OR| Oregon’s permanent Administrative Order ID 5-2026 amends OAR 836-053-0013 to update the state’s standard bronze and silver health benefit plans for the 2027 plan year, effective July 1, 2026. The rule preserves the existing framework—defining “coverage,” inpatient and outpatient services, and essential health benefits—but confirms that standard plans must comply with federal EHB, mental health parity, HB 3391, and USP-based prescription drug requirements, including formulary filing and P&T committee standards. It reaffirms naming conventions for “Standard Bronze/Silver” plans, cost-sharing alignment through updated bronze and silver cost-sharing matrices, and the conversion of annual and lifetime dollar limits to non-dollar actuarial equivalents, while clarifying copay and coinsurance treatment for therapy, vision, specialty providers, and emergency room admissions.
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