Oregon Administrative Code

836-043-0170 Premium Audit Hearings (1) This rule establishes the procedure for an insured to request a hearing to dispute the results of an audit, as described in a final premium audit billing issued by an insurer to the insured, pursuant to ORS 737.318(3)(d) and 737.505(4) to (…

836-043-0175 Statutory Authority; Purpose; Applicability (1) OAR 836-043-0175 to 836-043-0185 are adopted by the Director of the Department of Consumer and Business Services pursuant to the provisions of ORS 737.310. (2) The purpose of these rules is to prescribe minimum standard…

836-043-0180 Definitions As used in OAR 836-043-0175 to 836-043-0185 unless the context requires otherwise: (1) "Bureau" means the licensed rating organization of this state for workers' compensation insurance. (2) "Classification" means a grouping of insurance risks according to…

836-043-0185 Insurer Classification Notice (1) When an insurer issues a workers' compensation insurance policy to an insured for the first time, an insurer shall provide each insured a written rate classification notice describing the work activities of each classification assign…

836-043-0200 Statutory Authority; Purpose; Applicability (1) OAR 836-043-0200 to 836-043-0240 are adopted by the Director pursuant to 731.244, 737.310(13) and 737.526(1) to aid in the effectuation of insurer filings under 737.205, the review of workers’ compensation insurance fil…

836-043-0210 Definitions As used in; OAR 836-043-0200 to 836-043-0240, unless the context requires otherwise: (1) “Aggrieved Person” means any person adversely affected by application of a rating system or by any decision of the Committee. (2) “Classification” means a grouping of…

836-043-0220 Committee Participation (1) The Committee shall consist of seven voting and one nonvoting member as follows: (a) Five voting members shall be insurers, one of which shall be the State Accident Insurance Fund Corporation. No two insurers that share common ownership or…

836-043-0230 Committee Operating Rules (1) The term of each Committee shall commence on June 1 and expire on May 31 of the following year. (2) The Committee shall meet either in person or by teleconference at the beginning of each term for purposes of electing the First Vice-chai…

836-043-0240 Committee Activities The subject matter jurisdiction of the Committee shall include but not be limited to the following: (1) Any insured or insurer grievance regarding the application of any part of the NCCI rating system adopted by the insurer, including but not lim…

836-043-0300 Qualifications for Workers’ Compensation Rating Oganizations (1) Prior to operating in Oregon, a worker’s compensation rating organization shall apply to the Director for a license. The Director shall act on the application within 60 days of the application. Prior to…

836-043-0310 Exchange of Data Among Workers’ Compensation Rating Organizations (1) Not later than the 25th day of each month, each licensed workers’ compensation rating organization shall report to the statistical agent all edited data reported by its member insurers under OAR 83…

836-043-0320 Competitive Selection Process; Designation of a Workers’ Compensation Statistical Agent (1) When the Director licenses more than one workers’ compensation rating organization, the Director shall notify each licensed rating organization of the Director’s intent to beg…

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. Statutory/Other Authority: O…

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, addresse…

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-add…

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 form…

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 Me…

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 instruc…

836-050-0120 Effective Date; Temporary Provisions (1) Except as provided in sections (2) and (3) of this rule, OAR 836-050-0105 and 836-050-0110 as amended are effective August 1, 1995, for claims other than dental care claims and for dental care claims. (2) For claims other than…

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 again…

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 insuranc…

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 protec…

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. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 742.005 & 746.240 History: ID 10-1988, f. &…

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 th…

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 tha…

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 inclu…

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…

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 …

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 …

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 …

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…

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 …

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 Orego…

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 Oreg…

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 authori…

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 …

836-051-0005 Statutory Authority; Purpose; Applicability (1) OAR 836-051-0005 to 836-051-0020 are adopted by the Director pursuant to general rulemaking authority in ORS 731.244, and specific authority in 742.009 to issue rules requiring disclosures to prospective insurance purch…

836-051-0010 Definitions As used in OAR 836-051-0005 to 836-051-0020: (1) "Buyer's Guide" means a document that contains, and is limited to, the wording contained in Exhibit 1 or other wording approved by the Director. (2) "Cash Dividend" means the currently illustrated dividend …

836-051-0015 Disclosure Requirements (1) An insurer shall provide to each prospective buyer of life insurance a Buyer's Guide and a Policy Summary prior to accepting the applicant's initial premium or premium deposit, except that if the policy for which application is made contai…

836-051-0020 General Requirements (1) An insurer shall maintain at its home office or principal office a complete file containing one copy of each document authorized by the insurer for use pursuant to OAR 836-051-0005 to 836-051-0020. Each such document shall be retained in the …

836-051-0030 Purpose and Applicability (1) The purpose of OAR 836-051-0030 to 836-051-0040 is to establish rules that ensure meaningful information is provided to the purchasers of small face amount policies. (2) OAR 836-051-0030 to 836-051-0040 apply to insurance policies and ce…

836-051-0032 Definition "Small face amount policy" means a life insurance policy or certificate with an initial face amount of $15,000 or less. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 743.218, 746.100, 746.110 & 746.240 History: I…

836-051-0034 Exemptions OAR 836-051-0030 to 836-051-0040 apply to all group and individual life insurance policies and certificates except: (1) Variable life insurance; (2) Individual and group annuity contracts; (3) Credit life insurance; (4) Group or individual policies of life…

836-051-0036 Disclosure Requirements (1) An insurer issuing a small face amount policy, where over the term of the policy the cumulative policy premiums paid may exceed the face amount of the policy, shall clearly and prominently disclose, on or before policy delivery, the length…

836-051-0038 Insurer Duties The insurer and its producers shall provide additional information to any policyholder or certificate holder who asks questions about the disclosure statement. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 74…

836-051-0040 Trade Practice Regulation Violation of any provision of OAR 836-051-0030 to 836-051-0040 is an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 743.218, 746.100, 746.110 & 746.240 Histo…

836-051-0101 Statutory Authority; Purpose; Applicability; and Effective Date (1) OAR 836-051-0101 to 836-051-0115 are adopted pursuant to the general rulemaking authority of the Director in ORS 731.244, and specific authority of 733.306 and 743.215 for approving mortality tables …

836-051-0106 Life Insurance Valuation and Nonforfeiture Standards (1) The following definitions apply in this rule: (a) "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of…

836-051-0110 Life Insurance Nonforfeiture Standards for Men and Women (1) Use of the blended tables procedure described in section (2) of this rule shall be limited to situations in which sex neutral benefits are required to comply with the decision of the United States Supreme C…

836-051-0115 Smoker/Nonsmoker Mortality Tables Insurers may use the tables as described in Proposed NAIC Model Rule Permitting Smoker/Nonsmoker Mortality Rates for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits. NAIC Proceedings, 1984 Volume I, pp. 458–…