OAR 811-015-0002: Pre-Paid and Contracted Treatment Plans

A pre-paid plan is a package of services and/or products that are purchased by patients at a reduced or discounted cost than if the services were purchased individually. (1) Chiropractic physicians may accept pre-payment for services planned but not yet delivered only if they do so in such a way that it does not constitute the practice of insurance. (a) “Insurance” is defined as a contract whereby one undertakes to indemnify another or pay or allow a specified or ascertainable amount or benefit upon determinable risk contingencies, pursuant to ORS 731.102. (b) Chiropractic physicians or clinics who are certified by the Oregon Department of Insurance as Medical Retainer Plans are exempted from this section. (c) These plans must not be in violation of OAR 811-015-0000. (2) Pre-paid and contracted treatment plans must include the following, in writing: (a) The total costs/fees that the patient will incur and the method and timing of payment(s); (b) Description of what services and products are included and excluded - If nutritional products or other types of products including braces, supports, or patient aids are to be used during the proposed treatment plan, the patient's documents must state whether these items are included in the gross treatment costs or if they constitute a separate and distinct service and fee. Any additional fees must be explained to the patient in advance and noted in the chart notes; (c) Description of the time frame which the plan covers; (d) How special circumstances, such as extended absences, new injury, or illness are handled; and (e) Statement that there is no claim or representation of a guarantee of results, outcome, or the cure of a particular condition. (3) Early Termination of Care: (a) The pre-payment plan must include a written explanation on how the unused portion of funds are calculated or prorated should the patient complete care early or discontinue care due to the patient’s choice, doctor’s choice, moving, new injury, or condition. The written explanation must be clearly labeled “Refund Policy” in plain language that is understood by the patient. The explanation must include a table of calculations that illustrates the amount of refunds or amount owed in the event of the pre-paid plan’s early termination. (b) The patient may have the right to terminate the pre-paid plan at any time. In the event of early termination of a pre-paid plan by the patient, the maximum fee charged cannot exceed the chiropractic physician's usual and customary fee cash pay (including any time of service discount) for the services rendered. (c) The chiropractic physician or clinic may terminate the pre-paid plan at any time, for good and sufficient cause, except licensee must ensure that patient abandonment does not occur. In the event of early termination of a pre-paid plan by the chiropractic physician or clinic, the maximum fee charged cannot exceed pro-rated fees as agreed upon in the pre-paid plan. (4) Pre-paid plans must comply with all other applicable state or federal laws.