2011 Oregon Revised Statutes
ORS Volume 16, Chapters 705 - 752
ORS Chapter 743

• 743.003 [1967 c.359 335; renumbered 742.001 in 1989]
• 743.006 [Formerly 736.300; renumbered 742.003 in 1989]
• 743.009 [1967 c.359 337; 1969 c.336 11; 1973 c.608 1; renumbered 742.005 in 1989] GENERAL PROVISIONS
• 743.010 Health insurance policy and health benefit plan forms; rules.
• 743.011 [1985 c.827 2; repealed by 1989 c.255 15]
• 743.012 [1967 c.359 338; 1989 c.700 13; renumbered 742.007 in 1989]
• 743.013 Disclosure of differences in replacement health insurance policies; nonduplication for persons 65 and older; rules.
• 743.015 Filing and approval of credit life and credit health insurance forms; filing of rates.
• 743.018 Filing of rates for life and health insurance; rules.
• Note: Additions by chapter 322, Oregon Laws 2011, to the series 743.730 to 743.773, which become operative January 2, 2014, expand the series to 743.730 to 743.773, 743.822 and 743.826. See sections 1, 2 [743.822 (2)], 3 [743.822 (1)], 4 [743.826] and 6, chapter 322, Oregon Laws 2011. See Preface to Oregon Revised Statutes for further explanation.
• 743.019 Public comment on proposed rates for health insurance.
• Note: 743.019 and 743.020 were added to and made a part of ORS chapter 743 by legislative action but were not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.020 Rate filing to include statement of administrative expenses; rules.
• Note: See note under 743.019.
• 743.021 [1967 c.359 341; 1971 c.231 21; 1973 c.525 1; renumbered 742.009 in 1989]
• 743.024 Personal insurance, insurable interest and beneficiaries.
• 743.027 Consent of individual required for life and health insurance; exceptions.
• 743.028 Uniform health insurance claim forms.
• 743.030 Life insurance for benefit of charity.
• 743.033 [1967 c.359 344; renumbered 742.011 in 1989]
• 743.036 [Formerly 736.330; 1973 c.823 149; repealed by 1973 c.827 83]
• 743.037 [1973 c.521 2; renumbered 743.721 in 1989]
• 743.039 Alteration of application for life or health insurance.
• 743.041 Payment discharges insurer.
• 743.042 [1967 c.359 347; 1985 c.465 1; renumbered 742.013 in 1989]
• 743.043 Assignment of policies.
• 743.045 [Formerly 736.305; 1971 c.231 22; 1985 c.465 2; renumbered 742.016 in 1989]
• 743.046 Exemption of proceeds of individual life insurance other than annuities.
• 743.047 Exemption of proceeds of group life insurance.
• 743.048 [Formerly 736.315; renumbered 742.018]
• 743.049 Exemption of proceeds of annuity policies; assignability of rights.
• 743.050 Exemption of proceeds of health insurance.
• 743.051 [1967 c.359 350; renumbered 742.021 in 1989]
• 743.052 [1971 c.372 2; renumbered 743.719 in 1989]
• 743.053 Prohibition on requirement that death or dismemberment occur in less than 180 days after accident.
• 743.054 [1967 c.359 351; renumbered 742.023 in 1989]
• 743.055 [1991 c.875 2; repealed by 1995 c.506 11]
• 743.056 Insurer may not refuse to defend or pay claim based on provider s disclosure of adverse event.
• Note: 743.056 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.057 [1967 c.359 352; renumbered 742.026 in 1989]
• 743.060 [1967 c.359 353; renumbered 742.028 in 1989]
• 743.061 Uniform standards for health care financial and administrative transactions; rules.
• Note: 743.061 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.062 Stakeholder work group to recommend uniform standards.
• Note: 743.062 and 743.064 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 743 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 743.063 [1967 c.359 354; renumbered 742.033 in 1989]
• 743.064 Coordination with Oregon Health Authority concerning uniform standards; Department of Human Services to be subject to standards.
• Note: See note under 743.062.
• 743.066 [1967 c.359 355; 1971 c.231 23; renumbered 742.036 in 1989]
• 743.069 [1967 c.359 356; renumbered 742.038 in 1989]
• 743.072 [Formerly 736.310; 1971 c.231 24; 1973 c.149 1; renumbered 742.041 in 1989]
• 743.075 [1967 c.359 358; 1975 c.391 1; 1977 c.742 8; renumbered 742.043 in 1989]
• 743.078 [1967 c.359 359; renumbered 742.046 in 1989]
• 743.080 [1971 c.231 5; 1983 c.249 1; renumbered 742.048 in 1989]
• 743.081 [1967 c.359 360; renumbered 742.051 in 1989]
• 743.082 Selling and leasing of provider panels by contracting entity; definitions.
• Note: 743.082, 743.085 and 743.086 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 743 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 743.083 Registration of contracting entity.
• Note: 743.083 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.084 [1967 c.359 361; renumbered 743.041 in 1989]
• 743.085 Third party contracts for leasing of provider panels; requirements.
• Note: See note under 743.082.
• 743.086 Additional requirements for third party contracts.
• Note: See note under 743.082.
• 743.087 [1967 c.359 362; renumbered 743.043 in 1989]
• 743.090 [Formerly 736.335; repealed by 1973 c.827 83]
• 743.093 [1967 c.359 364; renumbered 742.053 in 1989]
• 743.096 [1967 c.359 365; renumbered 742.056 in 1989]
• 743.099 [Formerly 739.405; renumbered 743.046 in 1989] POLICY LANGUAGE SIMPLIFICATION
• 743.100 Short title.
• 743.101 Purpose.
• 743.102 [1967 c.359 367; renumbered 743.047 in 1989]
• 743.103 Definitions for ORS 743.100 to 743.109.
• 743.104 Scope of ORS 743.100 to 743.109.
• 743.105 [1967 c.359 368; renumbered 743.049 in 1989]
• 743.106 Reading ease standards for life and health insurance policies.
• 743.107 When director may authorize lower standards.
• 743.108 [1967 c.359 369; renumbered 743.050 in 1989]
• 743.109 Approval of certain policy forms containing specified provisions; conditions for approval.
• 743.111 [Formerly 744.090; renumbered 742.058 in 1989]
• 743.114 [Formerly 736.325; 1971 c.123 1; 1981 c.667 1; renumbered 742.061 in 1989]
• 743.115 [1987 c.774 46; 1989 c.376 1; renumbered 742.063 in 1989]
• 743.116 [1971 c.603 2; 1981 c.422 1; 1981 c.891 2; renumbered 743.701 in 1989]
• 743.117 [1967 c.271 2,3; renumbered 743.703 in 1989]
• 743.118 [1987 c.720 2; renumbered 743.704 in 1989]
• 743.119 [1981 c.254 2; renumbered 743.706 in 1989]
• 743.120 [1975 c.135 2; renumbered 743.707 in 1989]
• 743.123 [1975 c.338 2; renumbered 743.709 in 1989]
• 743.125 [1979 c.268 6; renumbered 743.710 in 1989]
• 743.128 [1979 c.785 20; renumbered 743.712 in 1989]
• 743.132 [1979 c.1 15; renumbered 743.713 in 1989]
• 743.135 [1981 c.422 5; 1989 c.721 54; 1989 c.1080 1; renumbered 743.714 in 1989]
• 743.138 [1987 c.739 2,4b; renumbered 743.715 in 1989]
• 743.140 [1985 c.536 1; renumbered 743.716 in 1989]
• 743.143 [1985 c.312 2; renumbered 743.717 in 1989]
• 743.145 [1985 c.747 59; renumbered 743.700 in 1989]
• 743.147 [1987 c.530 2; renumbered 743.718 in 1989] INDIVIDUAL LIFE INSURANCE AND ANNUITIES (Generally)
• 743.150 Scope of ORS 743.150, 743.153 and 743.156.
• 743.153 Statement of benefits.
• 743.154 Acceleration of death benefits; rules.
• 743.156 Statement of premium.
• 743.159 Scope of ORS 743.162 to 743.243.
• 743.162 Payment of premium.
• 743.165 Grace period.
• 743.168 Incontestability.
• 743.171 Incontestability and limitation of liability after reinstatement.
• 743.174 Entire contract.
• 743.177 Statements of insured.
• 743.180 Misstatement of age.
• 743.183 Dividends.
• 743.186 Policy loan.
• 743.187 Maximum interest rate on policy loan; adjustable interest rate.
• 743.189 Reinstatement.
• 743.192 Payment of claim; payment of interest upon failure to pay proceeds.
• 743.195 Installment payments.
• 743.198 Title.
• 743.201 Beneficiary of industrial policies.
• 743.204 Standard Nonforfeiture Law for Life Insurance; applicability.
• 743.207 Required provisions relating to nonforfeiture.
• 743.210 Determination of cash surrender values; applicability to certain policies.
• 743.213 Determination of paid-up nonforfeiture benefits.
• 743.215 Calculation of adjusted premiums.
• 743.216 Adjusted premiums; applicability.
• 743.218 Requirements for determination of future premium amounts or minimum values.
• 743.219 Supplemental rules for calculating nonforfeiture benefits.
• 743.221 Cash surrender values upon default in premium payment.
• 743.222 Policy benefits and premiums that shall be disregarded in calculating cash surrender values and paid-up nonforfeiture benefits.
• 743.225 Prohibited provisions.
• 743.228 Acts of corporate insured or beneficiary with respect to policy.
• 743.230 Variable life policy provisions.
• 743.231 Profit-sharing policy defined.
• 743.234 Charter policy or founders policy defined.
• 743.237 Coupon policy defined.
• 743.240 Profit-sharing, charter or founders policies prohibited.
• 743.243 Restrictions on form of coupon policy.
• 743.245 Variable life insurance policy provisions.
• 743.247 Notice to variable life insurance policyholders.
• 743.252 Scope of ORS 743.255 to 743.273.
• 743.255 Grace period for annuities.
• 743.258 Incontestability.
• 743.261 Entire contract.
• 743.264 Misstatement of age or sex.
• 743.267 Dividends.
• 743.268 Advancement of policy loans.
• 743.269 Periodic payments for period certain.
• 743.270 Reinstatement.
• 743.271 Periodic stipulated payments on variable annuities.
• 743.272 Computing benefits.
• 743.273 Standard provisions of reversionary annuities.
• 743.275 Standard Nonforfeiture Law for Individual Deferred Annuities; application.
• 743.278 Required provisions in annuity policies; exception.
• 743.281 [1977 c.320 4; repealed by 2003 c.370 9]
• 743.284 Computation of benefits.
• 743.287 Commencement of annuity payments at optional maturity dates; calculation of benefits.
• 743.290 Notice of nonpayment of certain benefits to be included in annuity policy.
• 743.293 Minimum forfeiture amounts for annuity policies; rules.
• 743.295 Effect of certain life insurance and disability benefits on minimum nonforfeiture amounts.
• 743.303 Requirements for issuance of group life insurance policies.
• 743.306 Required provisions in group life insurance policies.
• 743.309 Nonforfeiture provisions.
• 743.312 Grace period.
• 743.315 Incontestability.
• 743.318 Application; representations by policyholders and insureds.
• 743.321 Evidence of insurability.
• 743.324 Misstatement of age.
• 743.327 Payments under policy; payment of interest upon failure to pay proceeds.
• 743.330 Issuance of certificates.
• 743.333 Termination of individual coverage.
• 743.336 Termination of policy or class of insured persons.
• 743.339 Death during period for conversion to individual policy.
• 743.342 Statement furnished to insured under credit life insurance policy.
• 743.345 Assignability of group life policies.
• 743.348 Certain sales practices prohibited.
• 743.350 [1979 c.708 2; renumbered 743.100 in 1989]
• 743.351 Eligibility of association to be group life policyholder; rules.
• 743.353 [1979 c.708 3; renumbered 743.101 in 1989]
• 743.354 Requirements for certain group life policies issued to trustees of certain funds; rules.
• 743.356 Continuing coverage upon replacement of group life policy.
• Note: 743.356 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 743 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 743.357 [1979 c.708 4; renumbered 743.103 in 1989]
• 743.358 Borrowing by certificate holders under group life policy.
• 743.360 Alternative group life insurance coverage.
• 743.362 [1979 c.708 5; renumbered 743.104 in 1989]
• 743.365 [1979 c.708 6; renumbered 743.106 in 1989]
• 743.368 [1979 c.708 7; renumbered 743.107 in 1989]
• 743.370 [1979 c.708 8; renumbered 743.109 in 1989] CREDIT LIFE AND CREDIT HEALTH INSURANCE
• 743.371 Definitions for credit life and credit health insurance provisions.
• 743.372 Applicability of credit life and credit health insurance provisions.
• 743.373 Forms of credit life and credit health insurance.
• 743.374 Limits on amount of credit life insurance.
• 743.375 Limit on amount of credit health insurance.
• 743.376 Duration of credit life and credit health insurance.
• 743.377 Credit life and credit health insurance policy or group certificate; contents; delivery of policy, certificate or copy of application.
• 743.378 Charges and refunds to debtor.
• 743.379 Status of remuneration to creditor.
• 743.380 Claim report and payment.
• 743.402 Exceptions to individual health insurance policy requirements.
• 743.405 General requirements.
• 743.408 Mandatory provisions.
• 743.411 Entire contract; changes.
• 743.412 [1977 c.632 2; 1981 c.319 1; 2001 c.900 230; renumbered 743A.160 in 2007]
• 743.414 Time limit on certain defenses; incontestability.
• 743.417 Grace period.
• 743.420 Reinstatement.
• 743.423 Notice of claim.
• 743.426 Claim forms.
• 743.429 Proofs of loss.
• 743.432 Time of payment of claims.
• 743.435 Payment of claims.
• 743.438 Physical examinations and autopsy.
• 743.441 Legal actions.
• 743.444 Change of beneficiary.
• 743.447 Optional provisions.
• 743.450 Change of occupation.
• 743.453 Misstatement of age.
• 743.456 Other insurance in same insurer.
• 743.459 Insurance with other insurers; expense incurred benefits.
• 743.462 Insurance with other insurers; other than expense incurred benefits.
• 743.465 Relation of earnings to insurance.
• 743.468 Unpaid premium.
• 743.471 Cancellation.
• 743.472 Permissible reasons for cancellation or refusal to renew.
• Note: 743.472 was added to and made a part of 743.405 to 743.498 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.474 Conformity with state statutes.
• 743.477 Illegal occupation.
• 743.480 [1967 c.359 452; 1979 c.744 64; 2007 c.128 1; renumbered 743A.164 in 2007]
• 743.483 Arrangement of provisions.
• 743.486 Scope of term insured in statutory policy provisions.
• 743.489 Extension of coverage beyond policy period; effect of misstatement of age.
• 743.492 Policy return and premium refund provision.
• 743.495 Use of terms noncancelable or guaranteed renewable ; synonymous terms.
• 743.498 Statement in policy of cancelability or renewability.
• 743.499 Notice to policyholder required for cancellation or nonrenewal of health benefit plan; effect of failure to give notice.
• Note: 743.499 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.516 [1967 c.359 459; repealed by 1999 c.987 28]
• 743.519 [1967 c.359 460; 1971 c.231 25; repealed by 1999 c.987 28]
• 743.520 [1971 c.231 4; repealed by 1999 c.987 28] (Group and Blanket)
• 743.522 Group health insurance described.
• 743.523 Certain sales practices prohibited.
• 743.524 Eligibility of association to be group health policyholder; rules.
• 743.525 [1967 c.359 462; repealed by 1981 c.752 17]
• 743.526 Determination of whether trustees are policyholders; consequences; rules.
• Note: Sections 11 and 14, chapter 752, Oregon Laws 2007, provide:
• Sec. 11.
• Sec. 14.
• 743.527 When group health insurance policies to continue in effect upon payment of premium by insured individual.
• 743.528 Required provisions in group health insurance policies.
• 743.529 Continuation of benefits after termination of group health insurance policy; rules.
• 743.530 Continuation of benefits after injury or illness covered by workers compensation.
• 743.531 Direct payment of hospital and medical services; rate limitations.
• 743.532 [1987 c.782 2; repealed by 1989 c.1044 7]
• 743.533 Leased workers; offering group health insurance.
• 743.534 Blanket health insurance defined.
• 743.537 Required provisions for blanket health insurance policies.
• 743.540 Application and certificates not required for blanket health insurance policies.
• 743.543 Payment of benefits under blanket health insurance policies.
• 743.546 Exemption of policy form approval for blanket health insurance policies.
• 743.549 Restriction on reduction of benefits provisions in group and blanket health insurance policies.
• 743.550 Student health insurance.
• 743.552 Guidelines for application of ORS 743.549; rules.
• 743.555 [1973 c.143 4; repealed by 2005 c.22 495]
• 743.556 [1987 c.411 2; 1989 c.721 55; 1991 c.67 198; 1991 c.470 19; 1991 c.654 2; 1999 c.1086 1; 2001 c.900 217; 2003 c.33 5; 2005 c.705 1; 2007 c.71 240; renumbered 743A.168 in 2007]
• 743.557 [1975 c.698 2; 1977 c.632 3; 1981 c.319 2; 1983 c.601 5; repealed by 1987 c.411 9]
• 743.558 [1973 c.613 2; 1983 c.601 6; repealed by 1987 c.411 9]
• 743.559 [1983 c.601 12; repealed by 1991 c.182 20]
• 743.560 Minimum grace period; notice upon termination of policy; effect of failure to notify.
• 743.561 [Formerly 739.565; renumbered 743.371 in 1989]
• 743.562 Applicability of ORS 743.560.
• 743.564 [Formerly 739.570; 1969 c.336 13; 1989 c.1073 1; renumbered 743.372 in 1989]
• 743.565 Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium.
• 743.566 Rules for certain notice requirements.
• Note: 743.566 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 743 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 743.567 [Formerly 739.575; renumbered 743.373 in 1989]
• 743.570 [1967 c.359 473; renumbered 743.374 in 1989]
• 743.573 [Formerly 741.425; renumbered 743.375 in 1989]
• 743.576 [Formerly 739.585; renumbered 743.376 in 1989]
• 743.579 [Formerly 739.590; renumbered 743.377 in 1989]
• 743.582 [Formerly 739.600; renumbered 743.378 in 1989]
• 743.585 [Formerly 739.603; renumbered 743.379 in 1989]
• 743.588 [Formerly 739.610; renumbered 743.380 in 1989] (Continuation)
• 743.600 Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older.
• 743.601 Procedure for obtaining continuation of coverage under ORS 743.600.
• 743.602 Premium for continuation of coverage under ORS 743.600; termination of right to continuation.
• 743.603 [Formerly 744.070; renumbered 742.200 in 1989]
• 743.606 [1967 c.359 481; 1967 c.453 3; renumbered 742.202 in 1989]
• 743.607 [1967 c.453 2; renumbered 742.204 in 1989]
• 743.609 [1967 c.359 482; 1971 c.231 26; renumbered 742.206 in 1989]
• 743.610 Continuation of coverage under group policy upon termination of membership in group health insurance policy; applicability of waiting period to rehired employee.
• 743.611 [Formerly 743.855; 1991 c.673 6; repealed by 1995 c.603 42]
• 743.612 [1967 c.359 483; 1985 c.465 3; renumbered 742.208 in 1989]
• 743.613 [Formerly 743.860; repealed by 1995 c.603 42]
• 743.614 [Formerly 743.865; repealed by 1995 c.603 42]
• 743.615 [1967 c.359 484; renumbered 742.210 in 1989]
• 743.616 [Formerly 743.870; repealed by 1995 c.603 42]
• 743.617 [Formerly 743.875; repealed by 1995 c.603 42]
• 743.618 [1967 c.359 485; renumbered 742.212 in 1989]
• 743.619 [Formerly 743.880; repealed by 1995 c.603 42]
• 743.620 [Formerly 743.885; repealed by 1995 c.603 42]
• 743.621 [1967 c.359 486; renumbered 742.214 in 1989]
• 743.622 [Formerly 743.890; repealed by 1995 c.603 42]
• 743.624 [1967 c.359 487; renumbered 742.216 in 1989]
• 743.627 [1967 c.359 488; renumbered 742.218 in 1989]
• 743.630 [1967 c.359 489; renumbered 742.220 in 1989]
• 743.633 [1967 c.359 490; renumbered 742.222 in 1989]
• 743.636 [1967 c.359 491; 1989 c.426 2; renumbered 742.224 in 1989]
• 743.639 [1967 c.359 492; renumbered 742.226 in 1989]
• 743.642 [1967 c.359 493; renumbered 742.228 in 1989]
• 743.645 [1967 c.359 494; 1989 c.426 1; renumbered 742.230 in 1989]
• 743.648 [1967 c.359 495; renumbered 742.232 in 1989] (Long Term Care)
• 743.650 Long Term Care Insurance Act; purpose; application.
• 743.651 [1967 c.359 496; renumbered 742.234 in 1989]
• 743.652 Definitions for ORS 743.650 to 743.665.
• Note: The amendments to 743.652 by section 3, chapter 69, Oregon Laws 2011, apply to long term care insurance policies issued or renewed on or after July 1, 2012. See section 8, chapter 69, Oregon Laws 2011. The text that applies to policies issued or renewed before July 1, 2012, is set forth for the user s convenience.
• 743.652. 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 proposed certificate holder. (2) Certificate means any certificate issued under a group long term care insurance policy, if the policy has been delivered or issued for delivery in this state. (3) Group long term care insurance means a long term care insurance policy that is delivered or issued for delivery in this state and issued to: (a) One or more employers or labor organizations, or to a trust or to the trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations; (b) Any professional, trade or occupational association for its members or former or retired members, or combination thereof, if such association: (A) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and (B) Has been maintained in good faith for purposes other than obtaining insurance; (c)(A) An association or a trust or the trustee of a fund established, created or maintained for the benefit of members of one or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations shall file evidence with the director that the association or associations have been organized and maintained in good faith for purposes other than that of obtaining insurance; have been in active existence for at least one year; and have a constitution and bylaws that provide that: (i) The association or associations hold regular meetings not less than annually to further purposes of the members; (ii) Except for credit unions, the association or associations collect dues or solicit contributions from members; and (iii) The members have voting privileges and representation on the governing board and committees; and (B) Sixty days after the filing, the association or associations shall be considered to satisfy the organizational requirements, unless the director makes a finding that the association or associations do not satisfy those organizational requirements; or (d) A group other than as described in paragraphs (a), (b) and (c) of this subsection, subject to a finding by the director that: (A) The issuance of the group policy is not contrary to the best interest of the public; (B) The issuance of the group policy would result in economies of acquisition or administration; and (C) The benefits are reasonable in relation to the premiums charged. (4) Long term care insurance means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than 24 consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis; for one or more necessary or medically necessary services, including but not limited to nursing, diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care services, provided in a setting other than an acute care unit of a hospital. Long term care insurance includes group and individual annuities and life insurance policies or riders that provide directly or supplement long term care insurance. Long term care insurance also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity, and qualified long term care insurance contracts. Long term care insurance may be issued by insurers; fraternal benefit societies; nonprofit health, hospital and medical service corporations; prepaid health plans; or health maintenance organizations, health care service contractors or any similar organization to the extent they are otherwise authorized to issue life or health insurance. Long term care insurance does not include any insurance policy that is offered primarily to provide basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income or related asset protection coverage, catastrophic coverage, accident only coverage, specified disease or specified accident coverage or limited benefit health coverage. With regard to life insurance, long term care insurance does not include life insurance policies that accelerate the death benefit specifically for one or more of the qualifying events of terminal illness, medical conditions requiring extraordinary medical intervention or permanent institutional confinement, and that provide the option of a lump-sum payment for those benefits and when neither the benefits nor the eligibility for the benefits is conditioned upon the receipt of long term care. Notwithstanding any other provision of ORS 743.650 to 743.665, any product advertised, marketed or offered as long term care insurance is subject to ORS 743.650 to 743.665. (5) Policy means any policy, contract, subscriber agreement, rider or indorsement delivered or issued for delivery in this state by an insurer; fraternal benefit society; nonprofit health, hospital or medical service corporation; prepaid health plan; or health maintenance organization, health care service contractor or any similar organization. (6) Qualified long term care insurance means: (a) The portion of a life insurance contract that provides long term care insurance coverage by rider or as part of the contract and that satisfies the requirements of section 7702B(b) and (e) of the Internal Revenue Code; or (b) Individual or group long term care insurance as defined in this section that meets all of the following requirements of section 7702B(b) of the Internal Revenue Code: (A) The only insurance protection provided under the contract is coverage of qualified long term care services. A contract shall not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate. (B) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act, or would be reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subparagraph do not apply to expenses that are reimbursable under Title XVIII of the Social Security Act only as a secondary payer. A contract does not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate. (C) The contract is guaranteed renewable within the meaning of section 7702B(b)(1)(C) of the Internal Revenue Code. (D) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subparagraph (E) of this paragraph. (E) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract. (F) The contract meets the consumer protection provisions set forth in section 7702B(g) of the Internal Revenue Code.
• 743.653 Prohibition on certain policies.
• Note: The amendments to 743.653 by section 4, chapter 69, Oregon Laws 2011, apply to long term care insurance policies issued or renewed on or after July 1, 2012. See section 8, chapter 69, Oregon Laws 2011. The text that applies to policies issued or renewed before July 1, 2012, is set forth for the user s convenience.
• 743.653. 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 (3)(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.
• 743.654 [1967 c.359 497; renumbered 742.236 in 1989]
• 743.655 Rules; disclosure; contents of policy.
• Note: The amendments to 743.655 by section 5, chapter 69, Oregon Laws 2011, apply to long term care insurance policies issued or renewed on or after July 1, 2012. See section 8, chapter 69, Oregon Laws 2011. The text that applies to policies issued or renewed before July 1, 2012, is set forth for the user s convenience.
• 743.655. (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. (b) In adopting rules setting standards under this section, the director must give timely notice to, and shall consider recommendations from the Director of Human Services. (2) A long term care insurance policy may not: (a) Be canceled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; (b) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; (c) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care; (d) Exclude coverage for Alzheimer s disease and related dementias; (e) Be nonrenewed or otherwise terminated for nonpayment of premiums until 31 days overdue and then only after notice of nonpayment is given the policyholder prior to expiration of the 31 days, except as otherwise provided by rule; or (f) Be sold to provide less than 24 months coverage. (3)(a) A long term care insurance policy or certificate other than a policy or certificate issued to a group described in ORS 743.652 (3)(a), (b) or (c) may not use a definition of preexisting condition that is more restrictive than the following: Preexisting condition means a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person. (b) A long term care insurance policy or certificate other than a policy or certificate thereunder issued to a group described in ORS 743.652 (3)(a), (b) or (c) may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person. (c) The Director of the Department of Consumer and Business Services may extend the limitation periods set forth in paragraphs (a) and (b) of this subsection as to specific age group categories or specific policy forms upon findings that the extension is in the best interest of the public. (d) The definition of preexisting condition does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, over the 10 years immediately prior to the date of application, and, on the basis of the answers on the application, from underwriting in accordance with that insurer s established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in paragraph (b) of this subsection expires. A long term care insurance policy or certificate may not exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in paragraph (b) of this subsection. (4) A long term care insurance policy may not be delivered or issued for delivery in this state if the policy: (a) Conditions eligibility for any benefits on a prior hospitalization requirement; (b) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or (c) Conditions eligibility for any benefits other than waiver of premium or post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement. (5)(a) A long term care insurance policy containing post-confinement, post-acute care or recuperative benefits must clearly label in a separate paragraph of the policy or certificate titled Limitations or Conditions of Eligibility for Benefits all such limitations or conditions, including any required number of days of confinement. (b) A long term care insurance policy or rider that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days. (6) Individual long term care insurance applicants 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. Long term care insurance policies and certificates must have a notice prominently printed on the first page or attached thereto stating in substance that the applicant has 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, other than a certificate issued pursuant to a policy issued to a group described in ORS 743.652 (3)(a), the applicant is not satisfied for any reason. This subsection also applies to denials of applications. Any refund must be made within 30 days of the return or denial. (7)(a)(A) An outline of coverage shall be delivered to a prospective applicant for long term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose. (B) The director by rule must prescribe a standard format, including style, arrangement and overall appearance, and the content of an outline of coverage. (C) In the case of solicitations by an insurance producer, the insurance producer must deliver the outline of coverage prior to the presentation of an application or enrollment form. (D) In the case of direct response solicitations, the outline of coverage must be presented in conjunction with any application or enrollment form. (E) In the case of a policy issued to a group described in ORS 743.652 (3)(a), an outline of coverage is not required to be delivered as long as the information described in paragraph (b) of this subsection is contained in other materials related to the enrollment. Upon request, these other materials must be made available to the director. (b) The outline of coverage must include: (A) A description of the principal benefits and coverage provided in the policy; (B) A statement of the principal exclusions, reductions and limitations contained in the policy; (C) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premium. Continuation or conversion provisions of group coverage shall be specifically described; (D) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions; (E) A description of the terms under which the policy or certificate may be returned and premium refunded; (F) A brief description of the relationship of cost of care and benefits; and (G) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be qualified long term care insurance as defined in ORS 743.652. (8) A certificate issued pursuant to a group long term care insurance policy if the policy is delivered or issued for delivery in this state shall include: (a) A description of the principal benefits and coverage provided in the policy; (b) A statement of the principal exclusions, reductions and limitations contained in the policy; and (c) A statement that the group master policy determines governing contractual provisions. (9) If an application for a long term care insurance policy or certificate is approved, the insurer must deliver the policy or certificate to the applicant no later than 30 days after the date of approval. (10) At the time of policy delivery, a policy summary must be delivered for an individual life insurance policy that provides long term care benefits within the policy or by rider. In the case of direct response solicitations, the insurer must deliver the policy summary upon the applicant s request, but regardless of request must make delivery not later than at the time of policy delivery. In addition to complying with all applicable requirements, the summary must also include the provisions required in this subsection. The required provision may be incorporated into a basic illustration or into the life insurance policy summary if required by rule. The following provisions must be included in the summary: (a) An explanation of how the long term care benefit interacts with other components of the policy, including deductions from death benefits; (b) An illustration of the amount of benefits, the length of benefits and the guaranteed lifetime benefits, if any, for each covered person; (c) Any exclusions, reductions and limitations on benefits of long term care; (d) A statement that any long term care inflation protection option required by rule is not available under the policy; and (e) If applicable to the policy type, the following: (A) A disclosure of the effects of exercising other rights under the policy; (B) A disclosure of guarantees related to long term care costs of insurance charges; and (C) Current and projected maximum lifetime benefits. (11) When a long term care benefit that is funded through a life insurance policy by an acceleration of the death benefit is in benefit payment status, the insurer must provide a monthly report to the policyholder. The report must include: (a) Any long term care benefits paid out during the month; (b) An explanation of any changes in the policy, such as death benefits or cash values, owing to payment of long term care benefits; and (c) The amount of long term care benefits existing or remaining. (12) If a claim under a long term care insurance policy is denied, then not later than the 60th day after the date of a written request by the policyholder or certificate holder, or a representative of either, the insurer must: (a) Provide a written explanation of the reasons for the denial; and (b) Make available all information directly related to the denial. (13) A policy may not be advertised, marketed or offered as long term care or nursing home insurance unless it complies with the provisions of ORS 743.650 to 743.665. (14) Rules adopted pursuant to ORS 743.650 to 743.665 shall be in accordance with the provisions of ORS chapter 183. (15) This section is exempt from ORS 743A.001.
• 743.656 Eligibility for benefits; providers required to be covered.
• 743.657 [1967 c.359 498; renumbered 742.238 in 1989]
• 743.660 [1967 c.359 499; renumbered 742.240 in 1989]
• 743.662 Rescission of policy and denial of claims.
• 743.663 [1967 c.359 500; renumbered 742.242 in 1989]
• 743.664 Offer of nonforfeiture benefit; rules.
• Note: The amendments to 743.664 by section 6, chapter 69, Oregon Laws 2011, apply to long term care insurance policies issued or renewed on or after July 1, 2012. See section 8, chapter 69, Oregon Laws 2011. The text that applies to policies issued or renewed before July 1, 2012, is set forth for the user s convenience.
• 743.664. (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. (2) When a group long term care insurance policy is issued, the offer required in subsection (1) of this section must be made to the group policyholder. However, if the policy is issued as group long term care insurance as described in ORS 743.652 (3)(d), other than to a continuing care retirement community or similar entity, the offering shall be made to each proposed certificate holder. (3) The Director of the Department of Consumer and Business Services by rule shall specify: (a) The type or types of nonforfeiture benefits to be offered as part of long term care insurance policies and certificates; (b) The standards for nonforfeiture benefits; and (c) The standards governing contingent benefits upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium increase that triggers a contingent benefit upon lapse as described in subsection (1) of this section. (4) This section is exempt from ORS 743A.001.
• 743.665 Prompt pay requirements; rules.
• Note: Section 8, chapter 69, Oregon Laws 2011, provides:
• Sec. 8.
• 743.666 [Formerly 744.125; renumbered 742.244 in 1989]
• 743.669 [Formerly 744.130; renumbered 742.246 in 1989]
• 743.672 [Formerly 744.430; renumbered 742.248 in 1989]
• 743.675 [Formerly 744.440; renumbered 742.250 in 1989]
• 743.678 [Formerly 744.450; renumbered 742.252 in 1989] (Medicare Supplement)
• 743.680 Definitions for ORS 743.680 to 743.689.
• 743.681 [Formerly 744.460; renumbered 742.254 in 1989]
• 743.682 Application of ORS 743.680 to 743.689.
• 743.683 Policy contents; standards for benefit and claims payments; rules.
• 743.684 Filing of policy; loss ratio standards; insurance producer compensation.
• 743.685 Outline of coverage; information brochure; rules.
• 743.686 Right to return of policy; premium refund.
• 743.687 Advertising.
• 743.688 Rules.
• 743.689 Director s authority upon violation of ORS 743.680 to 743.689.
• 743.690 [1981 c.247 17; renumbered 742.280 in 1989]
• 743.691 [2003 c.748 2; renumbered 743A.110 in 2007]
• 743.693 [1999 c.428 2; 2001 c.104 289; renumbered 743A.080 in 2007]
• 743.694 [2001 c.742 2; renumbered 743A.184 in 2007]
• 743.695 [1997 c.573 2; renumbered 743A.060 in 2007]
• 743.697 [1997 c.573 3; renumbered 743A.062 in 2007]
• 743.699 [1997 c.651 2; 2003 c.137 1; renumbered 743A.012 in 2007]
• 743.700 [Formerly 743.145; 2005 c.69 1; 2005 c.482 3; 2007 c.313 4; renumbered 743A.001 in 2007]
• 743.701 [Formerly 743.116; renumbered 743A.010 in 2007]
• 743.702 [Formerly 746.010; repealed by 1969 c.692 11]
• 743.703 [Formerly 743.117; 2005 c.442 4; renumbered 743A.040 in 2007]
• 743.704 [Formerly 743.118; repealed by 2001 c.742 3]
• 743.705 [Formerly 746.030; 1969 c.692 9; 1973 c.179 1; 1982 s.s.1 c.5 1; 1987 c.846 13; renumbered 742.282 in 1989]
• 743.706 [Formerly 743.119; renumbered 743A.148 in 2007]
• 743.707 [Formerly 743.120; 1991 c.674 2; 1995 c.506 10; renumbered 743A.090 in 2007]
• 743.708 [Formerly 746.080; 1969 c.692 10; 1973 c.823 150; renumbered 742.284 in 1989]
• 743.709 [Formerly 743.123; renumbered 743A.048 in 2007]
• 743.710 [Formerly 743.125; renumbered 743A.088 in 2007]
• 743.711 [1987 c.846 15; renumbered 742.286 in 1989]
• 743.712 [Formerly 743.128; renumbered 743A.036 in 2007]
• 743.713 [Formerly 743.132; 1993 c.142 15; 2005 c.22 496; renumbered 743A.028 in 2007]
• 743.714 [Formerly 743.135; renumbered 743A.024 in 2007]
• 743.715 [Formerly 743.138; repealed by 1991 c.182 21]
• 743.716 [Formerly 743.140; repealed by 1995 c.506 11]
• 743.717 [Formerly 743.143; renumbered 743A.180 in 2007]
• 743.718 [Formerly 743.147; renumbered 743A.014 in 2007]
• 743.719 [Formerly 743.052; renumbered 743A.032 in 2007]
• 743.720 [1979 c.866 4; 1987 c.774 56; renumbered 742.300 in 1989]
• 743.721 [Formerly 743.037; renumbered 743A.084 in 2007]
• 743.722 [1989 c.832 2; 1991 c.314 3; 1995 c.79 365; repealed by 2007 c.313 3]
• 743.723 [1979 c.866 5; 1981 c.525 1; 1987 c.774 57; renumbered 742.302 in 1989]
• 743.724 [Formerly 746.307; repealed by 1997 c.695 2 (743.725 enacted in lieu of 743.724)]
• 743.725 [1997 c.695 3 (enacted in lieu of 743.724); 2003 c.446 1; 2007 c.346 1; renumbered 743A.044 in 2007]
• 743.726 [1997 c.496 2; 2003 c.263 1; renumbered 743A.188 in 2007]
• 743.727 [1993 c.575 2; 1999 c.429 1; renumbered 743A.100 in 2007]
• 743.728 [1993 c.576 2; 1999 c.429 2; renumbered 743A.104 in 2007]
• 743.729 [1993 c.407 2; renumbered 743A.070 in 2007] (Small Employer, Group, Individual and Portability Health Insurance, Generally)
• 743.730 Definitions for ORS 743.730 to 743.773.
• Note: The amendments to 743.730 by section 49, chapter 500, Oregon Laws 2011, become operative January 2, 2014. See section 6, chapter 322, Oregon Laws 2011, as amended by section 50, chapter 500, Oregon Laws 2011. The text that is operative on and after January 2, 2014, is set forth for the user s convenience.
• 743.730. For purposes of ORS 743.730 to 743.773: (1) Actuarial certification means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the Director of the Department of Consumer and Business Services that a carrier is in compliance with the provisions of ORS 743.736, 743.760 or 743.761, based upon the person s examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the carrier in establishing premium rates for small employer and portability health benefit plans. (2) Affiliate of, or person affiliated with, a specified person means any carrier who, directly or indirectly through one or more intermediaries, controls or is controlled by or is under common control with a specified person. For purposes of this definition, control has the meaning given that term in ORS 732.548. (3) Affiliation period means, under the terms of a group health benefit plan issued by a health care service contractor, a period: (a) That is applied uniformly and without regard to any health status related factors to an enrollee or late enrollee in lieu of a preexisting condition exclusion; (b) That must expire before any coverage becomes effective under the plan for the enrollee or late enrollee; (c) During which no premium shall be charged to the enrollee or late enrollee; and (d) That begins on the enrollee s or late enrollee s first date of eligibility for coverage and runs concurrently with any eligibility waiting period under the plan. (4) Basic health benefit plan means a health benefit plan that provides bronze plan coverage and that is approved by the Department of Consumer and Business Services under ORS 743.736. (5) Bona fide association means an association that meets the requirements of 42 U.S.C. 300gg-91 as amended and in effect on March 23, 2010. (6) Bronze plan means a health benefit plan that meets the criteria for a bronze plan prescribed by the director by rule pursuant to ORS 743.822 (2). (7) Carrier, except as provided in ORS 743.760, means any person who provides health benefit plans in this state, including: (a) A licensed insurance company; (b) A health care service contractor; (c) A health maintenance organization; (d) An association or group of employers that provides benefits by means of a multiple employer welfare arrangement and that: (A) Is subject to ORS 750.301 to 750.341; or (B) Is fully insured and otherwise exempt under ORS 750.303 (4) but elects to be governed by ORS 743.733 to 743.737; or (e) Any other person or corporation responsible for the payment of benefits or provision of services. (8) Catastrophic plan means a health benefit plan that meets the requirements for a catastrophic plan under 42 U.S.C. 18022(e) and that is offered through the Oregon Health Insurance Exchange. (9) Creditable coverage means prior health care coverage as defined in 42 U.S.C. 300gg as amended and in effect on February 17, 2009, and includes coverage remaining in force at the time the enrollee obtains new coverage. (10) Dependent means the spouse or child of an eligible employee, subject to applicable terms of the health benefit plan covering the employee. (11) Eligible employee means an employee who works on a regularly scheduled basis, with a normal work week of 17.5 or more hours. The employer may determine hours worked for eligibility between 17.5 and 40 hours per week subject to rules of the carrier. Eligible employee does not include employees who work on a temporary, seasonal or substitute basis. Employees who have been employed by the employer for fewer than 90 days are not eligible employees unless the employer so allows. (12) Employee means any individual employed by an employer. (13) Enrollee means an employee, dependent of the employee or an individual otherwise eligible for a group, individual or portability health benefit plan who has enrolled for coverage under the terms of the plan. (14) Exchange means the Oregon Health Insurance Exchange established pursuant to section 17, chapter 595, Oregon Laws 2009. (15) Exclusion period means a period during which specified treatments or services are excluded from coverage. (16) Financial impairment means that a carrier is not insolvent and is: (a) Considered by the director to be potentially unable to fulfill its contractual obligations; or (b) Placed under an order of rehabilitation or conservation by a court of competent jurisdiction. (17)(a) Geographic average rate means the arithmetical average of the lowest premium and the corresponding highest premium to be charged by a carrier in a geographic area established by the director for the carrier s: (A) Group health benefit plans offered to small employers; (B) Individual health benefit plans; or (C) Portability health benefit plans. (b) Geographic average rate does not include premium differences that are due to differences in benefit design or family composition. (18) Grandfathered health plan has the meaning prescribed by the United States Secretaries of Labor, Health and Human Services and the Treasury pursuant to 42 U.S.C. 18011(e). (19) Group eligibility waiting period means, with respect to a group health benefit plan, the period of employment or membership with the group that a prospective enrollee must complete before plan coverage begins. (20)(a) Health benefit plan means any: (A) Hospital expense, medical expense or hospital or medical expense policy or certificate; (B) Health care service contractor or health maintenance organization subscriber contract; or (C) Plan provided by a multiple employer welfare arrangement or by another benefit arrangement defined in the federal Employee Retirement Income Security Act of 1974, as amended, to the extent that the plan is subject to state regulation. (b) Health benefit plan does not include: (A) Coverage for accident only, specific disease or condition only, credit or disability income; (B) Coverage of Medicare services pursuant to contracts with the federal government; (C) Medicare supplement insurance policies; (D) Coverage of TRICARE services pursuant to contracts with the federal government; (E) Benefits delivered through a flexible spending arrangement established pursuant to section 125 of the Internal Revenue Code of 1986, as amended, when the benefits are provided in addition to a group health benefit plan; (F) Separately offered long term care insurance, including, but not limited to, coverage of nursing home care, home health care and community-based care; (G) Independent, noncoordinated, hospital-only indemnity insurance or other fixed indemnity insurance; (H) Short term health insurance policies that are in effect for periods of 12 months or less, including the term of a renewal of the policy; (I) Dental only coverage; (J) Vision only coverage; (K) Stop-loss coverage that meets the requirements of ORS 742.065; (L) Coverage issued as a supplement to liability insurance; (M) Insurance arising out of a workers compensation or similar law; (N) Automobile medical payment insurance or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance; or (O) Any employee welfare benefit plan that is exempt from state regulation because of the federal Employee Retirement Income Security Act of 1974, as amended. (c) For purposes of this subsection, renewal of a short term health insurance policy includes the issuance of a new short term health insurance policy by an insurer to a policyholder within 60 days after the expiration of a policy previously issued by the insurer to the policyholder. (21) Health statement means any information that is intended to inform the carrier or insurance producer of the health status of an enrollee or prospective enrollee in a health benefit plan. Health statement includes the standard health statement approved by the director under ORS 743.745. (22) Individual coverage waiting period means a period in an individual health benefit plan during which no premiums may be collected and health benefit plan coverage issued is not effective. (23) Initial enrollment period means a period of at least 30 days following commencement of the first eligibility period for an individual. (24) Late enrollee means an individual who enrolls in a group health benefit plan subsequent to the initial enrollment period during which the individual was eligible for coverage but declined to enroll. However, an eligible individual shall not be considered a late enrollee if: (a) The individual qualifies for a special enrollment period in accordance with 42 U.S.C. 300gg as amended and in effect on February 17, 2009; (b) The individual applies for coverage during an open enrollment period; (c) A court issues an order that coverage be provided for a spouse or minor child under an employee s employer sponsored health benefit plan and request for enrollment is made within 30 days after issuance of the court order; (d) The individual is employed by an employer that offers multiple health benefit plans and the individual elects a different health benefit plan during an open enrollment period; or (e) The individual s coverage under Medicaid, Medicare, TRICARE, Indian Health Service or a publicly sponsored or subsidized health plan, including, but not limited to, the medical assistance program under ORS chapter 414, has been involuntarily terminated within 63 days after applying for coverage in a group health benefit plan. (25) Minimal essential coverage has the meaning given that term in section 5000A(f) of the Internal Revenue Code. (26) Multiple employer welfare arrangement means a multiple employer welfare arrangement as defined in section 3 of the federal Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. 1002, that is subject to ORS 750.301 to 750.341. (27) Oregon Medical Insurance Pool means the pool created under ORS 735.610. (28) Preexisting condition exclusion means a health benefit plan provision applicable to an enrollee or late enrollee that excludes coverage for services, charges or expenses incurred during a specified period immediately following enrollment for a condition for which medical advice, diagnosis, care or treatment was recommended or received during a specified period immediately preceding enrollment. For purposes of ORS 743.730 to 743.773: (a) Pregnancy does not constitute a preexisting condition except as provided in ORS 743.766; (b) Genetic information does not constitute a preexisting condition in the absence of a diagnosis of the condition related to such information; and (c) Except for coverage under an individual grandfathered health plan, a preexisting condition exclusion may not exclude coverage for services, charges or expenses incurred by an individual who is under 19 years of age. (29) Premium includes insurance premiums or other fees charged for a health benefit plan, including the costs of benefits paid or reimbursements made to or on behalf of enrollees covered by the plan. (30) Rating period means the 12-month calendar period for which premium rates established by a carrier are in effect, as determined by the carrier. (31) Representative does not include an insurance producer or an employee or authorized representative of an insurance producer or carrier. (32) Silver plan means an individual or small group health benefit plan that meets the criteria for a silver plan prescribed by the director by rule pursuant to ORS 743.822 (2). (33)(a) Small employer means an employer that employed an average of at least two but not more than 50 employees on business days during the preceding calendar year, the majority of whom are employed within this state, and that employs at least two eligible employees on the date on which coverage takes effect under a health benefit plan offered by the employer. (b) Any person that is treated as a single employer under subsection (b), (c), (m) or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as one employer for purposes of this subsection. (c) The determination of whether an employer that was not in existence throughout the preceding calendar year is a small employer shall be based on the average number of employees that it is reasonably expected the employer will employ on business days in the current calendar year.
• Note: Additions by chapter 322, Oregon Laws 2011, to the series 743.730 to 743.773, which become operative January 2, 2014, expand the series to 743.730 to 743.773, 743.822 and 743.826. See sections 1, 2 [743.822 (2)], 3 [743.822 (1)], 4 [743.826] and 6, chapter 322, Oregon Laws 2011. See Preface to Oregon Revised Statutes for further explanation.
• 743.731 Purposes.
• Note: Additions by chapter 322, Oregon Laws 2011, to the series 743.730 to 743.773, which become operative January 2, 2014, expand the series to 743.730 to 743.773, 743.822 and 743.826. See sections 1, 2 [743.822 (2)], 3 [743.822 (1)], 4 [743.826] and 6, chapter 322, Oregon Laws 2011. See Preface to Oregon Revised Statutes for further explanation.
• 743.732 [Formerly 747.080; renumbered 742.350 in 1989]
• 743.733 Issuance of group health benefit plan to affiliated group of employers; determination of number of employees for purpose of determining eligibility as small employer.
• 743.734 Group health benefit plans subject to provisions of specified laws; exemptions.
• Note: The amendments to 743.734 by section 13, chapter 500, Oregon Laws 2011, become operative January 2, 2014. See section 13, chapter 752, Oregon Laws 2007, as amended by section 4, chapter 81, Oregon Laws 2010, and section 10, chapter 500, Oregon Laws 2011. The text that is operative on and after January 2, 2014, is set forth for the user s convenience.
• 743.734. (1) Every health benefit plan shall be subject to the provisions of ORS 743.733 to 743.737, if the plan provides health benefits covering one or more employees of a small employer and if any one of the following conditions is met: (a) Any portion of the premium or benefits is paid by a small employer or any eligible employee is reimbursed, whether through wage adjustments or otherwise, by a small employer for any portion of the health benefit plan premium; or (b) The health benefit plan is treated by the employer or any of the eligible employees as part of a plan or program for the purposes of section 106, section 125 or section 162 of the Internal Revenue Code of 1986, as amended. (2) Except as provided in ORS 743.733 to 743.737, 743.764 and 743A.012, no state law requiring the coverage or the offer of coverage of a health care service or benefit applies to the basic health benefit plans offered or delivered to a small employer. (3) Except as otherwise provided by ORS 743.733 to 743.737 or other law, no health benefit plan offered to a small employer shall: (a) Inhibit a carrier from contracting with providers or groups of providers with respect to health care services or benefits; or (b) Impose any restriction on the ability of a carrier to negotiate with providers regarding the level or method of reimbursing care or services provided under health benefit plans. (4) Except to determine the application of a preexisting condition exclusion for a late enrollee who is 19 years of age or older, a carrier shall not use health statements when offering small employer health benefit plans and shall not use any other method to determine the actual or expected health status of eligible enrollees. Nothing in this subsection shall prevent a carrier from using health statements or other information after enrollment for the purpose of providing services or arranging for the provision of services under a health benefit plan. (5) Except as provided in this section and ORS 743.737, a carrier shall not impose different terms or conditions on the coverage, premiums or contributions of any eligible employee of a small employer that are based on the actual or expected health status of any eligible employee. (6)(a) A carrier may provide different health benefit plans to different categories of employees of a small employer that has at least 26 but no more than 50 eligible employees when the employer has chosen to establish different categories of employees in a manner that does not relate to the actual or expected health status of such employees or their dependents. The categories must be based on bona fide employment-based classifications that are consistent with the employer s usual business practice. (b) Except as provided in ORS 743.736 (9), a carrier that offers coverage to a small employer with no more than 25 eligible employees shall offer coverage to all eligible employees of the small employer, without regard to the actual or expected health status of any eligible employee. (c) If a small employer elects to offer coverage to dependents of eligible employees, the carrier shall offer coverage to all dependents of eligible employees, without regard to the actual or expected health status of any eligible dependent. (7) Notwithstanding any other provision of law, an insurer may not deny, delay or terminate participation of an individual in a group health benefit plan or exclude coverage otherwise provided to an individual under a group health benefit plan based on a preexisting condition of the individual if the individual is under 19 years of age.
• 743.735 [Formerly 747.100; 1973 c.823 151; renumbered 742.352 in 1989]
• 743.736 Requirement to offer basic health benefit plans to small employers; approval of plans and forms; offering of plan by carriers; exceptions.
• 743.737 Requirements for small employer health benefit plans.
• 743.738 [Formerly 747.110; renumbered 742.354 in 1989]
• 743.739 [1991 c.916 8; repealed by 1995 c.603 32]
• 743.740 [1991 c.916 9; 1993 c.18 162; repealed by 1995 c.603 32]
• 743.741 [Formerly 747.130; renumbered 742.356 in 1989]
• 743.742 [1991 c.916 10; repealed by 1995 c.603 32]
• 743.743 [1991 c.916 11; 1993 c.18 163; 1993 c.649 13; repealed by 1995 c.603 32]
• 743.744 [Formerly 747.140; renumbered 742.358 in 1989]
• 743.745 Requirements for basic health benefit plans; director s authority to regulate portability, small group and individual plans; standard health statement for late enrollees; allowable preexisting condition exclusions.
• Note: Additions by chapter 322, Oregon Laws 2011, to the series 743.730 to 743.773, which become operative January 2, 2014, expand the series to 743.730 to 743.773, 743.822 and 743.826. See sections 1, 2 [743.822 (2)], 3 [743.822 (1)], 4 [743.826] and 6, chapter 322, Oregon Laws 2011. See Preface to Oregon Revised Statutes for further explanation.
• 743.746 [1997 c.716 9c; repealed by 1999 c.987 28]
• 743.747 [Formerly 747.150; renumbered 742.360 in 1989]
• 743.748 Submission of information by carriers offering health benefit plans.
• Note: The amendments to 743.748 by section 18, chapter 500, Oregon Laws 2011, become operative January 2, 2014. See section 13, chapter 752, Oregon Laws 2007, as amended by section 4, chapter 81, Oregon Laws 2010, and section 10, chapter 500, Oregon Laws 2011. The text that is operative on and after January 2, 2014, is set forth for the user s convenience.
• 743.748. (1) Each carrier offering a health benefit plan shall submit to the Director of the Department of Consumer and Business Services on or before April 1 of each year a report that contains: (a) The following information for the preceding year that is derived from the exhibit of premiums, enrollment and utilization included in the carrier s annual report: (A) The total number of members; (B) The total amount of premiums; (C) The total amount of costs for claims; (D) The medical loss ratio; (E) The average amount of premiums per member per month; and (F) The percentage change in the average premium per member per month, measured from the previous year. (b) The following aggregate financial information for the preceding year that is derived from the carrier s annual report: (A) The total amount of general administrative expenses, including identification of the five largest nonmedical administrative expenses and the assessment against the carrier for the Oregon Medical Insurance Pool; (B) The total amount of the surplus maintained; (C) The total amount of the reserves maintained for unpaid claims; (D) The total net underwriting gain or loss; and (E) The carrier s net income after taxes. (2) A carrier shall electronically submit the information described in subsection (1) of this section in a format and according to instructions prescribed by the Department of Consumer and Business Services by rule. (3) The department shall evaluate the reporting requirements under subsection (1)(a) of this section by the following market segments: (a) Individual health benefit plans; (b) Health benefit plans for small employers; (c) Health benefit plans for employers described in ORS 743.733; and (d) Health benefit plans for employers with more than 50 employees. (4) The department shall make the information reported under this section available to the public through a searchable public website on the Internet.
• 743.749 Certifications and disclosure of coverage.
• 743.750 [1967 c.359 516; renumbered 742.362 in 1989]
• 743.751 Use of health statements in group health benefit plans.
• 743.752 Coverage in group health benefit plans; consideration of prospective enrollee health status restricted; effect of discontinuing offer of plans; exceptions; coverage by multiple employer welfare arrangements.
• 743.753 [Formerly 747.170; 1969 c.526 2; renumbered 742.364 in 1989]
• 743.754 Requirements for group health benefit plans.
• 743.755 [1969 c.526 1; renumbered 742.366 in 1989]
• 743.756 [Formerly 747.180; renumbered 742.368 in 1989]
• 743.757 Health benefit coverage for guaranteed association.
• 743.758 Implementation of federal laws; rules.
• 743.759 [Formerly 747.190; renumbered 742.370 in 1989]
• 743.760 Approval of portability plans; offering of plans by carriers; required provisions; actuarial certification.
• Note: Additions by chapter 322, Oregon Laws 2011, to the series 743.730 to 743.773, which become operative January 2, 2014, expand the series to 743.730 to 743.773, 743.822 and 743.826. See sections 1, 2 [743.822 (2)], 3 [743.822 (1)], 4 [743.826] and 6, chapter 322, Oregon Laws 2011. See Preface to Oregon Revised Statutes for further explanation.
• 743.761 Satisfaction of requirements of ORS 743.760 by carrier offering individual health benefit plans; rules.
• 743.762 [Formerly 747.082; 1989 c.634 1; renumbered 742.372 in 1989]
• 743.763 [1995 c.603 20; 1997 c.716 26; renumbered 735.616 in 1997]
• 743.764 Preventive health services; coverage; cost sharing.
• Note: 743.764 was added to and made a part of 743.730 to 743.773 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.765 [Formerly 747.084; 1989 c.634 2; renumbered 742.374 in 1989]
• 743.766 Use of health statements in individual health benefit plans; preexisting condition exclusions; eligibility to apply for Oregon Medical Insurance Pool; renewal; discontinuation of coverage.
• 743.767 Premium rates for individual health benefit plans.
• 743.768 [Formerly 747.086; 1983 c.338 964; 1989 c.634 3; renumbered 742.376 in 1989]
• 743.769 Carrier marketing of individual health benefit plans; rules; duties of carrier regarding applications; effect of discontinuing offer of plans.
• 743.770 [Formerly 743.780; 1987 c.774 60; renumbered 742.400 in 1989]
• 743.771 [1987 c.774 151; renumbered 742.405 in 1989]
• 743.772 [Formerly 743.783; renumbered 742.031 in 1989]
• 743.773 Rules for ORS 743.766 to 743.769.
• 743.774 [Formerly 486.097; renumbered 806.190 in 1987]
• 743.775 Submission of information by carriers offering individual health benefit plans.
• 743.776 [Formerly 486.541; renumbered 742.450 in 1989]
• 743.777 Electronic administration; discounted rates; requirements.
• Note: 743.777 (1) to (6) were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 743 or any series therein. 743.777 (7) was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 743 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 743.778 [Formerly 486.546; renumbered 742.454 in 1989]
• 743.779 [Formerly 486.551; 1989 c.700 14; renumbered 742.456 in 1989]
• 743.780 [1975 c.796 10; 1977 c.448 12; 1985 c.103 14; 1985 c.323 10; 1985 c.624 17a; renumbered 743.770; renumbered 742.400 in 1989]
• 743.781 [Formerly 486.556; 1989 c.700 15; renumbered 742.458 in 1989]
• 743.782 [Formerly 486.561; 1989 c.700 16; renumbered 742.460 in 1989]
• 743.783 [Formerly 736.320; renumbered 743.772; renumbered 742.031 in 1989]
• 743.784 [Formerly 486.564; 1989 c.700 17; renumbered 742.462 in 1989]
• 743.785 [Formerly 486.566; renumbered 742.464 in 1989]
• 743.786 [1967 c.482 1; 1971 c.523 11; 1979 c.842 7; 1983 c.338 965; renumbered 742.500 in 1989]
• 743.787 Definitions for ORS 743.788.
• 743.788 Prescription drug identification card.
• 743.789 [1967 c.482 2; 1975 c.390 1; 1981 c.586 1; 1983 c.338 966; 1987 c.632 1; renumbered 742.502 in 1989]
• 743.790 Rules for prescription drug identification cards.
• 743.791 [2005 c.482 2; renumbered 743A.108 in 2007]
• 743.792 [1967 c.482 3; 1977 c.600 3; 1979 c.842 8; 1983 c.338 967; renumbered 742.504 in 1989]
• 743.793 [2003 c.91 4; renumbered 743A.064 in 2007]
• 743.794 [2005 c.477 2; renumbered 743A.120 in 2007]
• 743.795 [1979 c.842 10; renumbered 742.506 in 1989]
• 743.796 [1987 c.742 3; renumbered 742.508 in 1989]
• 743.797 [1987 c.742 2; renumbered 742.510 in 1989]
• 743.798 [2005 c.628 2; renumbered 743A.050 in 2007]
• 743.799 [2005 c.765 6; renumbered 743A.124 in 2007]
• 743.800 [1971 c.523 2; 1973 c.551 1; 1975 c.784 1; 1979 c.871 45; 1981 c.414 1; 1983 c.338 968; 1987 c.588 1; renumbered 742.520 in 1989] MISCELLANEOUS
• 743.801 Definitions.
• 743.802 [1987 c.588 5; renumbered 742.522 in 1989]
• 743.803 Medical services contract provisions; nonprovider party prohibitions; future contracts.
• Note: 743.803, 743.806 and 743.811 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 743. See Preface to Oregon Revised Statutes for further explanation.
• 743.804 Required notices to applicants and enrollees; grievances, internal appeals and external reviews.
• 743.805 [1971 c.523 3; 1973 c.551 2; 1975 c.784 2; 1981 c.414 2; 1987 c.588 2; 1989 c.775 1; renumbered 742.524 in 1989]
• 743.806 Utilization review requirements for medical services contracts to which insurer not party.
• Note: See note under 743.803.
• 743.807 Utilization review requirements for insurers offering health benefit plan.
• 743.808 Requirements for insurers that require designation of participating primary care physician; exceptions.
• 743.809 [1995 c.672 5; repealed by 2003 c.87 26]
• 743.810 [1971 c.523 4; 1973 c.551 4; 1975 c.784 3; renumbered 742.526 in 1989]
• 743.811 Applicability.
• Note: See note under 743.803.
• 743.812 [1987 c.588 4; renumbered 742.528 in 1989]
• 743.813 [1995 c.669 2; renumbered 743.845 in 1997]
• 743.814 Requirements for insurers offering managed health insurance; quality assessment; rules.
• 743.815 [1971 c.523 5; 1973 c.551 3; 1975 c.784 4; 1981 c.414 3; renumbered 742.530 in 1989]
• 743.816 [1995 c.506 2; renumbered 743.847 in 1997]
• 743.817 Requirements for insurers offering managed health or preferred provider organization insurance; rules; opportunity to participate.
• 743.818 Data reporting.
• Note: 743.818 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.819 Reporting requirements; rules.
• 743.820 [1971 c.523 6; 1975 c.784 5; 1981 c.414 4; renumbered 742.532 in 1989]
• 743.821 Required managed health insurance contract provision; enrollee liability.
• 743.822 Requirement to offer bronze and silver plans; rules.
• Note: 743.822 becomes operative January 2, 2014. See section 6, chapter 322, Oregon Laws 2011, as amended by section 50, chapter 500, Oregon Laws 2011.
• Note: 743.822 and 743.826 were added to and made a part of 743.730 to 743.773 by legislative action but were not added to any other series. See Preface to Oregon Revised Statutes for further explanation.
• 743.823 Enforcement of Newborns and Mothers Health Protection Act of 1996.
• 743.824 Cash dividends for healthy behaviors.
• Note: 743.824 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.825 [1971 c.523 7; 1975 c.784 6; 1987 c.569 4; 1987 c.632 2; renumbered 742.534 in 1989]
• 743.826 Requirements for catastrophic plans.
• Note: 743.826 becomes operative January 2, 2014. See section 6, chapter 322, Oregon Laws 2011, as amended by section 50, chapter 500, Oregon Laws 2011.
• Note: See second note under 743.822.
• 743.827 Health Care Consumer Protection Advisory Committee.
• 743.828 [1975 c.784 8; renumbered 742.536 in 1989]
• 743.829 Decisions regarding health care facility length of stay, level of care and follow-up care.
• 743.830 [1971 c.523 8; 1975 c.784 9; renumbered 742.538 in 1989]
• 743.831 Consortium established; managed health care performance.
• 743.833 [1975 c.784 12; renumbered 742.540 in 1989]
• 743.834 Insurer prohibited practices; patient communication and referral.
• 743.835 [1971 c.523 9; 1975 c.784 10; 1987 c.632 3; renumbered 742.542 in 1989]
• 743.837 Prior authorization requirements.
• 743.839 Disclosure of information.
• 743.840 [1985 c.527 2; renumbered 742.466 in 1989]
• 743.842 Emergency eye care services without referral from primary care provider.
• 743.845 Designation of women s health care provider as primary care provider; direct access to women s health care provider.
• 743.847 Medicaid not considered in coverage eligibility determination; claims for services paid for by medical assistance; prohibited ground for denial of enrollment of child; insurer duties.
• 743.850 [1981 c.752 1; 1983 c.817 1; 1987 c.505 1; renumbered 743.610 in 1989]
• 743.851 [1987 c.505 3; renumbered 743.600 in 1989]
• 743.852 [1987 c.505 3a,4; 1989 c.784 22; renumbered 743.601 in 1989]
• 743.853 [1987 c.505 5; renumbered 743.602 in 1989]
• 743.854 Continuity of care.
• 743.855 [1981 c.752 2; renumbered 743.611 in 1989]
• 743.856 Referrals to specialists.
• 743.857 External review; rules.
• 743.858 Director to contract with independent review organizations to provide external review; rules.
• 743.859 Notice to enrollee of right to sue if insurer does not follow decision of independent review organization.
• 743.860 [1981 c.752 3; renumbered 743.613 in 1989]
• 743.861 Enrollee application for external review; when enrollee deemed to have exhausted internal appeal.
• 743.862 Duties of independent review organizations; expedited reviews.
• 743.863 Civil penalty for failure to comply by insurer that agreed to be bound by decision.
• 743.864 Private right of action.
• 743.865 [1981 c.752 4; renumbered 743.614 in 1989]
• 743.866 [2001 c.747 2; renumbered 743.911 in 2007]
• 743.868 [2001 c.747 3; renumbered 743.913 in 2007]
• 743.870 [1981 c.752 5; renumbered 743.616 in 1989]
• 743.871 Definitions for ORS 743.871 to 743.893.
• Note: 743.871 to 743.893 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 743 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
• 743.874 Estimate of costs for in-network procedure or service.
• Note: See note under 743.871.
• 743.875 [1981 c.752 6; renumbered 743.617 in 1989]
• 743.876 Estimate of costs for out-of-network procedure or service.
• Note: See note under 743.871.
• 743.878 Submission of methodology used to determine insurer s allowable charges.
• Note: See note under 743.871.
• 743.880 [1981 c.752 7; renumbered 743.619 in 1989]
• 743.883 Alternative mechanism for disclosure of costs and charges.
• Note: See note under 743.871.
• 743.885 [1981 c.752 8; renumbered 743.620 in 1989]
• 743.890 [1981 c.752 9; renumbered 743.622 in 1989]
• 743.893 Rules.
• Note: See note under 743.871.
• 743.894 Rescinding coverage; permissible bases; notice; rules.
• Note: 743.894 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.900 [1971 c.476 2; 1975 c.570 1; renumbered 742.560 in 1989]
• 743.905 [1971 c.476 3; renumbered 742.562 in 1989]
• 743.910 [1971 c.476 4; 1977 c.600 7; 1989 c.426 3; renumbered 742.564 in 1989] PAYMENT OF CLAIMS
• 743.911 Payment or denial of health benefit plan claims; rules.
• 743.912 Refund of paid claims.
• Note: 743.912 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.913 Interest on unpaid claims.
• 743.915 [1971 c.476 5; repealed by 1975 c.570 2 (743.916 enacted in lieu of 743.915)]
• 743.916 [1975 c.570 3 (enacted in lieu of 743.915); 1977 c.600 8; 1989 c.426 4; renumbered 742.566 in 1989]
• 743.917 Underpayment of claims.
• Note: 743.917 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.918 Claims submitted during credentialing period.
• Note: 743.918 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
• 743.920 [1971 c.476 6; renumbered 742.568 in 1989]
• 743.925 [1971 c.476 7; renumbered 742.570 in 1989]
• 743.930 [1971 c.476 8; 1977 c.600 4; renumbered 742.572 in 1989]
• 743.940 [1987 c.774 36; renumbered 742.700 in 1989]
• 743.942 [1987 c.774 37; renumbered 742.702 in 1989]
• 743.944 [1987 c.774 38; renumbered 742.704 in 1989]
• 743.946 [1987 c.774 39,40; 1989 c.700 18; renumbered 742.706 in 1989]
• 743.948 [1987 c.774 41; renumbered 742.708 in 1989]
• 743.950 [1987 c.774 42; 1989 c.181 1; renumbered 742.710 in 1989] ASSESSMENT ON CLAIMS ADMINISTERED BY PUBLIC EMPLOYEES BENEFIT BOARD
• 743.951 Payment procedures; right to hearing.
• Note: Section 3a, chapter 867, Oregon Laws 2009, provides:
• Sec. 3a.
• Note: 743.951 to 743.965 and 743.990 were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation. ASSESSMENT ON PREMIUMS
• 743.960 Definitions for ORS 743.960 and 743.961.
• Note: See second note under 743.951.
• 743.961 Payment procedures.
• Note: See second note under 743.951.
• Note: Section 8, chapter 867, Oregon Laws 2009, provides:
• Sec. 8.
• 743.965 Incorrect payments; right to hearing.
• Note: See second note under 743.951.
• 743.990 Penalties.
• Note: See second note under 743.951.
• Note: See second note under 743.961. _______________