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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
A-Engrossed
House Bill 2540
Ordered by the House March 12
Including House Amendments dated March 12
Sponsored by Representatives DIEHL, JAVADI, MCINTIRE, PHAM H; Representatives ANDERSEN, BOSHART
DAVIS, EVANS, HARBICK, NELSON, SKARLATOS (Presession filed.)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure. The statement includes a measure digest written in compliance with applicable readability standards.
Digest: Makes certain health insurers credit certain costs to an enrollee’s health plan. (Flesch
Readability Score: 60.7).
Requires certain health insurers to credit any amount an enrollee pays directly to a provider
toward out-of-pocket costs and deductibles in certain circumstances.
A BILL FOR AN ACT
Relating to medical out-of-pocket costs.
Be It Enacted by the People of the State of Oregon:
SECTION 1. Section 2 of this 2025 Act is added to and made a part of ORS 743B.280 to
743B.285.
SECTION 2.(1) An insurer offering a health benefit plan as defined in ORS 743B.005 shall
credit any amount an enrollee pays directly to a health care provider to the enrollee’s
deductible and annual out-of-pocket expenses if:
(a) The health care item or service is medically necessary and covered under the
enrollee’s health benefit plan;
(b) The enrollee does not submit the claim to the insurer; and
(c) The amount paid to the health care provider is less than the average discounted rate
for the item or service paid to an in-network health care provider with the same license.
(2) An insurer shall:
(a) Establish a process for an enrollee to submit a claim for the credit described in sub-
section (1) of this section, including the necessary documentation the enrollee is required to
submit in support of the claim; or
(b) Require an enrollee to utilize the system the insurer uses to process and adjudicate
claims to submit a claim for the credit described in subsection (1) of this section.
(3) Notwithstanding ORS 750.055 (1)(i), this section does not apply to a health mainte-
nance organization as defined in ORS 750.005.
SECTION 3. Section 2 of this 2025 Act applies to a health benefit plan issued, renewed
or extended on or after the effective date of this 2025 Act.
NOTE:Matter in boldfaced type in an amended section is new; matter [italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
LC 2584