New Mandates in Oregon and Clark County

Oregon Mandates —Effective January 1, 2010

For group plans, all mandates are effective beginning January 1, 2010 as plans are issued or renewed. In Oregon, there are three mandates that will impact Regence benefits.

Hearing Aid Mandate—HB 2589 requires the coverage of hearing aids and hearing aid evaluations for dependents.  Coverage for children will extend to age 23 or the limiting age in the contract. Benefits will be extended to spouses and domestic partners who are enrolled in an accredited educational institution.  Coverage is limited to $4,000 every four calendar years, which will be adjusted every January as determined by the DCBS based on the Consumer Price Index.  Routine hearing exams and supplies are not included in the coverage.

Tobacco Use Cessation Programs Mandate—SB 734 requires the coverage of tobacco use cessation programs when recommended by a physician.  Under medical plan coverage, tobacco use cessation services will be covered to a $500 lifetime maximum (the deductible applies); under prescription medication coverage, tobacco use cessation prescription medications will be covered to a separate $500 lifetime maximum (the deductible applies, if applicable).  Not all medications for smoking (and no over the counter drugs) are covered.

Telemedical Services Mandate—SB 24 requires coverage of telemedical health services.  Coverage includes telemedical health services rendered at originating sites in rural health professional areas as well as at urban sites. Telemedical refers to service delivered through a two-way video communication that allows a health professional to interact with a patient who is at an originating site, which is the physical location of the patient receiving a telemedical health service.

Clark County Mandates—Effective January 1, 2010

All mandates are effective January 1, 2010 as plans are issued or renewed.  In Washington, there are three mandates that will impact Regence group benefits.

Organ Transplant Lifetime Maximum—SB 5725 requires health plans to limit transplants to a separate lifetime maximum of not less than $350,000. The lifetime maximum will increase to $350,000.  Covered services received within 90 days of the transplant will apply towards the lifetime maximum

Organ Transplant Waiting Periods—HB 1308 requires health plans to reduce organ transplant waiting periods by the amount of time a person had prior creditable coverage.

Chemical Dependency—Each year the minimum benefit for chemical dependency treatment services increases by $500.  For 2010, the amount is $15,000 every 24 consecutive months for BlueChoices products, or every two calendar years for Innova, Engage, Activate, and Regence HSA Healthplan.  This change only applies to small groups.  The change was not made to groups with 51 or more contracts due to the Federal Mental Health Parity Law where benefits for such services cannot be limited.

The accompanying Summary of Changes document highlights the changes made to accommodate Oregon and Washington State mandates.
Oregon New Product Summary of Change
Washington New Product Summary of Change
Oregon Legacy Summary of Change
Washington Legacy Summary of Change

If you have further questions, please contact your Regence Sales representative.

« Back to Communications