OAR 836-053-0857: Definitions

(1) As used in ORS 743.601, “enrollee” has the same meaning as “covered person” as defined in ORS 743.610. (2) As used in ORS 743.610: (a) “Claim” means a request for payment of medical treatment, services, drugs, equipment, or other medical benefit under a health benefit plan. (b) “Notice” means the notice provided by an insurer to a covered person or qualified beneficiary about continuing group coverage after a qualifying event. (c) “Qualified beneficiary” does not include: (A) An individual eligible for Federal Medicare coverage. (B) An individual eligible for any other group health plan. This limitation does not apply to coverage consisting only of: (i) Dental, vision, counseling, or referral services; (ii) Coverage under a health flexible spending arrangement as defined in section 106(c)(2) of the Internal Revenue Code of 1986; or (iii) Treatment that is furnished in an on-site medical facility maintained by an employer. (d) “Similar” means a plan that provides benefits that are the same or nearly the same as the coverage provided under the group health benefit plan that is being terminated. (3) As used in ORS 743.610(7)(a), “coverage” means the benefits provided under a health benefit plan continued by a covered person or qualified beneficiary. (4) As used in ORS 743.601 and 743.610 “dissolution” includes a separation upon a judgment of separation granted pursuant to ORS 107.025.