OR| The Oregon Department of Consumer and Business Services, Insurance Division Bulletin No. DFR 2025-3, outlines the director’s expectations for health benefit plans under the Oregon Reproductive Health Equity Act (RHEA). The bulletin clarifies requirements for providing reproductive health services without cost sharing and ensures consistent access to care.
Key Points:
- Scope of Covered Services: RHEA requires health benefit plans to cover services without cost sharing, including those not mandated by federal law, and ensures coverage is not limited by sex or gender.
- Denial or Restriction of Coverage: Plans can deny or restrict coverage only if specifically authorized under ORS 743A.067, such as for experimental treatments or those lacking medical evidence.
- Screenings and Tests: Plans must cover screenings like chlamydia, gonorrhea, and HIV/AIDS without cost sharing, following USPSTF guidelines, and cover all tests for conditions like anemia and pregnancy.
- Contraceptive Coverage: RHEA mandates coverage for all FDA-approved contraceptives without medical management, including those prescribed for non-contraceptive purposes.
- Medical Management: Except for contraception and abortion, plans may use reasonable medical management techniques, but these must not result in wholesale denial of coverage or conflict with RHEA’s requirements.