Oregon Administrative Code

836-100-0110 Adoption of Standards (1) On or after October 1, 2012, to the extent possible, all health insurers and health care entities must conduct eligibility benefit inquiry and response transactions with health care providers as electronic transactions that conform to the un…

836-100-0115 Waiver If the director has granted a waiver before January 1, 2014, upon expiration of the waiver, the health insurer or health care entity shall comply with the requirements of OAR 836-100-0100. Statutory/Other Authority: ORS 731.244 & 743.061 Statutes/Other Impleme…

836-100-0120 Review and Update of Standards (1) The Department of Consumer and Business Services and the Oregon Health Authority shall jointly appoint an Oregon Companion Guide Oversight Committee. The members appointed to the committee must demonstrate knowledge of the transacti…

836-150-0010 Purpose and Statutory Authority The purpose of OAR 836-150-0010 to 836-150-0060 is to administer the Oregon Reinsurance Program established in the Department of Consumer and Business Services for the purposes of stabilizing the rates and premiums for individual healt…

836-150-0020 Definitions The terms used in OAR 836-150-0010 to 836-150-0060 have the meaning prescribed in section 19, chapter 538, Oregon Laws 2017 (Enrolled House Bill 2391) and: (1) “Benefit year” means a calendar year beginning on or after January 1, 2018 for which a reinsura…

836-150-0030 Information Reporting (1) As a condition of receiving reinsurance payments from the Oregon Reinsurance Program, a reinsurance eligible issuer must provide, for each benefit year, the following information to the department in the form and manner prescribed by the dep…

836-150-0040 Reinsurance Parameters (1) For the benefit year beginning on January 1, 2022 the parameters for the Oregon Reinsurance Program are: (a) An attachment point of $92,000; (b) A reinsurance cap of $1,000,000; and (c) A coinsurance rate of fifty percent. (2) For the benef…

836-150-0050 Reinsurance Payments (1) The department will calculate the total reinsurance payment owed to each reinsurance eligible issuer. (a) Subject to paragraph (b) and (c) of this rule, the reinsurance payment made to each reinsurance eligible issuer for a benefit year will …

836-150-0060 Duties of the Administrator As administrator of the Oregon Reinsurance program, the department will: (1) Conduct an audit of the information submitted under 836-150-0030. (2) Notify reinsurance eligible issuers of the results of the calculation described under 836-15…

836-200-0000 Statutory Authority; Registration; Fees; Expiration; Renewal (1) OAR 836-200-0000 to 836-200-0060 are adopted under the authority of ORS 646.267 and 646.285 for the purpose of implementing 646.263 to 646.285. (2) The fee for filing a registration as an obligor of ser…

836-200-0010 Assessments (1) An obligor shall pay an annual assessment as required in ORS 646.281 in the amount of $75. The amount of the assessment is based on the expected costs of this registration program. (2) Assessments under section (1) of this rule shall be imposed and co…

836-200-0020 Filing Procedures (1) An applicant for registration must include proof of financial stability with the registration application. The proof must satisfy applicable requirements of OAR 836-200-0030 and 836-200-0040, or ORS 646.267(6). (2) An applicant for registration …

836-200-0030 Form 10 K and Other Financial Stability Filings (1) As provided in ORS 646.267, a registrant or applicant for registration may submit as proof of financial stability its own most recent Form 10-K that is filed with the Securities and Exchange Commission or, if the ob…

836-200-0040 Reimbursement Insurance Policy (1) When an obligor or applicant for registration relies on a reimbursement insurance policy for purposes of the financial stability requirement in ORS 646.267, the obligor or applicant must submit a copy of the policy to the Director. …

836-200-0050 Registration Requirements Not Exclusive Compliance with the filing requirements of OAR 836-200-0000 to 836-200-0060 are additional to and not in lieu of filing and other requirements established by law for the purpose of doing business in this state, including but no…

836-200-0055 Annual Report For the purpose of enabling the Director to determine the assessment against each registrant according to the formula established in 836-200-0010, each registrant shall file a report for the preceding calendar year with the Director on or before March 1…

836-200-0060 Service on Registrant The Director may make service on a registrant at the address shown on the current registration of the registrant on file with the Director, in the manner provided in ORS 183.310 to 183.550. Statutory/Other Authority: ORS 646.267 & 646.285 Statut…

836-200-0100 Notice, Collision Damage Waivers For purposes of ORS 646.859, which provides that an auto rental agency offering collision damage waivers shall post a sign approved by the Department, the Department shall consider a sign approved if the sign meets the following requi…

836-200-0105 Statutory Authority; Registration; Fees; Expiration; Renewal (1) OAR 836-200-0100 to 836-200-0140 are adopted under the authority of section 11, ch. 685, Oregon Laws 2007, for the purpose of implementing sections 1 to 11, Ch. 685, Oregon Laws 2007. (2) The fee for su…

836-200-0110 Registration Procedures (1) A warrantor of a vehicle protection product shall register with the Department of Consumer and Business Services by submitting to the Director a completed Warrantor of Vehicle Protection Product Registration Application on the form prescri…

836-200-0120 Warranty To comply with the requirement in section 3, chapter 685, Oregon Laws 2007 that each warranty must list the name, mailing address, and telephone number for the Division of Financial Regulation, Department of Consumer and Business Services, a warrantor shall …

836-200-0130 Reimbursement Insurance Policy (1) A reimbursement insurer must deliver to the warrantor and the Director of the Department of Consumer and Business Services the written notice of cancellation for a reimbursement insurance policy as required by Section 6(2), Ch. 685,…

836-200-0140 Registration Requirements Not Exclusive Compliance with the registration requirements of OAR 836-200-0100 to 836-200-0140 is additional to and not in lieu of any other requirements established by law for the purpose of doing business in this state, including but not …

836-200-0200 License, Discount Medical Plan Organization; Renewal (1) An applicant for a license to operate as a discount medical plan organization shall apply for the license by completing and submitting to the Director the application form prescribed by the Director. The applic…

836-200-0210 Renewal of expired license (1) A person whose license as a discount medical plan organization has expired may renew the license by submitting a completed license renewal application on the form prescribed by the Director, not later than the 90th day after the date th…

836-200-0215 One-time processing fee, cancelled application A discount medical plan organization may retain a one-time processing fee that is not more than $30 when the organization refunds fees, service or subscription charges, dues or other consideration paid by a member who ca…

836-200-0220 License Requirement Not Exclusive Compliance with the licensing requirement of OAR 836-200-0200 is additional to and not in lieu of any other requirements established by law for the purpose of doing business in this state, including but not limited to compliance with…

836-200-0250 Purpose and Authority OAR 836-200-0255 is adopted to implement the provisions of Section 3, chapter 561, Oregon Laws 2011. OAR 836-014-0255 applies to a contracting entity as defined in Section 1, chapter 561, Oregon Laws 2011 (Enrolled Senate Bill 634) other than an…

836-200-0255 Registration of Contracting Entity (1) A contracting entity, as defined in Section 1, chapter 561, Oregon Laws 2011 (Enrolled Senate Bill 634), that is not operating under a certificate of authority or license issued by the Department of Consumer and Business Service…

836-200-0300 Statement of Purpose; Authority OAR 836-200-0300 to 836-200-0315 are adopted by the Director of the Department of Consumer and Business Services pursuant to sections 2 and 3, chapter 499, Oregon Laws 2011 (Enrolled Senate Bill 86). The purpose of OAR 836-200-0300 to …

836-200-0305 Retainer Medical Practice Application for Certification (1) The director of the Department of Consumer and Business Services may certify a retainer medical practice for a period of one year or more, if the applicant: (a) Acts in accordance with the attestations requi…

836-200-0310 Retainer Medical Practice Application for Renewal (1) The director may renew a retainer medical practice certification if the practice complies with all of the following: (a) The retainer medical practice completes and submits to the satisfaction of the director a re…

836-200-0315 Disclosures; Form and Contents (1) The disclosures required by Oregon Laws 2011, chapter 499, section 2(4) shall be in 12-point font or larger, on the first content page of marketing materials, including websites, and in the first content page of contracts with retai…

836-200-0401 Statement of Purpose; Authority; Applicability Under the authority of Oregon Laws 2013, chapter 570, section 1, ORS 735.530 to 735.552 shall be administered and enforced in accordance with the Insurance Code. The rules promulgated under ORS 735.530 to 735.552 are aut…

836-200-0406 Application Requirements for Pharmacy Benefit Manager (1) Each pharmacy benefit manager conducting business in Oregon must obtain a license to transact business as a pharmacy benefit manager from the Department of Consumer and Business Services. To obtain a license u…

836-200-0411 Renewal of Pharmacy Benefit License (1) All pharmacy benefit manager licenses expire annually on September 1 unless renewed on or before that date. A pharmacy benefit manager must apply for renewal of the license by submitting a renewal application, in form as posted…

836-200-0416 Licensure Requirements Not Exclusive Compliance with pharmacy benefit manager licensure requirements is additional to and not in lieu of filing and other requirements established by law for the purpose of doing business in this state, including but not limited to lic…

836-200-0418 Aggregated Rebate and Payment Reports (1) For the purposes of this rule, “health benefit plan” has the meaning defined in ORS 743B.005(16). (2) For the purposes of this rule, “pharmacy benefit manager” has the meaning defined in ORS 735.530. (3) For the purposes of t…

836-200-0421 Service on Licensee The director of the Department of Consumer and Business Services may direct notices and inquiries to, and make service on a pharmacy benefit manager at, the address shown on the current license of the pharmacy benefit manager on file with the dire…

836-200-0436 Submission of Complaints (1) Any complaint filed with the Department of Consumer and Business Services by a pharmacy, or by an entity acting on behalf of a pharmacy, alleging a violation of ORS 735.530 to 735.552, shall be in form as posted on the department’s Divisi…

836-200-0440 Market Conduct Requirements for Pharmacy Benefit Managers (1) A pharmacy benefit manager shall allow a network pharmacy to mail, ship or deliver prescription drugs to its patients as an ancillary service. A contract between a pharmacy benefit manager and a network ph…

836-200-0500 Purpose and Statutory Authority The purpose of OAR 836-200-0500 to 836-200-0560 is to administer the Oregon Prescription Drug Price Transparency Program established in the Department of Consumer and Business Services for the purposes of providing notice and disclosur…

836-200-0505 Definitions For purposes of OAR 836-200-0500 to 836-200-0560, the following definitions apply, unless the context requires otherwise: (1) “Course of treatment” means the total dosage of a drug that would be prescribed in a single prescription to a patient taking the …

836-200-0510 Account Generation Requirement (1) Beginning in 2020 and for any subsequent year, reporting manufacturers must create an online account with the department no later than 30 days after becoming a reporting manufacturer or 10 days prior to a required reporting deadline…

836-200-0515 Threshold for Reporting Drug Price Increase (1) No later than July 1, 2019, a reporting manufacturer must report the information described in OAR 836-200-0530(2) to the department regarding each prescription drug for which: (a) The price at any point in 2018 was $100…

836-200-0520 Threshold for Reporting New Prescription Drug (1) For new prescription drugs introduced on or after March 15, 2019, with a price for a one-month supply that exceeds the threshold established by the Centers for Medicare and Medicaid Services for specialty drugs in the…

836-200-0525 Expectations of Reporting Manufacturers (1) Reporting manufacturers must act in good faith to include all of the information required in a report or a response to a request for additional information under OAR 836-200-0530 to 836-200-0535, and conduct a reasonable in…

836-200-0530 Form and Manner Requirements for Drug Pricing Reporting (1) General requirements. All reports submitted by drug manufacturers under ORS 646A.689 must: (a) Be provided in an electronic format specified by the department; (b) Be provided via an electronic system specif…

836-200-0531 Prescription Drug Reporting – New Prescription Drug For new prescription drugs meeting the conditions specified in OAR 836-200-0520, the report furnished to the department must include the following information: (1) The full trade name of the drug (proprietary), full…

836-200-0532 Prescription Drug Reporting – Patient Assistance Programs (1) If a reporting manufacturer offers one or more patient assistance programs to consumers residing in Oregon to reduce consumer out-of-pocket costs for a drug meeting the conditions specified in OAR 836-200-…