Title 56, Insurance

ORS 735.300 to 735.365 shall be known and may be cited as the Oregon Liability Risk Retention Law. [1987 c.774 §98a] SURPLUS LINES LAW

ORS 735.400 to 735.495 shall be liberally construed and applied to promote its underlying purposes which include: (1) Protecting persons seeking insurance in this state; (2) Permitting surplus lines insurance to be placed with reputable and financially sound nonadmitted insurers …

As used in ORS 735.400 to 735.495: (1) “Admitted insurer” means an insurer authorized to do an insurance business in this state. (2) “Affiliated group” means any group of entities that, with respect to an insured, exercise control over the insured, are under the control of the in…

Beginning on January 1, 2015, and each fifth January 1 occurring thereafter, the amounts in ORS 735.405 (6)(c)(A), (B) and (D) shall be adjusted to reflect the percentage change for such five-year period in the Consumer Price Index for All Urban Consumers, West Region (All Items)…

(1) Insurance may be procured through a surplus lines licensee from a nonadmitted insurer if: (a) The insurer is an eligible surplus lines insurer; (b) A diligent search has first been made among the insurers who are authorized to transact and are actually writing the particular …

(1) A surplus lines licensee may not place any coverage with a nonadmitted insurer unless at the time of placement the nonadmitted insurer has done all of the following: (a) Obtained authorization to write the kind of insurance to be placed by the surplus lines licensee by the in…

(1) Each insured in this state who obtains independently procured insurance, or continues or renews independently procured insurance on Oregon home state risks, other than insurance procured through a surplus lines licensee, shall file, within 30 days after the date the insurance…

For purposes of carrying out the Nonadmitted and Reinsurance Reform Act of 2010 (P.L. 111-203, Title V, Subtitle B), after receiving express legislative approval, the Director of the Department of Consumer and Business Services is authorized to enter into a compact or to otherwis…

(1) The Director of the Department of Consumer and Business Services may declare a surplus lines insurer described in ORS 735.415 (1) ineligible if the director has reason to believe that the surplus lines insurer: (a) Is in unsound financial condition; (b) Is no longer eligible …

(1) Within 90 days after the placing of any surplus lines insurance in this state on an Oregon home state risk, each surplus lines licensee shall file with the Director of the Department of Consumer and Business Services: (a) A statement signed by the licensee regarding the insur…

(1) The Surplus Line Association of Oregon is the advisory organization of surplus lines licensees to: (a) Facilitate and encourage compliance by resident and nonresident surplus lines licensees with the laws of this state and the rules of the Director of the Department of Consum…

(1) Upon placing surplus lines insurance on an Oregon home state risk, the surplus lines licensee shall promptly deliver to the insured or the producing insurance producer the policy, or if such policy is not then available, a certificate as described in subsection (4) of this se…

Insurance contracts procured under ORS 735.400 to 735.495 shall be valid and enforceable as to all parties. [1987 c.774 §125]

A payment of premium to a surplus lines licensee acting for a person other than the surplus lines licensee in negotiating, continuing or renewing any policy of insurance under ORS 735.400 to 735.495 shall be deemed to be payment to the insurer, whatever conditions or stipulations…

A person may not procure any contract of surplus lines insurance with any nonadmitted insurer for an Oregon home state risk unless the person is licensed under ORS chapter 744 to transact surplus lines insurance. A person may obtain a license to transact surplus lines insurance o…

(1) A surplus lines licensee may originate surplus lines insurance on an Oregon home state risk or accept such insurance from any other insurance producer duly licensed as to the kinds of insurance involved on an Oregon home state risk, and the surplus lines licensee may compensa…

(1) Each surplus lines licensee shall keep a full and true record of each surplus lines insurance contract placed on an Oregon home state risk by or through the licensee as required by ORS 744.068, including a copy of the policy, certificate, cover note or other evidence of insur…

(1) On or before the end of each month, each surplus lines licensee shall file with the Director of the Department of Consumer and Business Services, as prescribed by the director, a verified report of all surplus lines insurance transacted on Oregon home state risks during the p…

(1)(a) The surplus lines licensee shall pay the Director of the Department of Consumer and Business Services a surplus lines premium tax equal to two percent of the gross amount of premiums received on Oregon home state risks as shown in the report required by ORS 735.465. (b) No…

If the tax collectible by a surplus lines licensee under ORS 735.400 to 735.495 is not paid within the time prescribed, the same shall be recoverable in a suit brought by the Director of the Department of Consumer and Business Services against the surplus lines licensee. [1987 c.…

The Director of the Department of Consumer and Business Services may suspend, revoke or refuse to renew the license of a surplus lines licensee after notice and hearing as provided under the applicable provision of this state’s laws upon any one or more of the following grounds: …

(1) A surplus lines insurer may be sued upon any cause of action arising in this state under any surplus lines insurance contract on an Oregon home state risk made by it or evidence of insurance issued or delivered by the surplus lines licensee pursuant to the procedure provided …

(1) An insurer transacting insurance on an Oregon home state risk under the provisions of ORS 735.400 to 735.495 may be sued upon any cause of action, arising under any policy of insurance so issued and delivered by it, in the courts for the county where the insurance producer wh…

ORS 731.324, 731.328, 731.512 and 731.624 do not apply to surplus lines insurers. [2005 c.185 §17]

(1) ORS 735.400 to 735.495 shall be known and may be cited as “The Oregon Surplus Lines Law.” (2) If any provisions of ORS 735.400 to 735.495, or the application of such provision to any person or circumstance, is held invalid, the remainder of ORS 735.400 to 735.495 and the appl…

(1) As used in this section and ORS 735.510: (a) “Control” means the possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting stock, by contract or otherwise. A person who…

A certified retainer medical practice shall: (1) Notify the Department of Consumer and Business Services immediately whenever: (a) The license of a provider who has provided services on behalf of the practice is denied, suspended, revoked or not renewed in this state or in any ot…

(1) As used in this section: (a) “Dental services contract” means a contract between an insurer and a provider or a group of providers to provide dental health services for enrollees. “Dental services contract” does not include a contract of employment or a contract creating lega…

(1) As used in this section: (a) “Eligible employer” means an operator of a facility that: (A) Is a participating provider in the state medical assistance program; (B) Elects to participate in the Oregon Essential Workforce Health Care Program; and (C) Meets other requirements pr…

As used in ORS 735.530 to 735.552: (1) “Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or service. (2) “Enrollee” means an individual who has enrolled for cover…

(1) A person may not transact business or purport to transact business in this state as a pharmacy benefit manager unless the person has a license to transact business as a pharmacy benefit manager issued by the Department of Consumer and Business Services. (2) To obtain a licens…

(1) In accordance with ORS chapter 183, the Department of Consumer and Business Services may deny an application for a license to transact business as a pharmacy benefit manager or deny an application for renewal of a license to transact business as a pharmacy benefit manager, an…

(1) As used in this section: (a) “Conflict of interest” means: (A) Present employment, ownership or control by a covered entity, pharmaceutical manufacturer, pharmacy benefit manager or health benefit plan as defined in ORS 743B.005; or (B) Third party employment, ownership or co…

(1) As used in this section, “out-of-pocket cost” means the amount paid by an enrollee under the enrollee’s coverage, including deductibles, copayments, coinsurance or other expenses as prescribed by the Department of Consumer and Business Services by rule. (2) A pharmacy benefit…

(1) As used in this section: (a) “Administrative fee” means the administrative and service fees charged by pharmacy benefit managers to manufacturers and carriers that are typically a percentage of the list price of a prescription drug. (b) “Carrier” has the meaning given that te…

(1) As used in this section, “pharmacy services administrative organization” means an entity that: (a) Contracts with a pharmacy to act as the pharmacy’s agent with respect to matters involving a pharmacy benefit manager, third party payer or other entity, including by negotiatin…

As used in ORS 735.540 to 735.552: (1) “Audit” means an on-site or remote review of the records of a pharmacy, or a request for records from a pharmacy for the purpose of an audit, by or on behalf of an entity. (2) “Clerical error” means a minor error: (a) In the keeping, recordi…

An entity that audits claims or an independent third party that contracts with an entity to audit claims: (1) Must establish, in writing, a procedure for a pharmacy to appeal the entity’s findings with respect to a claim and must provide a pharmacy with a notice regarding the pro…

An entity’s finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation or other means that project an error using the number of patients served who have a similar diagnosis or the number of …

An entity that contracts with an independent third party to conduct audits may not: (1) Agree to compensate the independent third party based on a percentage of the amount of overpayments recovered; or (2) Disclose information obtained during an audit except to the contracting en…

For purposes of ORS 735.540 to 735.552, an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim: (1) An electronic or physical copy of a prescription that complies with ORS chapter 689 if the prescr…

(1)(a) After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than 45 days after the date on which the audit was completed and must be…

ORS 735.540 to 735.552 do not: (1) Preclude an entity from instituting an action for fraud against a pharmacy; (2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is evidenced by physical review, review of claims data or stateme…

As used in ORS 735.631 to 735.643: (1) “Discount medical plan” means a contract, agreement or other business arrangement between a discount medical plan organization and a plan member in which the organization, in exchange for fees, service or subscription charges, dues or other …

(1) A person may not conduct business as or purport to conduct business as a discount medical plan organization unless the person first obtains a license to operate as a discount medical plan organization from the Director of the Department of Consumer and Business Services in ac…

(1) A discount medical plan organization shall have a written contract or other written agreement with all providers or provider networks that the organization includes or purports to include in a discount medical plan, or with an entity that contracts with or enters into an agre…