OAR 836-010-0155: Gender Specific Contract Language

(1) As used in this rule, “provider” includes but is not limited to: (a) A physician as defined in ORS 677.010. (b) A physician group, independent practice association, physician-controlled organization, hospital organization or other provider organization that contracts with a provider for the purpose of facilitating the provider’s participation in a provider network contract. (c) A person licensed or certified by the laws of this state to administer medical services or mental health services in the ordinary course of business or practice of a profession. A person grandfathered under the provisions of Section 3, chapter 674, Oregon Laws 2015 (Enrolled Senate Bill 696) shall be considered licensed or certified under this section. (2) An individual’s attending provider determines whether a sex-specific recommended preventive service that is required to be covered without cost sharing under section 2713 of the Public Health Service Act and its implementing regulations is medically appropriate for a particular individual. When an attending provider determines that a recommended service is medically appropriate for an individual and the individual satisfies the criteria for the service or treatment, the insurer must provide coverage for the recommended service regardless of sex assigned at birth, gender identity, or gender of the individual otherwise recorded by the insurer.