The Oregon Administrative Rules contain OARs filed through November 15, 2015
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DEPARTMENT OF CONSUMER AND BUSINESS SERVICES,
INSURANCE DIVISION
DIVISION 50
GENERAL PROVISIONS
Assumption Reinsurance
836-050-0000
Purpose, Statutory Authority and Implementation
OAR 836-050-0000 to 836-050-0020 are adopted under the authority of ORS 731.244, 742.156 and 742.158, for the purpose of implementing 742.156 and 742.158, relating to assumption reinsurance.
Stat. Auth.: ORS 731.244, 742.156, 742.158
Stats. Implemented: ORS 742.156, 742.158
Hist.: ID 4-1996, f. & cert. ef. 2-28-96; ID 15-2006, f. & cert. ef. 7-27-06
836-050-0010
Notice of Transfer
(1) An insurer transferring obligations or risks through an assumption reinsurance agreement subject to ORS 742.150, shall provide or cause to be provided to each policyholder or certificate holder a notice of transfer by first-class mail, addressed to the last-known address of the policyholder or certificate holder or to the address to which premium notices or other policy documents are sent. For insurance business on which premiums are collected on a weekly or monthly basis by an insurance producer of the insurer, the notice of transfer must be sent by personal delivery with acknowledged receipt. Notice of transfer must also be sent to the transferring insurer's insurance producer or brokers of record on the affected policies.
(2) The notice of transfer must state or provide:
(a) The date the transfer and novation of the policyholder's policy or certificate holder's certificate are proposed to take place;
(b) The names, addresses and telephone numbers of the assuming insurer and the transferring insurer;
(c) That the policyholder or certificate holder may either consent to or reject the transfer and novation;
(d) The procedures and time limit for consenting to or rejecting the transfer and novation;
(e) A summary of any effect that consenting to or rejecting the transfer and novation will have on the policyholder's or certificate holder's rights;
(f) A statement that the assuming insurer is authorized to transact the type of insurance being assumed in the state in which the policyholder or certificate holder resides, or is otherwise authorized under ORS 742.150 to 742.162 to assume such insurance;
(g) The name and address of the representative of the transferring insurer to whom the policyholder or certificate holder should send its written statement of acceptance or rejection of the transfer and novation;
(h) The address and phone number of the insurance regulatory office of the state in which the policyholder or certificate holder resides so that the policyholder or certificate holder may write or call the office for further information regarding the financial information of the assuming insurer;
(i) A statement that the insurer will furnish to the policyholder or certificate holder, upon request, financial data for both insurers, including at a minimum the data described in section (3) of this rule; and
(j) An explanation of the reason for the transfer.
(3) The transferring insurer shall promptly furnish the following financial data for both insurers in response to a request for financial data by a policyholder or certificate holder or by an agent or broker of record of the transferring insurer with respect to the affected policies:
(a) Ratings for the previous year from two nationally recognized insurance rating services acceptable to the Director, including the rating service's explanation of the meaning of the ratings, and if ratings are unavailable for the year, the insurer shall so disclose;
(b) If the rating of either insurer furnished under subsection (a) of this section changed during the previous year, ratings for the year preceding from two nationally recognized insurance rating services acceptable to the Director, including the rating service's explanation of the meaning of the ratings, and if ratings are unavailable for the year preceding, the insurer shall so disclose;
(c) A balance sheet as of December 31 for the previous year if available and as of the date of the most recent quarterly statement; and
(d) A copy of the Management's Discussion and Analysis that was filed as a supplement to the previous year's annual statement.
(4) Notice in the form identical or substantially similar to Exhibit 1 to this rule is considered to comply with the requirements of section (2) of this rule.
(5) The notice of transfer shall include a pre-addressed, postage-paid response card that a policyholder or certificate holder may return as its written statement of acceptance or rejection of the transfer and novation.
[ED. NOTE: Exhibits referenced are available from the agency.]
Stat. Auth.: ORS 731.244 & Sec. 5 & 6, Ch. 30, OL 1995
Stats. Implemented: ORS 742.156, 742.158
Hist.: ID 4-1996, f. & cert. ef. 2-28-96; ID 8-2005, f. 5-18-05, cert. ef. 8-1-05; ID 15-2006, f. & cert. ef. 7-27-06
836-050-0020
Notice of Rejection
A policyholder or certificate holder who elects to reject the transfer and novation of the policy under an assumption reinsurance agreement to which ORS 742.150 applied must give notice indicating rejection to the transferring insurer on a pre-addressed, postage-paid response card provided by the transferring insurer in the notice of transfer as required in OAR 836-050-0010 and Exhibit 1 to that rule, or in another written notice by the policyholder or certificate holder.
[ED. NOTE: Exhibits referenced are available from the agency.]
Stat. Auth.: ORS 731.244, 742.156, 742.158
Stats. Implemented: ORS 742.156, 742.158
Hist.: ID 4-1996, f. & cert. ef. 2-28-96; ID 15-2006, f. & cert. ef. 7-27-06
836-050-0105
Statutory Authority; Purpose; Applicability
(1) OAR 836-050-0105 to 836-050-0120 are adopted by the Director pursuant to ORS 743.028.
(2) The purpose of OAR 836-050-0105 to 836-050-0120 is to prescribe, as required by ORS 743.028, uniform health insurance claims forms that must be accepted by all insurers transacting health insurance in this state and by all state agencies that require health insurance claim forms for their records.
(3) OAR 836-050-0105 to 836-050-0120 do not apply to claims for vision care or drugs, or to benefits paid on other than an expense-incurred basis.
(4) "Insurer" as used in OAR 836-050-0105 to 836-050-0120 includes health care service contractors and state agencies that require health insurance claim forms for their records.
Stat. Auth.: ORS 731.244 & ORS 743.028
Stats. Implemented: ORS 743.028
Hist.: IC 73, f. 2-25-77, ef. 3-1-77; IC 75, f. & ef. 5-27-77; ID 1-1995, f. 4-26-95, cert. ef. 8-1-95
836-050-0110
Uniform Claim Forms
(1) An insurer shall accept a properly completed claim submitted on the applicable uniform form prescribed by the exhibits to this rule, or on the substantially identical respective form approved by the American Medical Association's Council on Medical Services or the American Dental Association's Council on Dental Care Programs, as follows:
(a) Exhibit 1 -- For claims other than dental care claims;
(b) Exhibit 2 -- For dental care claims.
(2) If the information entered on the form is incomplete, the insurer may return the form to the provider for completion to the extent necessary.
(3) If additional information is essential to the insurer's proper handling of the claim, it may seek such information by letter, investigative inquiry, or other reasonable means of communication. These inquiries shall be kept to a minimum and shall not seek information duplicating what already is known to the insurer.
(4) An insurer may, at its option, accept a claim form different from the uniform form prescribed by this rule.
[ED. NOTE: The Exhibit(s) referenced in this rule is not printed in the OAR Compilation. Copies are available from the agency.]
Stat. Auth.: ORS 731.244 & ORS 743.028
Stats. Implemented: ORS 743.028
Hist.: IC 73, f. 2-25-77, ef. 3-1-77; IC 75, f. & ef. 5-27-77; ID 1-1995, f. 4-26-95, cert. ef. 8-1-95
836-050-0115
Permitted Modifications to Uniform Forms
(1) An insurer may add to the face of the form its own identification and similar information, including insurer name and logo and policy identification by color coding or otherwise. The captions may be supplemented by instructions that merely facilitate the completion of the form.
(2) An insurer may add to the back of the form or, for Exhibit 2, to any blank area on the face of the form, an item whose purpose is the certification of the status of the patient as a person in the insured group or as a member of the family or dependent of a person in the insured group. In the case of a claim form required by a state agency, the back of the form may also contain such provider certification and acknowledgment language as is required or permitted by law.
(3) No alteration may be made to the format of the face of the form. No addition to the form may impose any additional requirement on any person, except for the certification item permitted by section (2) of this rule.
(4) An insurer may screen the portions of the uniform claim form that it does not require to be completed, if the screening is done in such a way as to leave these portions usable by others.
[ED. NOTE: The Exhibit(s) referenced in this rule is not printed in the OAR Compilation. Copies are available from the agency.]
Stat. Auth.: ORS 731.244 & ORS 743.028
Stats. Implemented: ORS 743.028
Hist.: IC 73, f. 2-25-77, ef. 3-1-77; IC 75, f. & ef. 5-27-77
Notice of Advance Payment for Death or Personal Injury or
Destruction of Property on Running of Period of Limitation
836-050-0150
Advance Payments
(1) The notice required by ORS 12.155 shall contain the following:
(a) The time and location of the occurrence in regard to which the advance payment is made.
(b) A statement to the effect that the amount of any advance payment will be credited against any judgment entered in favor of the payee.
(c) The following words: "The period of limitation for commencement of an action for damages as set by Chapter 12 of Oregon Revised Statutes will expire on _____", or such other similar words as the Director of the Department of Consumer and Business Services approves.
(d) The signature of a person authorized to act for the insurer.
(e) The date on which notice is transmitted to the party entitled to the advance payment.
(2) The type size used in the portion of the notice described in section (1)(c) of this rule shall not be smaller than the type used for other typed or printed material required by this rule and shall not be arranged or displayed in such a way as to obscure the content of the notice.
Stat. Auth.: ORS 12.155 & 731.244
Stats. Implemented: ORS 12.155
Hist.: IC 48, f. 8-18-71, ef. 9-1-71; Renumbered from 836-020-0060; ID 15-1996, f. & cert. ef. 11-12-96; ID 22-2002, f. & cert. ef. 11-27-02, Renumbered from 836-020-0900
Life and Health Insurance Benefit Provisions
Relating to HIV Infection
836-050-0200
Purpose, Scope and Definitions
(1) OAR 836-050-0200 to 836-050-0215 provide for equitable coverage under life and health insurance policies for conditions relating to HIV-infection, including AIDS and ARC. OAR 836-050-0200 to 836-050-0215 apply to all health insurance policies, including those of fraternal benefit societies and health care service contractors, issued or delivered for issue in Oregon. OAR 836-050-0200, 836-050-0205, 836-050-0207, and 836-050-0210 apply to all life insurance policies, including those of fraternal benefit societies, issued or delivered for issue in Oregon.
(2) For purposes of OAR 836-050-0200 to 836-050-0215:
(a) "AIDS" means Acquired Immunodeficiency Syndrome;
(b) "ARC" means AIDS Related Complex;
(c) "HIV" means Human Immunodeficiency Virus.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS 742.003, 742.005 & 746.240
Hist.: ID 6-1987(Temp), f. & cert ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88
836-050-0205
Authority
OAR 836-050-0200 to 836-050-0215 are adopted by the Director pursuant to the general rulemaking authority of the Director under ORS 731.244, for the purpose of carrying out the responsibilities of the Director under 731.008 and 731.016, regarding the protection of the insurance-buying public, under 742.003 and 742.005, regarding approval of forms, and under ORS 746.240, regarding definition of unfair practices in the transaction of insurance.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS 742.005 & 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88; ID 1-1997(Temp), f. & cert. ef. 2-24-97; ID 12-1997, f. & cert. ef. 10-13-97; ID 2-1999, f. & cert. ef. 3-25-99
836-050-0207
Unfair Trade Practices
Failure of an insurer to comply with OAR 836-050-0210 and 836-050-0215 is an unfair trade practice under ORS 746.240.
Stat. Auth.: ORS 433, ORS 731, 743 & 746
Stats. Implemented: ORS 742.005 & 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88
836-050-0210
General Exclusions
(1) All health insurance policies, other than those providing coverage only for specified diseases, shall cover HIV infection, including AIDS and ARC, as they would any other serious medical condition.
(2) All life insurance policies, other than those providing coverage for specific causes of death only, shall cover death from AIDS or ARC as they would death from any other cause.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS 742.005 & 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88
836-050-0215
Pre-existing Condition Exclusions; Health Insurance
With respect to health insurance policies:
(1) Asymptomatic HIV infection shall not be considered a preexisting condition with respect to subsequent claims related to AIDS or ARC. "Asymptomatic HIV infection" is that which is identified solely through use of a test for a virus or antibodies to the virus.
(2) The period of exclusion for HIV infection claims, when physical symptoms were present before the coverage date, shall be no longer than that for other pre-existing diseases.
Stat. Auth.: ORS 433, ORS 731, ORS 743 & ORS 746
Stats. Implemented: ORS 742.005 & ORS 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88; ID 1-1997(Temp), f. & cert. ef. 2-24-97; ID 12-1997, f. & cert. ef. 10-13-97
Application Questions and Underwriting Practices
Relating to HIV Infection
836-050-0230
Purpose, Scope and Definitions
(1) OAR 836-050-0230 to 836-050-0255 provide for fair standards of underwriting for risks relating to HIV infection and apply to all transactions of life and health insurance subject to the Oregon Insurance Code. Such transactions include the underwriting of applicants for coverage under individual and group life and health insurance, as well as the setting of group underwriting standards. OAR 836-050-0230 to 836-050-0255 apply to all insurers, including health care service contractors and fraternal benefit societies, and all insurance producers and insurance support organizations, that are engaged in the transaction of life and health insurance under the Oregon Insurance Code.
(2) For purposes of OAR 836-050-0230 to 836-050-0255:
(a) "AIDS" means Acquired Immunodeficiency Syndrome;
(b) "ARC" means AIDS Related Complex;
(c) "HIV" means Human Immunodeficiency Virus.
[Publications: Publications referenced are available from the agency.]
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS 433.045(7), 742.005 & 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88; ID 8-2005, f. 5-18-05, cert. ef. 8-1-05
836-050-0235
Rulemaking Authority
OAR 836-050-0230 to 836-050-0255 are adopted by the Director pursuant to the general rulemaking authority of the Director under ORS 731.244, for the purpose of carrying out the responsibilities of the Director under 731.008 and 731.016, regarding the protection of the insurance-buying public, under 742.003 and 742.005, regarding approval of forms, and under 746.240, regarding definition of unfair practices in the transaction of insurance; and for the purpose of assuring compliance by insurers with the requirements of 433.045.
Stat. Auth.: ORS 433, ORS 731, 743 & 746
Stats. Implemented: ORS 433.045(7), 742.005 & 746.240
Hist.: ID 5-1988(Temp), f. & cert. ef. 2-26-88; ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88; ID 18-1988, f. & cert. ef. 10-31-88; ID 1-1997(Temp), f. & cert. ef. 2-24-97; ID 12-1997, f. & cert. ef. 10-13-97
836-050-0237
Unfair Trade Practices
Failure of an insurer to comply with any provision of OAR 836-050-0240 or 836-050-0245, or the requirement in 836-050-0250(2)(a) that testing for HIV infection be done only with the informed consent of the applicant for insurance, is an unfair trade practice under ORS 746.240.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS 433.045(7), 742.005 & 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88; ID 18-1988, f. & cert. ef. 10-31-88
836-050-0240
General Principles
(1) No inquiry in an application for health or life insurance coverage, in an investigation conducted by an insurer, insurance producer or insurance support organization in connection with an application for such coverage, shall be directed toward determining the applicant's sexual orientation.
(2) Sexual orientation shall not be used in the underwriting process or in the determination of insurability.
(3) Insurance support organization shall be directed by insurers not to investigate, directly or indirectly, the sexual orientation of an applicant or a beneficiary.
(4) Testing for or asking medical questions about HIV infection, including ARC and AIDS, is prohibited when not done in conjunction with testing for or asking medical questions about other health conditions. However, testing for HIV infection alone is permissible if the applicant has answered affirmatively that the applicant has tested positive in any HIV antibody test or has been diagnosed as having HIV infection, including AIDS or ARC.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS 433.045(7), 742.005 & 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88; ID 8-2005, f. 5-18-05, cert. ef. 8-1-05
836-050-0245
Medical and Lifestyle Application Questions and Underwriting Standards
(1) No question shall be used that is designed to establish the sexual orientation of the applicant.
(2) The following provisions govern medical questions relating to HIV infection:
(a) Questions relating to the applicant's having or having been diagnosed as having HIV infection, including AIDS or ARC, are permissible if the questions are factual and designed to establish the existence of the condition. For example, insurer shall not ask such questions as "do you believe you may have...?", or "have you had any indications of...?", but insurers may ask "have you been diagnosed or treated for...?";
(b) Questions relating to HIV infection, including AIDS and ARC, may be asked, but only if questions related to other high risk medical conditions are also asked. The questions must be presented and asked, and the answers used, in the same manner as other questions and their answers relating to other high risk medical conditions. Additional questions may be asked in a supplement but the supplement must be used in conjunction with medical questions on the application form.
(3) Questions relating to medical and other factual matters that are intended to reveal the possible existence of a medical condition are permissible if they are not used to establish the sexual orientation of the applicant and if the applicant is given opportunity to provide a detailed explanation for any affirmative answers given in the application. For example, insurers may ask such questions as, "Have you had chronic cough, significant weight loss, chronic fatigue, diarrhea, enlarged glands,...?" Such questions must pertain to a finite period of time preceding completion of the application, not to exceed ten years. The finite period does not apply to questions concerning prior diagnosis, treatment or testing.
(4) Questions relating to the applicant's having, or having been diagnosed as having, or having been advised to seek treatment for, a sexually transmitted disease are permissible.
(5) Neither the marital status, the "living arrangements", the occupation, the gender, the medical history, the beneficiary designation nor the zip code or other territorial classification of an applicant may be used to establish, or aid in establishing, the applicant's sexual orientation.
(6) For purposes of rating an applicant for health and life insurance, an insurer may impose territorial rates, but only if the rates are based on sound actuarial principles and are related to actual or reasonably anticipated experience.
(7) No adverse underwriting decision shall be based on information that the applicant has demonstrated AIDS, ARC or other HIV infection-related concerns by seeking counseling from health care professionals. This section does not apply to an applicant seeking treatment or diagnosis.
Stat. Auth.: ORS 433, ORS 731, ORS 743 & ORS 746
Stats. Implemented: ORS 433.045(7), ORS 742.005 & ORS 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88
836-050-0250
Testing for HIV Infection
(1) An insurer may not rate or deny coverage on the basis of test results unless the rating or denial is based on a test protocol consisting of two positive ELISA tests confirmed by a Western Blot test or another test or test series that the state epidemiologist finds to be no less accurate. This testing series may be performed on blood samples, or on oral specimens or urine obtained and tested according to approval by the federal Food and Drug Administration. If the result of a Western Blot test is indeterminate, the insurer may postpone action on the application not longer than six months after the date of that Western Blot test in order to retest the applicant for conclusive Western Blot test results. The insurer may rate or deny coverage only if retesting produces the positive testing result or if the applicant declines the retesting or fails to respond to a request for retesting by the insurer.
(2) The following provisions apply to all testing for HIV infection and consent therefor:
(a) Testing may be done only with the informed consent of the applicant. Any test that helps an insurer determine the presence of HIV infection and is performed in conjunction with an insurance application shall have a signed consent by the applicant regarding the specific types of tests involved. This consent shall require the applicant to designate the person to whom final positive test results are to be reported. The applicant may designate a named physician, the county health department or the applicant directly. An insurer may obtain the consent of the applicant at any time in the underwriting process prior to obtaining a sample or specimen.
(b) The consent form must be submitted to the Director for approval before use. A consent form may not be used unless the Director has approved the form as complying with OAR 836-050-0230 to 836-050-0255.
(c) An insurer shall disclose to the applicant when soliciting consent that the test is used for determining insurability.
(d) A copy of an informational brochure containing the information in Exhibit 1 shall be given to the applicant prior to or at the time of consent. [Exhibit not included. See ED. NOTE.] The consent form and informational brochure may be combined in one form.
(e) A consent form signed by an applicant is valid for six months following the date that the consent form was signed. The consent form must so state. If after six months the test is not performed or retesting is needed, a new signed consent form must be obtained.
(3) All final positive HIV results shall be directly or indirectly disclosed to the applicant as provided in this section. Information about the results that an insurer acquires through required tests other than from a physician shall be disclosed to the applicant through the physician or county health department named by the applicant for that purpose, so that the physician or county health department may give further explanation of the results to the applicant. Such information may be disclosed directly to the applicant only if the applicant requested disclosure in the consent form and if the insurer, after receipt of positive HIV results confirmed through the protocol in section (1) of this rule, has given the applicant another opportunity to designate a physician or county health department. Direct disclosure to the applicant of final positive HIV results shall include a notice that gives the Oregon AIDS Hotline numbers for securing local assistance and advises the applicant to call the Oregon AIDS Hotline or consult a physician.
(4) An insurer may report only positive test results determined under section (1) of this rule to the person or person designated in the consent form and to affiliates, reinsurers, employees and contractors of the insurer in relation to the underwriting of the insurance application. For positive test results as defined in section (1) of this section, an insurer may also make a report of a nonspecific abnormality determined by the testing of blood, oral specimen or urine to the Medical Information Bureau. An insurer may not make a report to the Medical Information Bureau when positive or inconclusive results occur only with respect to preliminary tests, even when the applicant fails to follow up with the required protocol.
[ED. NOTE: Copies of the Exhibit referenced in this rule are available from the agency.]
Stat. Auth.: ORS 433, ORS 731, ORS 743 & ORS 746
Stats. Implemented: ORS 433.045(7), ORS 742.005 & ORS 746.240
Hist.: ID 5-1988(Temp), f. & cert. ef. 2-26-88; ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88; ID 18-1988, f. & cert. ef. 10-31-88; ID 1-1997(Temp), f. & cert. ef. 2-24-97; ID 12-1997, f. & cert. ef. 10-13-97; ID 2-1999, f. & cert. ef. 3-25-99
836-050-0255
Inquiries Regarding Past Test Results
Insurers may ask whether an applicant has tested positive in any HIV antibody test, subject to the following restrictions:
(1) General questions asking only whether the applicant has taken such a test, regardless of outcome, are prohibited.
(2) Except as provided in this section, an insurer may not rate or deny coverage based merely on an affirmative response on the application to a questions about past test results. Before rating or denying coverage, the insurer must confirm a positive result to the full test protocol described in OAR 836-050-0250 through medical records or current retesting unless:
(a) The applicant fails to respond to a request by the insurer for the medical records or for retesting; or
(b) The insurer is informed that the applicant declines such further testing.
Stat. Auth.: ORS 433, ORS 731, ORS 743 & ORS 746
Stats. Implemented: ORS 433.045(7), ORS 742.00 & ORS 746.240
Hist.: ID 6-1987(Temp), f. & cert. ef. 11-9-88; ID 10-1988, f. & cert. ef. 6-10-88
GROUP POLICYHOLDERS
836-050-0275
Credit Unions as Associations; Group Life Insurance
A credit union organized under ORS Chapter 723, a credit union authorized to conduct business as a credit union in this state under 723.042 or a federal credit union the principal office of which is located in Oregon is considered to be maintained primarily for purposes other than the procurement of insurance. Such a credit union may qualify as an association for the purposes of being the policyholder of a group life insurance policy if:
(1) The credit union is authorized to provide insurance to its members under the laws under which the credit union is organized; and
(2) The Director determines that the credit union otherwise satisfies the requirements of ORS 743.351(1).
Stat. Auth.: ORS 731 & 743
Stats. Implemented: ORS 743.303 & 743.351
Hist.: ID 17-1990, f. & cert. ef. 7-25-90; ID 7-1994, f. & cert. ef. 6-3-94
836-050-0280
Credit Unions as Association; Group Health Insurance
A credit union organized under ORS chapter 723, a credit union authorized to conduct business as a credit union in this state under 723.042 or a federal credit union the principal office of which is located in Oregon is considered to have a constitution and bylaws and to be maintained primarily for purposes other than the procurement of insurance. Such a credit union may qualify as an association for the purposes of being the policyholder of a group health insurance policy if:
(1) The credit union is authorized to be such a policyholder under the laws under which the credit union is organized; and
(2) The Director determines that the credit union otherwise satisfies the requirements of ORS 743.522(2).
Stat. Auth.: ORS 731 & 743
Stats. Implemented: ORS 743.522 & 743.524
Hist.: ID 17-1990, f. & cert. ef. 7-25-90; ID 7-1994, f. & cert. ef. 6-3-94
Emergency Authority
836-050-0300
Purpose, Authority, Application
(1) OAR 836-050-0300 and 836-050-0305 are adopted to implement section 2, chapter 22, Oregon Laws 2008 (Enrolled HB 3605), which requires the Director to adopt rules establishing general criteria for orders that the Director is authorized to issue when the Governor declares a state of emergency under ORS 401.055.
(2) OAR 836-050-0300 and 836-050-0305 apply to a state of emergency declared by the Governor when the conditions leading to the declaration substantially interfere with the public’s ability to carry on its normal business affairs.
Stat. Auth.: ORS 731.244 & 2008 OL Ch. 22, Sec. 2
Stats. Implemented: 2008 OL Ch. 22, Sec. 2
Hist.: ID 10-2008, f. & cert. ef. 6-30-08; ID 12-2008, f. & cert. ef. 7-29-08
836-050-0305
Criteria for orders
(1) An order issued pursuant to section 2, chapter 22, Oregon Laws 2008 (Enrolled HB 3605):
(a) Must include the items required in that section to be specified by line of insurance; and
(b) Must make a statement of general findings that refers to the specific declaration of a state of emergency upon which the order is based, describes the need for the order and declares the harm to be prevented or mitigated by the order.
(2) If the Director determines that an order under this rule must address reporting requirements for claims, the Director shall consider to what extent the circumstances of the declared state of emergency prevent policyholders from using normal methods of reporting claims and shall determine what methods of reporting remain available to consumers in the affected areas. The Director shall prepare the order accordingly. The Director may direct insurers to accept alternative methods of reporting as may be available to policyholders and may extend the reporting period as appropriate, subject to limitations of section 2, chapter 22, Oregon Laws 2008.
(3) If the Director determines that an order under this rule must address grace periods for payment of insurance premiums and performance of other duties by insureds, the Director shall consider the extent to which the circumstances of the declared state of emergency prevent the payment and performance and shall prepare the order accordingly. The Director may direct insurers to extend the grace periods as appropriate, subject to limitations of section 2, chapter 2, Oregon Laws 2008.
(4) If the Director determines that an order under this rule must temporarily postpone policy cancellations and nonrenewals, the Director shall consider the extent to which the declared state of emergency prevents communication of notices of cancellation or nonrenewal from policyholders to their insurers and the extent to which communication is prevented from insurers to their policyholders. The Director shall prepare the order accordingly. The Director may direct insurers to accept alternative methods of communication of the notices and may postpone cancellations and nonrenewals as appropriate, subject to limitations of section 2, chapter 22, Oregon Laws 2008. An order including a temporary postponement under this section must include the following:
(a) The period for which an extension of policy coverage will apply and the method for determining premium for the extended term of coverage, and whether notices of cancellation or nonrenewals must be withdrawn and reissued;
(b) When and how an insurer that was unable to cancel or nonrenew a policy owing to an order may cancel or nonrenew the policy following the period to which the order applies, and the date on which the cancellation or nonrenewal may become effective; and
(c) That an insurer may not cancel or nonrenew a policy solely because of a claim resulting from the circumstances on which the emergency order is based, except that the Director may allow cancellation or nonrenewal of a policy under specific fact circumstances, including but not limited to fraud or material misrepresentation affecting the policy or in the presentation of a claim under the policy, upon application by an insurer.
(5) An order of the Director under this rule must establish at least the following matters, as appropriate:
(a) Whether the order applies to authorized insurers only or to other insurers as well;
(b) The classes and categories of insurance policies to which the order applies, whether by specific inclusion or exclusion;
(c) The categories of insureds and insured property to which the order applies.
(d) Whether an insurer who receives a claim from an insured owing premium may offset the premium due from any claim payment made under the policy;
(e) Whether a free look period in a variable life insurance policy or variable annuity contact is extended by the order; and
(f) Procedures to be followed by premium finance companies with respect to cancellation of policies, including notice, proof of notice and treatment of refunds.
(6) An extension of time by the Director under this rule does not relieve a policyholder who has a claim resulting from the state of emergency from compliance with the policyholder’s obligations to provide information and cooperate in the claim adjustment process relative to the claim.
Stat. Auth.: ORS 731.244 & 2008 OL Ch. 22, Sec. 2
Stats. Implemented: 2008 OL Ch. 22, Sec. 2
Hist.: ID 10-2008, f. & cert. ef. 6-30-08; ID 12-2008, f. & cert. ef. 7-29-08
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