Oregon Administrative Code

836-007-0001 Actions by Director for Restitution or Other Equitable Relief (1) As used in this rule: (a) “Actual damages” means reasonably foreseeable losses. (b) “Consumer” means an insured under a policy that is the subject of the enforcement action. (c) “Equitable relief” mean…

836-009-0001 Purpose The purpose of rules in OAR chapter 836, division 9 is to establish assessments, fees and charges for administering the regulatory program of the Division of Financial Regulation, Department of Consumer and Business Services. Statutory/Other Authority: ORS 18…

836-009-0007 Fees (1) The following fees apply to certificates of authority: (a) The fee for application for a certificate of authority to transact insurance as an insurer is $2,500. The fee for application as a domestic insurer must be paid when application for a permit to organ…

836-009-0008 Mailing List Fee The fee for inclusion of each entry on the Division of Financial Regulation mailing list established under ORS 183.335 for giving notice of rulemaking is $35. The fee shall be paid annually. The fee established under this rule does not apply to any f…

836-009-0011 Assessments Against Insurers (1) The percentage rates for assessments authorized under ORS 731.804 against authorized insurers shall be established as provided in this rule. An authorized insurer shall pay an assessment on each line of insurance transacted by the ins…

836-009-0015 Refunds Except as provided by rule for fees and assessments under ORS 731.804, when the Director determines that the Department has received moneys in excess of the amount legally due and payable to the Department under the Insurance Code or that the Department in ca…

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 fo…

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 f…

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-…

836-010-0014 Notice and Procedural Requirements for Expanded Transitional Health Benefit Plans Text in ORMS History: Suspended by ID 12-2015, f. & cert. ef. 10-16-15 ID 11-2015(Temp), f. & cert. ef. 10-12-15 thru 3-18-16 ID 10-2015(Temp), f. & cert. ef. 9-23-15 thru 3-18-16 Rever…

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 …

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 inter…

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 admini…

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 731.438. (2) The purpose of OAR 836-010-0130 to …

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 …

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.…

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 State…

836-010-0155 Gender Specific Contract Language (1) As used in this rule, “provider” includes but is not limited to: (a) A physician as defined in ORS 677.010. (b) A physician group, independent practice association, physician-controlled organization, hospital organization or othe…

836-011-0000 Annual Statement Blank and Instructions (1) For the purpose of complying with ORS 731.574, every authorized insurer, including every health care service contractor and multiple employer welfare arrangement, shall file its financial statement required by ORS 731.574 o…

836-011-0015 Property and Casualty Actuarial Opinion of Reserves and Supporting Documentation (1) Each authorized insurer transacting property or casualty insurance in this state, unless otherwise exempted by the domiciliary commissioner, shall submit annually to the Director of …

836-011-0020 Definitions As used in OAR 836-011-0020 to 836-011-0024: (1) “Insurance group” means those insurers and affiliates included within an insurance holding company system as defined in ORS 732.548. (2) “Insurer” has the meaning given that term in ORS 731.106 but does not…

836-011-0022 Filing Procedures (1) An insurer, or the insurance group of which the insurer is a member, required to file a CGAD by the Corporate Governance Annual Disclosure Model Act shall no later than June 1 of each calendar year, submit to the director a CGAD that contains th…

836-011-0024 Contents of Corporate Governance Annual Disclosure (1) The insurer or insurance group shall be as descriptive as possible in completing the CGAD, with inclusion of attachments or example documents that are used in the governance process, since these may provide a mea…

836-011-0030 Own Risk and Solvency Assessment (1) For the purpose of complying with ORS 732.650 to 732.672, every insurer, or insurance group of which the insurer is a member, shall use a process that is comparable to the process described in the December 2017 edition of the NAIC…

836-011-0050 Requirements for Segregation of Premium Received for Coverage Not Eligible for Federal Subsidies (1) As used in this rule, "health insurer" means any insurer, fraternal benefit society, health maintenance organization or health care service contractor authorized to t…

836-011-0100 Authority; Purpose; Scope (1) OAR 836-011-0100 to 836-011-0230 are adopted by the Director pursuant to ORS 731.488. The purpose of OAR 836-011-0100 to 836-011-0230 is to improve the Director's surveillance of the financial condition of insurers by requiring the follo…

836-011-0110 Definitions As used in OAR 836-011-0100 to 836-011-0230: (1) “Accountant” or “independent certified public accountant” means an independent certified public accountant or accounting firm in good standing with the American Institute of Certified Public Accountants and…

836-011-0120 Filing and Extensions for Filing of Annual Audited Financial Reports (1) All insurers shall have an annual audit by an independent certified public accountant and shall file an audited financial report with the Director on or before June 1 for the year ended December…

836-011-0130 Exemptions (1) The following authorized insurers are exempt from the requirements of OAR 836-011-0100 to 836-011-0230: (a) An insurer having direct premiums written in this state of less than $1,000,000 in any calendar year and having fewer than 1,000 policyholders o…

836-011-0140 Contents of Annual Audited Financial Report (1) An annual audited financial report required under OAR 836-011-0120 must report the financial position of the insurer as of the end of the most recent calendar year and the results of its operations, cash flows and chang…

836-011-0150 Designation of Independent Certified Public Accountant (1) Each insurer required by OAR 836-011-0120 to file an annual audited financial report, within 60 days after becoming subject to the requirement, must register with the Director in writing the name and address …

836-011-0160 Qualifications of Independent Certified Public Accountant (1) The Director shall not recognize any person as a qualified independent certified public accountant for the purposes of OAR 836-011-0100 to 836-011-0230 if the person: (a) Is not in good standing with the A…

836-011-0170 Consolidated or Combined Audits An insurer may apply in writing to the Director for approval to file audited consolidated or combined financial statements in lieu of separate annual audited financial statements if the insurer is part of a group of insurers that uses …

836-011-0180 Scope of Audit and Report of Independent Certified Public Accountant Financial statements furnished pursuant to OAR 836-011-0140 shall be audited by an independent certified public accountant. The audit of the insurer's financial statements must be conducted in accor…

836-011-0190 Notification of Adverse Financial Condition (1) An insurer required to furnish the annual audited financial report shall require the independent certified public accountant to report in writing to the board of directors or its audit committee any determination by the…

836-011-0200 Communication of Internal Control Related Matters Noted in an Audit (1) In addition to the annual audited financial report, each insurer shall furnish the Director with a written communication as to any unremediated material weaknesses in its internal control over fi…

836-011-0210 Accountant’s Letter of Qualifications (1) An accountant shall furnish the insurer, in connection with and for inclusion in the filing of the annual audited financial report, a letter stating: (a) That the accountant is independent with respect to the insurer and conf…

836-011-0220 Definition, Availability and Maintenance of Independent Certified Public Accountants Workpapers (1) For the purpose of this rule, workpapers are the records kept by an independent certified public accountant of the procedures followed, the tests performed, the inform…

836-011-0223 Requirements for Audit Committee (1) This rule does not apply to an authorized foreign or alien insurer or to an insurer that is a SOX Compliant Entity or a direct or indirect wholly-owned subsidiary of a SOX Compliant Entity. (2) The audit committee shall be directl…

836-011-0224 Internal Audit Function Requirements (1) An insurer is exempt from these requirements if: (a) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal …

836-011-0225 Conduct of Insurer in Connection with the Preparation of Required Reports and Documents (1) A director or officer of an insurer may not directly or indirectly: (a) Make or cause to be made a materially false or misleading statement to an accountant in connection with…

836-011-0227 Management’s Report of Internal Control over Financial Reporting (1) Each insurer required to file an audited financial report pursuant to OAR 836-011-0100 to 836-011-0230 that has annual direct written and assumed premiums of $500,000,000 or more, excluding premiums…

836-011-0230 Canadian and British Companies In the case of Canadian and British insurers, the annual audited financial report is the annual statement of total business on the form filed by such companies with their domiciliary supervision authority and audited by an independent c…

836-011-0235 Effective Dates (1) The requirements of OAR 836-011-0160(4) as amended effective July 1, 2008 apply to audits of the year beginning January 1, 2010 and thereafter. (2) The requirements of OAR 836-011-0223 first apply beginning January 1, 2010. An insurer or group of …

836-011-0250 Authority; Purpose; Scope (1) OAR 836-011-0250 to 836-011-0260 are adopted by the Director of the Department of Consumer and Business Services pursuant to ORS 731.244. The purpose of OAR 836-011-0250 to 836-011-0260 is to improve the Director's ability to determine w…

836-011-0253 Definitions As used in OAR 836-011-0250 to 836-011-0260: (1) “Annual contributions” means total contributions paid by program participants less any premium collected from participants to procure insurance of any kind. (2) “Annual financial statement” means the financ…

836-011-0255 Reserve Adequacy In order to demonstrate that a self-insurance program complies with the reserve adequacy provisions contained in ORS 30.282(6)(d) or 731.036(4), (5) or (6), the demonstration of compliance must be accompanied and supported by the written actuarial re…

836-011-0258 Unallocated Reserve Account In order to demonstrate compliance with the requirement to maintain an unallocated reserve account as set forth in ORS 30.282(6)(e)in which total assets exceed total liabilities by the greater of 25 percent of annual contributions or $250,…

836-011-0260 Distribution of Annual Financial Statement A public body or the administrator of a self-insurance program must make the annual financial statement available to program participants and to the director not later than six months after the close of the program’s fiscal …

836-011-0300 Statutory Authority; Statutes Implemented (1) OAR 836-011-0300 to 836-011-0390 apply to insurers that are subject to the capital and surplus requirements of ORS 731.554 and insurers that are subject to the capital and surplus requirements of 731.566. (2) OAR 836-011-…