In Oregon, rulemaking from administrative agencies occurs throughout the year. Important employee benefits updates that took effect or were finalized in the first quarter of 2025 are detailed below chronologically.
On December 23, 2024, the Oregon Division of Financial Regulation (DFR), Department of Insurance (DOI) finalized ID 41-2024 2025 Gender-Affirming Treatment Rule. The rule states that a carrier offering a health benefit plan may not deny, limit coverage, or impose additional cost-sharing (or other limitations or restrictions) for gender-affirming treatment if the treatment is medically necessary, as determined by a qualified physical or behavioral healthcare provider — and the treatment is prescribed according to accepted standards of care. The regulation also defines gender-affirming care, prohibits categorical cosmetic or blanket exclusions for medically necessary procedures, lists criteria for adverse benefit determinations, and imposes network adequacy requirements on health benefit plans for gender-affirming care providers. The regulation became effective January 1, 2025.
On March 24, 2025, the Oregon Department of Insurance (DOI) issued Bulletin DFR 2025-3 regarding the director’s expectations for health benefit plans under the Oregon Reproductive Health Equity Act (RHEA). The bulletin clarifies requirements for providing services under Oregon’s RHEA without cost-sharing and reiterates that while there is substantial overlap between RHEA and federal preventive services, RHEA mandates coverage for some services not required under federal law. RHEA also requires coverage for services without limitations on sex or gender. The bulletin addresses when health benefit plans can deny or restrict coverage under RHEA, coverage of contraceptives and therapeutic equivalents under RHEA, HDHP restrictions, and coverage of abortion. The bulletin became effective March 24, 2025.
Employers with plans governed by the state laws should be aware of these mandates, and can contact their carrier or third-party administrator for further details.