Oregon prompt pay law dental

Sourced answer

Oregon's prompt-pay chapter (ORS 743B.450; 743B.452; 743B.005(16)(b)(I)) does not reach standalone dental insurance at all — Oregon's 30-day rule does not reach stand-alone dental plans today. Section 743B.450 applies to claims under a "health benefit plan," and that definition expressly excludes dental-only coverage (ORS 743B.005(16)(b)(I)). The dental-specific section that exists now, ORS 743B.456, regulates only credit-card and electronic-payment fee disclosure and opt-in for dental insurers — it sets no payment deadline. The Legislative Assembly closed that gap prospectively: HB 4040 (2026) adds a 45-day clean-claim deadline for dental insurers, along with refund limits and a direct-payment mandate, operative January 1, 2028. Until then, a claim to an Oregon stand-alone dental carrier runs on the contract, not on ORS 743B.450. Where the chapter does apply (dental inside a comprehensive medical plan), the deadline is 30 days (health benefit plans; no format split). A self-funded private-employer (ERISA) dental plan is generally beyond a state prompt-pay statute's reach: 29 U.S.C. § 1144(b)(2)(B) bars a state from deeming such a plan an insurer, and the courts have read that to keep state insurance regulation off it. The statute itself never uses the words self-funded or prompt pay, and the rule is not categorical — a self-funded governmental or church plan is not an ERISA plan at all, so state law can reach it; § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law; and nothing in § 1144 addresses state enforcement against the third-party administrator or the network contract. Where the plan is a self-funded ERISA group health plan, the federal claims-procedure deadlines apply instead: a post-service benefit determination within 30 days (one 15-day extension), at least 180 days to appeal, and an appeal decision within 60 days (or two 30-day levels), under 29 CFR 2560.503-1.