Title 56, Insurance

(1) A health insurance policy may contain a provision as follows: “RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly bas…

A health insurance policy may contain a provision as follows: “UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.” [1967 c.359 §448]

A health insurance policy may contain a provision as follows: “CANCELLATION: The insurer may cancel this policy by written notice delivered to the insured, or mailed to the last address of the insured as shown by the records of the insurer. The notice must state the reason for ca…

An insurer selling individual health insurance policies may cancel or refuse to renew an individual health insurance policy only if the insurer makes a determination to cancel or not to renew all policies of the same type and form as the individual policy, or if the ground for ca…

A health insurance policy may contain a provision as follows: “CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date hereby is amended to conform to the mi…

A health insurance policy may contain a provision as follows: “ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the insured’s commission of or attempt to commit a felony or to which a contributing cause was the insured’s being eng…

The provisions of a health insurance policy that are the subject of ORS 743.408 to 743.477, or any corresponding provisions that are used in lieu thereof in accordance with the Insurance Code, shall be printed in the consecutive order of such sections or, at the option of the ins…

As used in ORS 743.402 to 743.498, the word “insured” shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indem…

If any health insurance policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer acce…

Every health insurance policy except single premium nonrenewable policies shall have printed on its face or attached thereto a notice stating in substance that the person to whom the policy is issued shall be permitted to return the policy within 10 days of its delivery to the pu…

(1) No health insurance policy shall contain the following unqualified terms except as provided in this subsection: (a) The unqualified terms “noncancelable” or “noncancelable and guaranteed renewable” may be used only in a policy which the insured has the right to continue in fo…

(1) A health insurance policy which is noncancelable or guaranteed renewable as those terms are used in ORS 743.495, except that the insured’s right is for a limited period of more than one year rather than for life, shall contain the applicable one of the following statements, o…

(1) A leasing company may offer group health insurance to its leased workers. If the leasing company does not offer group health insurance to its leased workers, the client employer may offer group health insurance to the leased workers. (2) If a leasing company offers group heal…

(1) As used in this section and ORS 743.521: (a) “Client employer” means an employer to whom workers are provided under contract and for a fee on a leased basis by a worker leasing company licensed under ORS 656.850. (b) “Employee” may include a retired employee. (c) “Leased work…

(1) No person selling group health insurance is authorized to sell membership in an association, including a labor union, for the purpose of qualifying an applicant who is an individual for group health insurance. (2) No person selling membership in an association, including a la…

(1) An insurer may not offer a policy of group health insurance to an association as the policyholder or offer coverage under such a policy, whether issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the associ…

(1) An insurer may not offer a policy of group health insurance described in ORS 731.098 (3) that insures persons in this state or offer coverage under such a policy, whether the policy is to be issued in this or another state, unless the Director of the Department of Consumer an…

(1) As used in this section, “guaranteed association” means an association that: (a) The Director of the Department of Consumer and Business Services has determined under ORS 743.524 meets the requirements described in ORS 731.098 (2); and (b) Is a statewide nonprofit organizatio…

“Blanket health insurance” means that form of a health insurance covering groups of persons defined in this section and issued on one of the following bases: (1) Under a policy issued to a common carrier or to an operator, owner or lessee of a means of transportation, who shall b…

A blanket health insurance policy shall contain provisions which in the opinion of the Director of the Department of Consumer and Business Services are not less favorable to the policyholder and the individual insureds than the provisions described in ORS 743.411, 743.423, 743.42…

An individual application need not be required from a person insured under a blanket health insurance policy, nor shall it be necessary for the insurer to furnish each person a certificate. [1967 c.359 §467]

All benefits under a blanket health insurance policy shall be payable to the person insured, or to the designated beneficiary or beneficiaries of the person, or to the estate of the person, except that if the person insured is a minor or otherwise not competent to give a valid re…

The Director of the Department of Consumer and Business Services may exempt from the policy form filing and approval requirements of ORS 742.003, for so long as the director deems proper, any blanket health insurance policy to which in the opinion of the director such requirement…

(1) Student health insurance is subject to ORS 743.537, 743.540, 743.543, 743.546 and 743B.475, except as provided in this section. (2) Coverage under a student health insurance policy may be mandatory for all students at the institution, voluntary for all students at the institu…

(1) As used in this section, “student health benefit plan” means a plan that is subject to rules adopted by the United States Department of Health and Human Services under 42 U.S.C. 18118(c). (2) Notwithstanding any other provision of law, the Department of Consumer and Business …

(1) ORS 743.650 to 743.665 may be known and cited as the “Long Term Care Insurance Act.” (2) The purpose of ORS 743.650 to 743.665 is to: (a) Promote the public interest in long term care insurance; (b) Promote the availability of long term care insurance policies; (c) Protect ap…

As used in ORS 743.650 to 743.665, unless the context requires otherwise: (1) “Applicant” means: (a) In the case of an individual long term care insurance policy, the person who seeks to contract for benefits; and (b) In the case of a group long term care insurance policy, the pr…

Group long term care insurance coverage may not be offered to a resident of this state under a group policy issued in another state to a group described in ORS 743.652 (4)(d), unless this state or another state having statutory and regulatory long term care insurance requirements…

(1)(a) The Director of the Department of Consumer and Business Services shall adopt rules that include standards for full and fair disclosure setting forth the manner, content and required disclosures for the sale of long term care insurance policies, terms of renewability, initi…

(1) No long term care insurance policy shall be delivered or issued for delivery in this state unless the policy determines eligibility for benefits through a determination that is not more restrictive than requiring that: (a) The policyholder be functionally impaired and needing…

(1)(a) An insurer may not issue an individual long term care insurance policy until the insurer receives from an applicant for the policy: (A) A written designation of the full name and residential address of at least one person, in addition to the applicant, to whom the insurer …

(1) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long term care insurance policy or certificate or deny an otherwise valid long term care insurance claim upon a showing of a misrepresentation that is material to the accepta…

(1) Except as provided in subsection (2) of this section, a long term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonfor…

The Director of the Department of Consumer and Business Services shall adopt by rule prompt payment requirements for long term care insurance. The rules shall include a definition of “claim” and a definition of “clean claim.” In adopting the rules, the director shall consider the…

As used in ORS 743.680 to 743.689, unless the context requires otherwise: (1) “Applicant” means: (a) In the case of an individual Medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits. (b) In the case of a group Medicare supple…

(1) Except as otherwise specifically provided, ORS 743.680 to 743.689 apply to: (a) All Medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after May 31, 1989; and (b) All certificates issued under group Medicare supplement p…

(1) A Medicare supplement insurance policy, contract or certificate in force in the state may not contain benefits which duplicate benefits provided by Medicare. (2) The Director of the Department of Consumer and Business Services shall adopt by rule specific standards for policy…

(1) Every insurer providing group Medicare supplement insurance benefits to a resident of this state pursuant to ORS 743.682 shall file a copy of the master policy and any certificate used in this state in accordance with the filing requirements and procedures applicable to group…

(1) In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made. (2) The Dir…

Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within 30 days of its delivery …

Every insurer, health care service plan or other entity providing Medicare supplement insurance or benefits in this state shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medium to the Direct…

Rules adopted pursuant to ORS 743.680 to 743.689 shall be subject to the provisions of ORS chapter 183. [1989 c.255 §9]

In addition to any other applicable penalties for violations of the Insurance Code, the Director of the Department of Consumer and Business Services may require insurers violating any provision of ORS 743.680 to 743.689 or rules adopted pursuant to ORS 743.680 to 743.689 to cease…

As used in ORS 743.788: (1) “Carrier” has the meaning given that term in ORS 743B.005. (2) “Enrollee” has the meaning given that term in ORS 743B.005. (3) “Health benefit plan” has the meaning given that term in ORS 743B.005. [2001 c.549 §2]

(1) A carrier that provides coverage for prescription drugs provided on an outpatient basis and issues a card or other technology for claims processing, or an administrator of a health benefit plan including, but not limited to, a third party administrator for a self-insured plan…

The Director of the Department of Consumer and Business Services may adopt rules to implement ORS 743.788 and may consider any relevant standards developed by a standards development organization accredited by the American National Standards Institute that represents organization…

(1) As used in this section, “healthy behaviors” means participating in constructive behaviors that encourage fitness, healthy eating and other activities that are beneficial to good health. (2) An insurer offering a health benefit plan, as defined in ORS 743B.005, may pay cash d…

(1) As used in this section: (a) “Catastrophic plan” means a health benefit plan that meets the requirements for a catastrophic plan under 42 U.S.C. 18022(e). (b) “Minimum essential coverage” has the meaning given that term in section 5000A(f) of the Internal Revenue Code. (2) A …