Chapter 743 — Chapter 743

ORS 743.618 [1967 c.359 §485; renumbered 742.212 in 1989]

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ORS 743.619 [Formerly 743.880; repealed by 1995 c.603 §42]

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ORS 743.620 [Formerly 743.885; repealed by 1995 c.603 §42]

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ORS 743.621 [1967 c.359 §486; renumbered 742.214 in 1989]

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ORS 743.622 [Formerly 743.890; repealed by 1995 c.603 §42]

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ORS 743.624 [1967 c.359 §487; renumbered 742.216 in 1989]

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ORS 743.627 [1967 c.359 §488; renumbered 742.218 in 1989]

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ORS 743.630 [1967 c.359 §489; renumbered 742.220 in 1989]

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ORS 743.633 [1967 c.359 §490; renumbered 742.222 in 1989]

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ORS 743.636 [1967 c.359 §491; 1989 c.426 §2; renumbered 742.224 in 1989]

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ORS 743.639 [1967 c.359 §492; renumbered 742.226 in 1989]

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ORS 743.642 [1967 c.359 §493; renumbered 742.228 in 1989]

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ORS 743.645 [1967 c.359 §494; 1989 c.426 §1; renumbered 742.230 in 1989]

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ORS 743.648 [1967 c.359 §495; renumbered 742.232 in 1989]

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ORS 743.650 Long Term Care Insurance Act; purpose; application. (1) ORS 743.650 to 743.665 may be known and cited as the “Long Term Care Insurance Act.”

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ORS 743.651 [1967 c.359 §496; renumbered 742.234 in 1989]

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ORS 743.652 Definitions for ORS 743.650 to 743.665. As used in ORS 743.650 to 743.665, unless the context requires otherwise

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ORS 743.653 Prohibition on certain policies. 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 substantially similar to those adopted in this state has made a determination that such requirements have been met. [1989 c.1022 §5; 1991 c.67 §199; 2007 c.486 §3; 2011 c.69 §4]

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ORS 743.654 [1967 c.359 §497; renumbered 742.236 in 1989]

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ORS 743.655 Rules; disclosure; contents of policy. (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, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, program for public understanding, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, underwriting at time of application, requirements for replacement, recurrent conditions and definitions of terms and that include required procedures for internal and external review of whether the conditions of a benefit trigger have been met

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ORS 743.656 Eligibility for benefits; providers required to be covered. (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

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ORS 743.657 [1967 c.359 §498; renumbered 742.238 in 1989]

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ORS 743.658 Notice of lapse or termination; rules. (1)(a) An insurer may not issue an individual long term care insurance policy until the insurer receives from an applicant for the policy

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ORS 743.660 [1967 c.359 §499; renumbered 742.240 in 1989]

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ORS 743.662 Rescission of policy and denial of claims. (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 acceptance for coverage

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ORS 743.663 [1967 c.359 §500; renumbered 742.242 in 1989]

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ORS 743.664 Offer of nonforfeiture benefit; rules. (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 nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. If the policyholder or certificate holder declines the nonforfeiture benefit, the insurer must provide a contingent benefit upon lapse that is available for a specified period of time following a substantial increase in premium rates

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ORS 743.665 Prompt pay requirements; rules. 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 prompt payment requirements in long term care insurance model acts developed by the National Association of Insurance Commissioners. [2011 c.69 §2]

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ORS 743.666 [Formerly 744.125; renumbered 742.244 in 1989]

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ORS 743.669 [Formerly 744.130; renumbered 742.246 in 1989]

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ORS 743.672 [Formerly 744.430; renumbered 742.248 in 1989]

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ORS 743.675 [Formerly 744.440; renumbered 742.250 in 1989]

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ORS 743.678 [Formerly 744.450; renumbered 742.252 in 1989]

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ORS 743.680 Definitions for ORS 743.680 to 743.689. As used in ORS 743.680 to 743.689, unless the context requires otherwise

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ORS 743.681 [Formerly 744.460; renumbered 742.254 in 1989]

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ORS 743.682 Application of ORS 743.680 to 743.689. (1) Except as otherwise specifically provided, ORS 743.680 to 743.689 apply to

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ORS 743.683 Policy contents; standards for benefit and claims payments; rules. (1) A Medicare supplement insurance policy, contract or certificate in force in the state may not contain benefits which duplicate benefits provided by Medicare

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ORS 743.684 Filing of policy; loss ratio standards; insurance producer compensation. (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 Medicare supplement policies issued in this state. However, no insurer shall be required to make a filing earlier than 30 days after insurance was provided to a resident of this state under a master policy issued for delivery outside this state

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ORS 743.685 Outline of coverage; information brochure; rules. (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

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ORS 743.686 Right to return of policy; premium refund. 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 and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid directly to the applicant by the insurer in a timely manner. [1989 c.255 §7]

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ORS 743.687 Advertising. 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 Director of the Department of Consumer and Business Services of this state for review or approval by the director to the extent it may be required under state law. [1989 c.255 §8]

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ORS 743.688 Rules. Rules adopted pursuant to ORS 743.680 to 743.689 shall be subject to the provisions of ORS chapter 183. [1989 c.255 §9]

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ORS 743.689 Director’s authority upon violation of ORS 743.680 to 743.689. 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 marketing any Medicare supplement policy or certificate in this state which is related directly or indirectly to a violation or may require such insurer to take such actions as are necessary to comply with the provisions of ORS 743.680 to 743.689, or both. [1989 c.255 §10]

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ORS 743.690 [1981 c.247 §17; renumbered 742.280 in 1989]

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ORS 743.691 [2003 c.748 §2; renumbered 743A.110 in 2007]

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ORS 743.693 [1999 c.428 §2; 2001 c.104 §289; renumbered 743A.080 in 2007]

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ORS 743.694 [2001 c.742 §2; renumbered 743A.184 in 2007]

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ORS 743.695 [1997 c.573 §2; renumbered 743A.060 in 2007]

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ORS 743.697 [1997 c.573 §3; renumbered 743A.062 in 2007]

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ORS 743.699 [1997 c.651 §2; 2003 c.137 §1; renumbered 743A.012 in 2007]

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