 2023 c.424 § 3]

743A.140 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.