2015 Oregon Revised Statutes
Volume : 16 - Financial Institutions, Insurance
Chapter 743 - Health and Life Insurance
Section 743.656 - Eligibility for benefits; providers required to be covered.

(1) No long term care insurance policy shall be delivered or issued for delivery in this state unless the policy determines eligibility for benefits through a determination that is not more restrictive than requiring that:

(a) The policyholder be functionally impaired and needing assistance in any three or more activities of daily living as defined by the Director of the Department of Consumer and Business Services, by rule, after consultation with the Director of Human Services.

(b) Benefits must be payable when the beneficiary is receiving covered services from any of the following providers approved by the insurer:

(A) Nursing home;

(B) Assisted living;

(C) Home care; and

(D) Adult foster care.

(c) The insurer shall approve nursing home, assisted living, home care, adult foster home and any other providers of covered services by using standards that have been submitted to and approved by the director in consultation with the Director of Human Services.

(2) No long term care policy that offers only nursing home benefits shall be sold in this state.

[1989 c.1022 §§13,14; 2003 c.14 §449]