Title 56, Insurance

(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 …

(1) Except as provided in subsection (4) of this section, any statute described in subsection (2) of this section that becomes effective on or after July 13, 1985, is repealed on the sixth anniversary of the effective date of the statute, unless the Legislative Assembly specifica…

No policy of health insurance shall exclude from payment or reimbursement losses incurred by an insured for any covered service because the service was rendered at any hospital owned or operated by the State of Oregon or any state approved community mental health program or commu…

(1) As used in this section: (a) “Behavioral health assessment” means an evaluation by a behavioral health clinician, in person or using telemedicine, to determine a patient’s need for immediate crisis stabilization. (b) “Behavioral health clinician” means: (A) A licensed psychia…

(1) As used in this section, “health benefit plan” has the meaning given that term in ORS 743B.005. (2) Notwithstanding ORS 743.543, with respect to a health benefit plan or a Medicare supplement insurance policy that provides coverage for ambulance care and transportation, the i…

(1) As used in this section: (a) “Health benefit plan” has the meaning given that term in ORS 743B.005. (b) “Osteopathic physician” means a person who holds a degree of Doctor of Osteopathic Medicine and is licensed under ORS 677.100 to 677.228. (2) An insurer that offers a healt…

(1) An individual or group health insurance policy that provides coverage for acupuncture services performed by a physician shall provide coverage for acupuncture services performed by an acupuncturist licensed under ORS 677.757 to 677.770. (2) The coverage required by subsection…

Whenever any individual or group health insurance policy or blanket health insurance policy described in ORS 743.536 (3) provides for payment or reimbursement for any service within the lawful scope of service of a clinical social worker licensed under ORS 675.530: (1) The insure…

Notwithstanding any provisions of any policy of insurance covering dental health, whenever such policy provides for reimbursement for any service that is within the lawful scope of practice of a denturist, the insured under such policy shall be entitled to reimbursement for such …

Notwithstanding any provision of a policy of health insurance, whenever the policy provides for payment of a surgical service, the performance for the insured of such surgical service by any dentist acting within the scope of the dentist’s license is compensable if performance of…

(1) If a policy of insurance covering dental health provides for coverage for services performed by a dentist licensed under ORS chapter 679, the policy must also cover the services when they are performed by an expanded practice dental hygienist, as defined in ORS 679.010, who h…

(1) Whenever any policy of health insurance provides for reimbursement for a primary care or mental health service provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service if provided by a licensed physician associate or a licen…

Notwithstanding any provision of any policy of health insurance, whenever the policy provides for payment or reimbursement for a service that is within the lawful scope of practice of a licensed optometrist, the insurer shall provide payment or reimbursement for the service, whet…

(1) An insurer may not refuse a claim solely on the ground that the claim was submitted by a physician associate rather than by a physician, podiatric physician or employer with whom the physician associate has entered into a collaboration agreement, as defined in ORS 677.495. (2…

Whenever any provision of any individual or group health insurance policy or contract provides for payment or reimbursement for any service which is within the lawful scope of a psychologist licensed under ORS 675.010 to 675.150: (1) The insured under such policy or contract shal…

(1) Notwithstanding any provisions of a health benefit plan as defined in ORS 743B.005, whenever the plan provides for payment or reimbursement for a service that is within the lawful scope of practice of a pharmacist, the insurer: (a) May provide payment or reimbursement for the…