Title 56, Insurance

(1) The health insurance exchange is under the supervision of the Director of the Oregon Health Authority. (2) The director has such powers as are necessary to carry out ORS 741.001 to 741.540. (3) The director may employ, supervise and terminate the employment of such staff as t…

(1) The Health Insurance Exchange Advisory Committee is created to advise the Oregon Health Policy Board in the development and implementation of the policies and operational procedures governing the administration of a health insurance exchange in this state including, but not l…

The Oregon Health Authority shall conduct a state or nationwide criminal records check under ORS 181A.195 on, and for that purpose may require the fingerprints of, a person who: (1) Is employed by or applying for employment with the authority in a position related to the administ…

The Oregon Health Authority shall procure and administer an information technology platform or service, separate from the federal platform, to provide electronic access to the health insurance exchange in this state on and after November 1, 2026. [2023 c.585 §2] Note: The amendme…

The Health Insurance Exchange Fund is established in the State Treasury, separate and distinct from the General Fund. Interest earned by the Health Insurance Exchange Fund shall be credited to the fund. The Health Insurance Exchange Fund consists of moneys received by the Oregon …

(1) The Oregon Health Authority shall establish, by rule, an administrative charge. The authority shall impose and collect the charge from all insurers participating in the health insurance exchange or offering a health plan certified by the authority and state programs participa…

(1) The Oregon Health Authority shall keep an accurate accounting of the operation and all activities, receipts and expenditures of the authority with respect to the health insurance exchange. (2) The Secretary of State shall conduct an annual financial audit of the authority’s r…

(1) The Director of the Oregon Health Authority shall report to the Legislative Assembly each year on: (a) The financial condition of the health insurance exchange, including actual and projected revenues and expenses of the administrative operations of the exchange and commissio…

As used in ORS 741.001 to 741.540: (1) “Coordinated care organization” has the meaning given that term in ORS 414.025. (2) “Essential health benefits” has the meaning given that term in ORS 731.097. (3) “Health benefit plan” has the meaning given that term in ORS 743B.005. (4) “H…

(1)(a) Individuals and families may purchase qualified health plans through the health insurance exchange. (b) The following groups may purchase qualified health plans through the Small Business Health Options Program: (A) Small employers as defined in ORS 743B.005; and (B) Distr…

The Oregon Health Authority, in developing and offering the health benefit package required by ORS 413.011 (1)(j), may not establish policies or procedures that discourage insurers from offering more comprehensive health benefit plans that provide greater consumer choice at a hig…

Health benefit plans offered through a Small Business Health Options Program, as defined in ORS 741.300, are subject to ORS 743.004, 743.022, 743.535 and 743B.003 to 743B.127 and to other provisions of the Insurance Code applicable to small employer group health insurance. [2015 …

The activities of insurers working under the direction of the Oregon Health Authority and the Department of Consumer and Business Services pursuant to ORS 413.011 (1)(j) or participating in the health insurance exchange administered under ORS 741.002 do not constitute a conspirac…

A person may not file or cause to be filed with the Oregon Health Authority any article, certificate, report, statement, application or any other information related to the health insurance exchange required or permitted by the authority to be filed, that is known by the person t…

(1) The Oregon Health Authority may serve by regular mail or, if requested by the recipient, by electronic mail a notice described in ORS 183.415 of the authority’s determination of: (a) A person’s eligibility to purchase or to continue to purchase a qualified health plan through…

(1)(a) The Oregon Health Authority shall adopt by rule the information that must be documented in order for a person to qualify for: (A) Qualified health plan coverage through the health insurance exchange; (B) Premium tax credits; and (C) Cost-sharing reductions. (b) The documen…

(1) Except as provided in subsection (3) of this section, documents, materials or other information that is in the possession or control of the Oregon Health Authority for the purpose of carrying out ORS 741.002, 741.310 and 741.500 or complying with federal health insurance exch…

(1) The Director of the Oregon Health Authority may enter into agreements governing the sharing and use of information consistent with this section and ORS 741.510 with other state or federal health insurance exchanges or regulatory authorities, the Department of Consumer and Bus…

(1) A complaint made to the Oregon Health Authority or the Department of Consumer and Business Services with respect to any prospective or certified qualified health plan, and the record thereof, shall be confidential and may not be disclosed except as provided in ORS 741.510 and…

Upon receipt of any inquiry from a health care provider regarding the eligibility, coverage or benefits of an insured under an enrollee’s plan, an insurer shall notify the health care provider, in the manner prescribed by the insurer, that the coverage is provided through a quali…

(1) As used in this section and ORS 741.800: (a) “Enrollee” means a person who is: (A) Enrolled in a qualified health plan purchased through the health insurance exchange; (B) Responsible for paying the premium on the qualified health plan and has paid at least one premium; and (…

The Oregon Health Authority shall produce written materials containing information for consumers about the requirements for paying the premiums for qualified health plans. The authority shall distribute the materials to health care providers upon request. [2015 c.580 §4; 2021 c.5…

(1) The Director of the Oregon Health Authority, in accordance with ORS 183.745, may impose a civil penalty for a violation of ORS 741.390 of no more than $10,000. (2) All penalties recovered under this section shall be deposited in the Health Insurance Exchange Fund. [2011 c.415…

Except as specifically provided in ORS 750.055 and 750.333, this chapter and ORS chapters 743, 743A and 743B apply to all insurance policies delivered or issued for delivery in this state except: (1) Reinsurance. (2) Wet marine and transportation insurance policies. (3) Surplus l…

(1) Except where otherwise provided by law, no basic policy form, or application form where written application is required and is to be made a part of the policy, or rider, indorsement or renewal certificate form shall be delivered or issued for delivery in this state until the …

(1) Notwithstanding provisions of the Insurance Code that require insurers to file rates and policy forms with the Director of the Department of Consumer and Business Services, and except as provided in subsections (3), (4) and (5) of this section, an insurer is exempt from the r…

The Director of the Department of Consumer and Business Services shall disapprove any form requiring the director’s approval: (1) If the director finds it does not comply with the law; (2) If the director finds it contains any provision, including statement of premium, or has any…

(1) The Director of the Department of Consumer and Business Services may, at any time after a hearing held not less than 20 days after written notice to the insurer, withdraw the director’s approval of any form on any ground set forth in ORS 742.005. The written notice of such he…

(1) As used in this section: (a) “Health benefit plan” has the meaning given that term in ORS 743B.005. (b) “Health savings account” means an account established under section 223 of the Internal Revenue Code. (2) This section applies to a health benefit plan that is: (a) Offered…

(1) The Director of the Department of Consumer and Business Services, if the director considers it necessary, may require the filing by an insurer or insurance producer of any sales presentation material for use in the sale or the presentation for sale of any policy. The director…

No policy of insurance of property or of any interest in property or arising from property shall be enforceable as to the insurance except for the benefit of persons having an insurable interest in the things insured as at the time of the loss. [Formerly 743.033]

(1) All statements and descriptions in any application for an insurance policy by or in behalf of the insured, shall be deemed to be representations and not warranties. Misrepresentations, omissions, concealments of facts and incorrect statements shall not prevent a recovery unde…

(1) Except as provided in ORS 742.043, every contract of insurance shall be construed according to the terms and conditions of the policy. When the contract is made pursuant to a written application therefor, if the insurer delivers a copy of such application with the policy to t…

No policy of insurance shall contain any condition, stipulation or agreement requiring such policy to be construed according to the laws of any other state or country. Any such condition, stipulation or agreement shall be invalid. [Formerly 736.315 and then 743.048]

(1) Insurance policies shall contain such standard or uniform provisions as are required by the applicable provisions of the Insurance Code. However, the insurer may at its option substitute for one or more of such provisions corresponding provisions of different wording approved…

(1) Every policy shall specify: (a) The names of the parties to the contract. (b) The subject of the insurance. (c) The hazards or perils insured against. (d) The time when the insurance thereunder takes effect and the period during which the insurance is to continue. (e) The pre…

(1) Two or more authorized insurers may jointly issue, and shall be jointly and severally liable on, an underwriters’ policy bearing their names. Any one insurer may issue policies in the name of an underwriter’s department and such policy shall plainly show the true name of the …

A policy may contain additional provisions not inconsistent with the Insurance Code and which are: (1) Required to be inserted by the laws of the insurer’s domicile; (2) Necessary, on account of the manner in which the insurer is constituted or operated, in order to state the rig…

A policy of insurance against loss or damage resulting from accident to or injury suffered by an employee or other person and for which the person insured is liable, or against loss or damage to property caused by horses or by any vehicle drawn, propelled or operated by any motiv…

No policy shall contain any provision purporting to make any portion of the charter, bylaws or other constituent document of the insurer (other than the subscriber’s agreement or power of attorney of a reciprocal insurer) a part of the contract unless such portion is set forth in…

Every policy issued on the assessment plan, and the form of any application for such a policy to be signed by the applicant, shall have conspicuously printed near the top of the face thereof in boldfaced type of a size not smaller than used for any caption in the policy or applic…

(1) A policy in violation of the Insurance Code, but otherwise binding on the insurer, shall be held valid, but shall be construed as provided in the Insurance Code. (2) Any insurance policy issued and otherwise valid which contains any condition, omission or provision not in com…

(1) Except as provided in this section, when more than one class of insurance as defined in ORS 731.150 to 731.194 is effected by an insurer each class shall be written in a separate and distinct policy. Any such policy may be canceled, surrendered or otherwise terminated without…

(1) Binders or other contracts for temporary insurance may be made orally or in writing, and shall be deemed to include all the usual terms of the policy as to which the binder was given together with such applicable indorsements as are designated in the binder, except as superse…

(1) Subject to the insurer’s requirements for paying premiums, the insurer shall mail or deliver every policy to the insured or to the person entitled to the policy within a reasonable period of time after the insurer issues the policy, unless the insured has not met a condition …

(1) Except as provided in subsections (2), (4) and (5) of this section, every policy of insurance shall contain a provision stating that coverage commences at 12:01 a.m. of the date upon which the insurance takes effect. (2) A policy of insurance may provide that the time at whic…