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Published: 2015

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The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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DEPARTMENT OF CONSUMER AND BUSINESS SERVICES,

INSURANCE DIVISION

 

DIVISION 10
GENERAL PROVISIONS
Rates and Forms

836-010-0000
Statutory Authority and Implementation
(1) OAR 836-010-0000, 836-010-0011
and 836-010-0021 are adopted under the authority of ORS 731.244 and 731.296, to
aid in giving effect to provisions of ORS Chapters 737, 742 and 743 relating to
the filing of rates and policy forms with the Director. The requirements of OAR
836-010-0000, 836-010-0011 and 836-010-0021 are in addition to any other requirements
established by statute or by rule or bulletin of the Department.
(2) OAR 836-010-0000, 836-010-0011,
and 836-010-0021 apply to all filings submitted or resubmitted to the Director on
or after May 1, 2002.
Stat. Auth.: ORS 731.244

Stats. Implemented: ORS 731.296,
737.205, 737.207, 742.001, 743.015 & 743.018

Hist.: ID 9-1994, f. 7-1-94,
cert. ef. 7-15-94; ID 20-1997(Temp), f. 12-29-97, cert. ef. 12-30-97 thru 6-11-98;
ID 11-1998, f. & cert. ef. 8-10-98; ID 11-2002(Temp), f. & cert. ef. 4-18-02
thru 10-11-02; ID 20-2002, f. 10-11-02, cert. ef. 10-12-02; ID 8-2010, f. 3-31-10,
cert. ef. 4-1-10; ID 20-2011, f. 12-16-11, cert. ef. 1-1-12
836-010-0011
Filing, Review of Rates and Forms
(1) Except as provided in this section,
this rule applies to filings of all insurers, including health care service contractors
as defined in ORS 750.005, multiple employer welfare arrangements as governed by
750.301 to 750.431 and fraternal benefit societies as governed by ORS Chapter 748.
This rule does not apply to:
(a) Purchasing group insurance
filings.
(b) Negotiated forms as described
in ORS 742.003, but only if each of the negotiated forms is issued only to one policyholder,
the insurer has determined that the forms comply with benefits and coverages mandated
by statute and the forms have a company-assigned form number.
(c) Rates and forms approved
by the Interstate Insurance Product Regulation Commission.
(2) An insurer must follow
the applicable standards set forth on the website of the Insurance Division of the
Department of Consumer and Business Services at www.insurance.oregon.gov, when making
rate and form filings, except that if the insurer files electronically on theSystem
for Electronic Rates and Forms Filing, (SERFF), the insurer must comply with the
Oregon standards set forth SERFF.
(3) An insurer must submit
a completed certificate of compliance as provided in this section with each filing
of a new or revised rate and each filing of a new or amended form. The insurer must
use the certificate of compliance in Exhibit 1 to this rule. The certificate of
compliance must certify compliance with the applicable filing requirements and product
standards set forth on the website of the Insurance Division of the Department of
Consumer and Business Services at www.insurance.oregon.gov or on the SERFF system
for Oregon, if filed electronically. The certificate must be accompanied by the
applicable product standards form. A certificate of compliance must be completed
and signed by:
(a) An officer of the insurer
who is authorized by the insurer to do so; and
(b) Signed by the filer who
is specifically designated by the insurer to prepare and make the filing.
(4) An insurer filing changes
to a form or forms that were previously approved must highlight or otherwise visually
call attention to the changes in new or revised forms and must submit a letter explaining
the changes.
(5) A filing received for
prior approval by the department that does not contain a certificate of compliance
and does not comply with the standards referenced in this rule is incomplete and
will be returned to the insurer as disapproved.
[ED. NOTE: Exhibits referenced are available
from the agency.]
Stat. Auth.: ORS 731.244
& 731.296
Stats. Implemented: ORS 731.296,
737.205, 737.207, 742.001, 732.820, 743.015, 743.018 & 743.825
Hist.: ID 9-1994, f. 7-1-94,
cert. ef. 7-15-94; ID 11-1996, f. 6-28-96, cert. ef. 7-1-96; ID 20-1997(Temp), f.
12-29-97, cert. ef. 12-30-97 thru 6-11-98; ID 11-1998, f. & cert. ef. 8-10-98;
Administrative correction 6-25-99; ID 6-2000, f. & cert. ef. 7-19-00; ID 3-2001,
f. 3-19-01, cert. ef. 5-1-01; ID 11-2002(Temp), f. & cert. ef. 4-18-02 thru
10-11-02; ID 20-2002, f. 10-11-02, cert. ef. 10-12-02; ID 8-2010, f. 3-31-10, cert.
ef. 4-1-10; ID 20-2011, f. 12-16-11, cert. ef. 1-1-12; ID 12-2013, f. 12-31-13,
cert. ef. 1-1-14
836-010-0013
Additional Filing Requirements for
Transitional Health Benefit Plans
(1) Under section 5, chapter 80, Oregon
Laws 2014, a transitional health benefit plan must comply with the Insurance Code
as of December 31, 2013.
(2) In addition to the requirements
of OAR 836-010-0000, 836-010-0011, and 836-010-0021 when submitting a filing for
a rate change to a transitional health benefit plan, the insurer shall comply with
the guidance provided in Exhibits 1 and 2 of this rule.
(3) The additional filing
requirements set forth in this section apply only to 2015 transitional plans.
[ED. NOTE:
Exhibits referenced are not included in rule text. Click here for PDF copy exhibits.]
Stat. Auth: ORS 731.244, 743.018
Stats. Implementing: Section
5, chapter 80, Oregon Laws 2014 (Enrolled Senate Bill 1582)
Hist.: ID 8-2014(Temp), f.
& cert. ef. 4-24-14 thru 10-20-14; ID 17-2014, f. & cert. ef. 10-6-14
836-010-0014
Notice and Procedural Requirements
for Expanded Transitional Health Benefit Plans
(1) As used in this rule, “expanded
transitional health benefit plan” means a transitional health benefit plan
described in section 2, chapter 515, Oregon Laws 2015.
(2) Under section 2, chapter
515, Oregon Laws 2015, an expanded transitional health benefit plan must be in effect
on December 31, 2015.
(3) An insurer shall comply
with the guidance provided in Exhibit 1 of this rule if the carrier intends to:
(a) Offered to continue a
plan in effect on December 31, 2015 as an expanded transitional health benefit plan;
or
(b) Discontinue a health
benefit plan that would otherwise meet the requirements of an expanded transitional
health benefit plan.
(4) In addition to any applicable
requirements of OAR 836-010-0000, 836-010-0011, and 836-010-0021 when submitting
a filing in accordance with ORS 743.018 related to a rate change to an expanded
transitional health benefit plan, the insurer shall comply with the guidance provided
in Exhibit 1 of this rule.
Stat. Auth: ORS 731.244, 743.018
Stats. Implementing: Sect.
2, Ch. 515, OL 2015 (Enrolled HB 2466)
Hist.: ID 10-2015(Temp),
f. & cert. ef. 9-23-15 thru 3-18-16; ID 11-2015(Temp), f. & cert. ef. 10-12-15
thru 3-18-16
836-010-0021
Required Actuarial Data
(1) An insurer shall file with the Director, on or before March 15 of each year, geographic average rates for small employer, portability and individual health benefit plans for a rating period. The supporting actuarial data must be submitted with the certificate of compliance. The geographic average rates must demonstrate compliance with the applicable provisions of:
(a) ORS 743.737, governing small employer premium rates;
(b) ORS 743.760, governing portability premiums rates; and
(c) ORS 743.767, governing individual premium rates.
(2) Except as provided in this section, supporting actuarial data shall accompany every filing of property or casualty insurance rates submitted on a file and use basis under ORS 737.205 and prior approved rates under ORS 737.207. The data shall be in sufficient detail to justify the rate level change and shall demonstrate compliance with ORS 737.310 governing the making of rates. This section does not apply to:
(a) Title insurance filings;
(b) Workers' compensation insurance filings;
(c) Surety filings;
(d) Home protection insurance filings;
(e) Filings for mortgage insurance, which is the insurance against financial loss by reason of nonpayment of sums agreed to be paid, as defined in ORS 731.178, rather than a life insurance product offering payment of a mortgage in the event of death or disability; and
(f) Purchasing group insurance filings.
(3) A rate filing for commercial liability insurance received by the Department that is subject to ORS 737.207 and does not comply with the requirement of section (2) of this rule is in noncompliance with the requirements and standards of ORS Chapter 737.
Stat. Auth.: ORS 731.244

Stats. Implemented: ORS 731.296, ORS 737.205, ORS 737.207, ORS 743.015 & ORS 743.018

Hist.: ID 9-1994, f. 7-1-94, cert. ef. 7-15-94; ID 20-1997(Temp), f. 12-29-97, cert. ef. 12-30-97 thru 6-11-98; ID 11-1998, f. & cert. ef. 8-10-98; Administrative correction, 6-25-99; ID 12-2000 f. 11-14-00, cert. ef. 1-1-01; ID 13-2000(Temp), f. & cert. ef. 12-21-00 thru 6-9-01; Administrative correction 11-20-01; ID 11-2002(Temp), f. & cert. ef. 4-18-02 thru 10-11-02; ID 20-2002, f. 10-11-02, cert. ef. 10-12-02
836-010-0026
Prohibition on the Use of Discretionary
Clauses
(1)(a) As used in this rule, “discretionary
clause” means a policy provision that purports to bind the claimant, or to
grant deference to the insurer, in proceedings subsequent to the insurer’s
decision, denial or interpretation of terms, coverage or eligibility for benefits.
“Discretionary clause” includes a policy provision that provides any
of the following:
(A) An insured or other claimant
may not appeal a denial of a claim;
(B) The insurer's decision
to deny coverage is binding upon a policyholder or other claimant or is otherwise
entitled to deference upon appeal or review;
(C) On appeal or review the
insurer's decision-making power as to coverage is binding or otherwise entitled
to deference;
(D) The insurer's interpretation
of the terms of a policy is binding upon a policyholder or other claimant or is
otherwise entitled to deference;
(E) On appeal the insurer's
interpretation of the terms of a policy is binding or is otherwise entitled to deference;
(F) A legal standard of review
on appeal that gives deference to the original claim decision, or gives rise to
such legal standard of review; or
(G) The insurer has sole
discretion to determine whether a claim is compensable or its interpretation of
the provisions of the policy is entitled to deference in a subsequent proceeding.
(b) Nothing in this section
prohibits a carrier from including a provision in a contract that informs an insured
that as part of its routine operations the carrier applies the terms of its contracts
for making decisions, including making determination regarding eligibility, receipt
of benefits and claims or explaining its policies, procedures and processes.
(2) A policy, contract or
agreement offered or issued in this state by an insurer to provide, deliver, arrange
for, pay for or reimburse claim costs may not contain a discretionary clause or
other language purporting to reserve discretion to the insurer to interpret the
terms of the contract, or to provide standards of interpretation or review that
are inconsistent with the laws of this state.
(3) This rule does not prevent
a policy provision that addresses alternative dispute resolution as allowed by law.
(4) This rule is self-executing.
The rule applies to policies, contracts and agreements issued or renewed on or after
the date the rule is adopted. If a policy, contract or agreement is renewed and
contains a provision rendered void and unenforceable by this rule, the parties to
the policy, contract or agreement and the courts shall treat that provision as void
and unenforceable.
Stat. Auth: ORS 731.244
Stats. Implemented: ORS 731.008,
742.003 & 742.005
Hist.: ID 2-2015, f. &
cert. ef. 3-12-15
Insurer Reporting or Response to
Insurance Division
836-010-0051
Requirements for Electronic Reporting
or Response
(1) As used in this rule:
(a) “Administrator”
means the individual responsible for a person’s electronic account activation
and maintenance.
(b) “Contact”
means the individual responsible for electronic account administration, an electronic
report or electronic response.
(c) “Contact Information”
means:
(A) Name;
(B) Title;
(C) Direct telephone number;
(D) Electronic mail address;
and
(E) Mailing address.
(d) “Maintenance”
means ensuring accurate and current company and contact information, providing and
updating user access and performing other activities necessary for user submission
of reports or responses and timely communication with the Insurance Division.
(e) “User” means
an individual with rights to access the person’s electronic account.
(2) This rule establishes
requirements for submitting information or responses through the reporting system
of the Insurance Division according to the instructions set forth on the website
of the Insurance Division of the Department of Consumer and Business Services at
www.insurance.oregon.gov.
(3) A person required to
submit information to the Insurance Division or to respond electronically to a request
from the Insurance Division must activate and maintain an account through the reporting
system of the Insurance Division.
(4) A person subject to section
(3) of this rule must:
(a) Designate at least one
administrator;
(b) Designate at least one
contact for account administration and for each electronic report or response; and
(c) Provide current, accurate
contact information for the administrator, company and each contact.
Stat. Auth: ORS 731.244
Stats. Implemented: ORS 731.296
Hist.: ID 12-2013, f. 12-31-13,
cert. ef. 1-1-14

Authorization of Insurers and General Requirements

836-010-0130
Statutory Authority; Purpose; Applicability
(1) OAR 836-010-0130 to 836-010-0145 are adopted pursuant to the general rulemaking authority of the Commissioner in ORS 731.244 to aid in the effectuation and enforcement of ORS 731.438.
(2) The purpose of OAR 836-010-0130 to 836-010-0145 is to prescribe title plant standards for title insurers.
(3) OAR 836-010-0130 to OAR 836-010-0145 applies to all authorized title insurers.
Stat. Auth.: ORS 731

Stats. Implemented: ORS 731.438

Hist.: IC 1-1978, f. 3-27-78, ef. 4-1-78
836-010-0135
Definitions
As used in OAR 836-010-0130 to 836-010-0145, unless the context requires otherwise:
(1) "Adequate Maps" means:
(a) A map record of all recorded plats in the county covered by the title plant;
(b) Maps based on a complete set of government surveys showing all surveyed sections, government lots and donation land claims within the county covered by the title plant;
(c) Maps of such a scale that they are readily workable. In an area where the majority of the parcels are of less than one sixteenth of a section, maps shall be of a scale no smaller than 400 feet to the inch. A full section of land shall not be represented in a scale smaller than 2,000 feet to the inch;
(d) Maps showing all public streets, roads, highways, and railroad rights of way of record which can be accurately located by a reasonable search of the records.
(2) "General Index" means a complete compilation of matters affecting real property which do not describe, or cannot solely be assigned to a specific real property account, which may be found by a search of the proper records within the county covered by the title plant, and includes, not is not limited to:
(a) Unsatisfied judgments and tax liens;
(b) Conservatorships, guardianships, and estates of deceased persons arising during the preceding ten-year period;
(c) Divorce suits closed or pending during the preceding ten-year period;
(d) Powers of attorney during the preceding ten-year period.
(3) "Tract or Geographic Index" means a record of documents and proceedings which affect real property in the county covered by the title plant. Such an index may consist of summaries or replicas:
(a) Tract or geographic indexes relating to recorded plats are maintained separately, and may be referred to by name or by number, with accounts segregated to the block or in the absence of blocks to the smallest unit designated on the applicable recorded plat;
(b) Tract or geographic indexes which relate to ownership in all unplatted areas of the county, except land in national forest reserves, national parks and unpatented lands, are maintained in accounts segregated into section subdivisions and government lots. In the event ownership of parcels does not conform to section subdivisions or government lots, such parcels are assigned arbitrary reference numbers or symbols which correspond to like numbers or symbols shown on the arbitrary maps of the area, except if there are 30 or fewer ownership accounts in a quarter section that do not conform to section subdivisions or government lots or are not in a recorded plat then those ownership accounts can be filed under the designation of that particular quarter section without being assigned arbitrary reference numbers or symbols;
(c) Tract or geographic indexes may be maintained on ledger sheets, separate cards, sheets of film, or any other form or system, whether manual, mechanical, electronic or otherwise, or any combination of such forms or systems. The index ledger sheets, cards, sheets, or film may be bound in books or contained in envelopes or storage files. The segregated account contains a reference to deeds, contracts, suits, liens, unsatisfied mortgages, and other matters of record imparting constructive notice that specifically describe the real property that is subject to the account.
(4) "Currently posted" means, respects an OAR 836-010-0135(3) "tract or geographic index," and index in which postings or entries are made within 15 working days of recording or filing. The "tract or geographic index" shall extend continuously for a period of 20 years from the date of Certificate of Authority respects title insurers or date of execution of agency contract respects title agents.
Stat. Auth.: ORS 731

Stats. Implemented: ORS 731.438

Hist.: IC 1-1978, f. 3-27-78, ef. 4-1-78
836-010-0140
Title Plant Standards
(1) The title plant shall maintain "adequate maps" as defined in OAR 836-010-0135, that will enable a person working the title plant to locate a tract of land which is the subject of a title search with reference to the government survey system.
(2) The title plant shall maintain a "general index," as defined in OAR 836-010-0135, in either alphabetical or phonetical order,so that any record pertaining to any person by name may be readily located.
(3) The title plant shall maintain a "currently posted" "tract or geographic index" as defined in OAR 836-010-0135.
Stat. Auth.: ORS 731

Stats. Implemented: ORS 731.438

Hist.: IC 1-1978, f. 3-27-78, ef. 4-1-78
836-010-0150
Marriage of Same-Gender Couple Validly
Performed
(1) This rule is adopted under the general
rulemaking authority of the Director of the Department of Consumer and Business
Services in ORS 731.244 to comply with the United States Supreme Court decision
in United States v. Windsor, 570 U.S. 12 (2013) and Geiger v. Kitzhaber, No. 6:
13-cv-01834-MC (D. Or. May 19, 2014).
(2) Any person or entity
subject to regulation by the Department of Consumer and Business Services under
the Insurance Code, must consider the marriage of a same-sex couple validly performed
the same as the person or entity considers any other marriage validly performed.
(3) This rule applies to
any action or activity related to the transaction of insurance in Oregon.
(4) Any privilege, immunity,
right or benefit granted under the Insurance Code to an individual because the individual
is or was married to an individual of the opposite sex, is granted on equivalent
terms, substantive and procedural, to an individual who is or was a partner in a
marriage of a same-sex couple validly performed.
Stat. Auth.: ORS 731.244
Stat. Implemented: ORS 731.008,
731.016 & 731.236
Other Auth.: SCOTUS Decision
in United States v. Windsor, 570 U.S. 12 (2013); Letter of Advice from Oregon Attorney
General dated October 16, 2013; Geiger v. Kitzhaber, No. 6: 13-cv-01834-MC (D. Or.
May 19, 2014).
Hist.: ID 11-2014, f. &
cert. ef. 7-17-14

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