ORS § 735.455 — OR Code / Title 56 / Chapter 735 / Section 735.455
735.455 Authority of licensee
Status: in_force

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

(2) A surplus lines licensee may charge a producing insurance producer a fee or a combination of a fee and a commission when transacting surplus lines for the producing insurance producer if the surplus lines licensee has a written agreement with the producing insurance producer prior to the binding or issuance of a surplus lines insurance policy. When a surplus lines licensee transacts surplus lines insurance directly for a prospective insured, the surplus lines licensee may charge the prospective insured a fee or a combination of a fee and a commission if the surplus lines licensee has a written agreement with the prospective insured prior to the binding or issuance of a surplus lines insurance policy.

(3) A producing insurance producer may charge a fee to a prospective insured when the producing insurance producer pays a fee or a combination of a fee and a commission to a surplus lines licensee under subsection (2) of this section if the producing insurance producer has a written agreement with the prospective insured prior to the binding or issuance of the surplus lines insurance policy. The fee may not exceed the amount of compensation paid by the producing insurance producer to the surplus lines licensee.

(4) For the purpose of determining the charge under subsection (2) of this section, the producing insurance producer and the surplus lines licensee may agree to any allocation of the fee that the producing insurance producer charges the prospective insured under this section.

(5) The fee or the fee and commission charged by a surplus lines licensee under subsection (2) of this section must be commensurate with the services provided by the surplus lines licensee. The Director of the Department of Consumer and Business Services may establish by rule minimum conditions for written agreements entered into under this section. An insurer or insurance producer who enters into a written agreement as provided in this section is not in violation of ORS 746.035 (Inducements not specified in policy) or 746.045 (Prohibition on rebates) . [1987 c.774 §128; 2003 c.364 §42; 2011 c.660 §15]

Source: Section 735.455 — Authority of licensee; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 732.810 — OR Code / Title 56 / Chapter 732 / Section 732.810
732.810 Definitions for ORS 732.810 to 732.814
Status: in_force

As used in ORS 732.810 (Definitions for ORS 732.810 to 732.814) to 732.814 (Authority of director over controlling producer and controlled insurer) :

(1) “Control” has the meaning given that term in ORS 732.548 (Definitions for ORS 732.517 to 732.596) .

(2) “Controlled insurer” means an authorized insurer that an insurance producer controls directly or indirectly.

(3) “Controlling producer” means an insurance producer who directly or indirectly controls an insurer.

(4) Intentionally left blank —Ed.

(a) “Insurance producer” has the meaning given that term in ORS 731.104 (“Insurance producer.”) .

(b) “Insurance producer” does not include a person who sells, solicits or negotiates an insurance contract on the insurance producer’s behalf. [1993 c.447 §58; 2003 c.364 §82; 2013 c.370 §34]

Note: 732.810 (Definitions for ORS 732.810 to 732.814) to 732.814 (Authority of director over controlling producer and controlled insurer) were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 732 or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 732.810 — Definitions for ORS 732.810 to 732.814 , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 732.475 — OR Code / Title 56 / Chapter 732 / Section 732.475
732.475 Members’ meetings and procedures of domestic mutual and reciprocal insurers
Status: in_force

The following provisions shall apply to and govern meetings of members of a domestic mutual insurer and, to the extent applicable, meetings of subscribers of a domestic reciprocal insurer:

(1) Unless the notice of the meeting is by personal mail or delivery to the members, or as provided in subsection (5) of this section, the annual meeting, and all special meetings of members shall be held at or in the immediate vicinity of the home office of the insurer.

(2) In lieu of personal notice mailed or delivered to members, notice of the annual meeting or of a special meeting of members may be given by publishing a notice thereof once a week for two consecutive weeks in the newspaper with the largest general circulation in this state and, if the home office is located outside the city of such newspaper, then also in the newspaper with the largest general circulation published at or nearest the home office city of the insurer. The published notice shall state the time and place of the meeting and the matters to be presented and considered and, if a special meeting, shall also state the purpose for which it is called. The date of the first publication thereof shall be not less than 20 nor more than 50 days prior to the meeting date.

(3) A copy of the meeting notice mailed, delivered or published shall be mailed or delivered to the Director of the Department of Consumer and Business Services at least 20 days prior to the meeting date. The director may attend any such meeting.

(4) The date and time of the annual meeting shall be set forth in the bylaws. Such date and time and location of the home office of the insurer shall be set forth in the policy issued to the member or in a notice forwarded to the policyholder within 30 days after the issuance of the policy. If the date or time of such meeting is changed by amendment to the bylaws, which amendment may be adopted in the same manner as any other amendment to the bylaws, there shall be mailed or delivered to each member not less than 30 days before the date of the annual meeting, the date or time of which has been changed, a notice of the change thereof. Such a notice may be given by policy or policy indorsement or by a separate notice document.

(5) Notwithstanding the provisions of subsections (1) to (4) of this section, if the director finds, after inquiry and investigation, that the operations of an insurer are not financially sound or that its management is not acting in a sound and prudent manner for the benefit of the members or that certain practices and procedures of or involving the insurer’s operations or management ought to be presented to the members, the director may direct that the insurer call a special meeting for such purpose or that such matters be put on the agenda at an annual meeting. In such case, the director may further direct that notice of such meeting be given in the manner prescribed in ORS 60.214 (Notice of meeting) . The notice shall also state that the special meeting is called, or that the particular matters are included on the agenda of the regular meeting, at the direction of the director.

(6) The members present in person or represented by proxy shall constitute a quorum at a duly called meeting of members. The affirmative vote of a majority of members voting on any matter presented at such meeting shall constitute the act of the members unless the voting of a greater number is required by law or the insurer’s articles of incorporation or bylaws. [1967 c.359 §193; 1971 c.231 §43; 1987 c.846 §9]

Source: Section 732.475 — Members’ meetings and procedures of domestic mutual and reciprocal insurers , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 750.321 — OR Code / Title 56 / Chapter 750 / Section 750.321
750.321 Assessment
Status: in_force

(1) Benefit plans issued by a trust must provide for a charge or deposit payable in cash and, except as provided in this section, for an assessment against member employers for purposes of subsection (2) of this section at least equal to one month’s contribution by the employer. The assessment may be prefunded. A member employer may not be liable under this subsection for an amount greater than the charge or deposit required in the plan.

(2) If at any time the capital and surplus of the trust are less than the requirement of ORS 750.309 (Requirements for trust) , the trust must immediately collect from member employers upon each plan a sufficient proportionate part of the amount assessable under subsection (1) of this section to restore the amount of capital and surplus required. An assessment of an employer under this subsection may not exceed the amount provided in the plan for an assessment for purposes of this subsection.

(3) In addition to assessments that may be collected under subsection (2) of this section, in the event of liquidation of a multiple employer welfare arrangement trust, the Director of the Department of Consumer and Business Services, acting in the capacity of receiver, may assess member employers an amount necessary to pay outstanding claims and costs necessary to administer the liquidation proceedings. An assessment of an employer under this subsection may not exceed the amount of one month’s contribution by the employer.

(4) A member employer of an association or group shall not be liable for any part of an assessment imposed under subsection (2) or (3) of this section in excess of the amount demanded within one year after the termination of the member employer’s participation in the plan. [1993 c.615 §13; 2001 c.318 §18]

Note: See note under 750.301 (Definitions for ORS 750.301 to 750.341) .

Source: Section 750.321 — Assessment; maintenance of capital and surplus , https://www.­oregonlegislature.­gov/bills_laws/ors/ors750.­html (accessed May 26, 2025).
ORS § 750.695 — OR Code / Title 56 / Chapter 750 / Section 750.695
750.695 ORS 750.505 to 750.715 not to affect regulation of practice of law
Status: in_force

(1) ORS 750.505 (Definitions for ORS 750.505 to 750.715) to 750.715 (Rules) do not affect the regulation of the practice of law.

(2) Except as provided in ORS 750.505 (Definitions for ORS 750.505 to 750.715) to 750.715 (Rules) , legal expense plans are not subject to the Insurance Code. [1989 c.331 §20]

Source: Section 750.695 — ORS 750.505 to 750.715 not to affect regulation of practice of law; plan not subject to Insurance Code , https://www.­oregonlegislature.­gov/bills_laws/ors/ors750.­html (accessed May 26, 2025).
ORS § 750.625 — OR Code / Title 56 / Chapter 750 / Section 750.625
750.625 Paying providing attorney contingent on claims experience prohibited
Status: in_force

Compensation paid to a providing attorney shall not be contingent on claims experience. This section does not prevent the compensation of a providing attorney from being based on membership fees collected or the number of claims paid or processed, nor does it prevent a providing attorney from sharing in a fund based on services performed. [1989 c.331 §15]

Source: Section 750.625 — Paying providing attorney contingent on claims experience prohibited , https://www.­oregonlegislature.­gov/bills_laws/ors/ors750.­html (accessed May 26, 2025).
ORS § 742.224 — OR Code / Title 56 / Chapter 742 / Section 742.224
742.224 Cancellation
Status: in_force

(1) A fire insurance policy shall contain a provision as follows: “This policy shall be canceled at any time at the request of the insured, in which case this company shall, upon demand and surrender of this policy, refund the excess of paid premium above the customary short rates for the expired time.”

(2) The policy also shall provide:

(a) That the insurer may cancel the policy at any time by giving 10 days’ written notice of cancellation to the insured in the event of nonpayment of premium or 30 days’ written notice for any other reason. However, when fire insurance coverage is part of a package policy including commercial liability insurance, cancellation of the policy is governed by the provisions of ORS 742.702 (Grounds for cancellation) .

(b) That cancellation by the insurer may be made with or without tender of the excess of paid premium above the pro rata premium for the expired time, and that the excess, if not tendered with the cancellation, will be refunded on demand.

(3) When an insurer gives notice of cancellation, the notice shall state that the excess of paid premium above the pro rata premium for the expired time, if not tendered with the notice, will be refunded on demand. [Formerly 743.636; 1991 c.768 §2]

Source: Section 742.224 — Cancellation , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 732.614 — OR Code / Title 56 / Chapter 732 / Section 732.614
732.614 Effect of conversion
Status: in_force

(1) Upon the effective date of a conversion, the membership interests of all members of the converting mutual insurer, whether or not eligible members, shall be extinguished, and the eligible members of the converting mutual insurer shall be entitled to receive the consideration described in ORS 732.612 (Consideration for membership interest in converting or reorganizing mutual insurer) in accordance with the plan.

(2) A converting mutual insurer becomes a stock insurer on the effective date of the conversion. The amended or restated articles of incorporation of the converting mutual insurer shall be filed with the Director of the Department of Consumer and Business Services and shall become effective on the effective date of the conversion. The certificate of authority of the converting mutual insurer shall be amended by the director on the effective date of the conversion.

(3) A converted stock insurer continues the corporate existence of the converting mutual insurer. Except as provided in the plan, the conversion does not annul, modify or change any existing license or other authority or any of the existing civil actions, rights, contracts or liabilities of the converting mutual insurer. All property, debts and choses in action and every other interest belonging to the converting mutual insurer before the conversion are retained by the converted stock insurer without further action needed. On and after the effective date of the conversion, the converted stock insurer shall exercise all rights and powers and perform all duties conferred or imposed by law upon insurers writing the classes of insurance written by the converted stock insurer, shall retain the rights and contracts of the converting mutual insurer existing immediately before the conversion and shall be subject to all obligations and liabilities of the converting mutual insurer existing immediately before the conversion, subject to the terms of the plan.

(4) Notwithstanding subsections (2) and (3) of this section, the conversion may be carried out through any other method described in the plan and approved by the director.

(5) Unless otherwise specified in the plan, the directors and officers of the converting mutual insurer shall serve as directors and officers of the converted stock insurer until new directors and officers are elected.

(6) The provisions of this section apply to the conversion of the converting mutual insurer whether or not the conversion is part of a reorganization. [1997 c.771 §7]

Source: Section 732.614 — Effect of conversion , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 735.532 — OR Code / Title 56 / Chapter 735 / Section 735.532
735.532 Registration of pharmacy benefit managers
Status: in_force

(1) To conduct business in this state, a pharmacy benefit manager must register with the Department of Consumer and Business Services and annually renew the registration.

(2) To register under this section, a pharmacy benefit manager must:

(a) Submit an application to the department on a form prescribed by the department by rule.

(b) Pay a registration fee in an amount adopted by the department by rule.

(3) To renew a registration under this section, a pharmacy benefit manager must pay a renewal fee in an amount adopted by the department by rule.

(4) The department shall deposit all moneys collected under this section into the Consumer and Business Services Fund created in ORS 705.145 (Consumer and Business Services Fund) .

(5) Any fee adopted by the department under this section must be based on the department’s reasonable costs in administering ORS 735.530 (Definitions for ORS 735.530 to 735.552) to 735.552 (Pharmacy claims audits) . [2013 c.570 §3; 2017 c.73 §3]

Note: See note under 735.530 (Definitions for ORS 735.530 to 735.552) .

Source: Section 735.532 — Registration of pharmacy benefit managers; fees; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 743b.427 — OR Code / Title 56 / Chapter 743b / Section 743b.427
743B.427 Nonquantitative treatment limitations on coverage of behavioral health conditions
Status: in_force

(1) As used in this section:

(a) “Behavioral health benefits” means insurance coverage of mental health treatment and services and substance use disorder treatment and services.

(b) “Carrier” has the meaning given that term in ORS 743B.005 (Definitions) .

(c) “Geographic region” means the geographic area of the state established by the Department of Consumer and Business Services for the purpose of determining geographic average rates, as defined in ORS 743B.005 (Definitions) .

(d) “Health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions) .

(e) “Median maximum allowable reimbursement rate” means the median of all maximum allowable reimbursement rates, minus incentive payments, paid for each billing code for each provider type during a calendar year.

(f) “Mental health treatment and services” means the treatment of or services provided to address any condition or disorder that falls under any of the diagnostic categories listed in the mental disorders section of the current edition of the:

(A) International Classification of Disease; or

(B) Diagnostic and Statistical Manual of Mental Disorders.

(g) “Nonquantitative treatment limitation” means a limitation that is not expressed numerically but otherwise limits the scope or duration of behavioral health benefits.

(h) “Substance use disorder treatment and services” means the treatment of or services provided to address any condition or disorder that falls under any of the diagnostic categories listed in the substance use section of the current edition of the:

(A) International Classification of Disease; or

(B) Diagnostic and Statistical Manual of Mental Disorders.

(2) Each carrier that offers an individual or group health benefit plan in this state that provides behavioral health benefits shall conduct an annual analysis of whether the processes, strategies, specific evidentiary standards or other factors the carrier used to design, determine applicability of and apply each nonquantitative treatment limitation to behavioral health benefits within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, specific evidentiary standards or other factors the carrier used to design, determine applicability of and apply each nonquantitative treatment limitation to medical and surgical benefits within the corresponding classification of benefits.

(3) On or before March 1 of each year, all carriers that offer individual or group health benefit plans in this state that provide behavioral health benefits shall report to the Department of Consumer and Business Services, in the form and manner prescribed by the department, the following information:

(a) The specific plan or coverage terms or other relevant terms regarding the nonquantitative treatment limitations and a description of all mental health or substance use disorder and medical or surgical benefits to which each such term applies in each respective benefits classification.

(b) The factors used to determine that the nonquantitative treatment limitations will apply to mental health or substance use disorder benefits and medical or surgical benefits.

(c) The evidentiary standards used for the factors identified in paragraph (b) of this subsection, when applicable, provided that every factor is defined, and any other source or evidence relied upon to design and apply the nonquantitative treatment limitations to mental health or substance use disorder benefits and medical or surgical benefits.

(d) The comparative analyses demonstrating that the processes, strategies, evidentiary standards and other factors used to apply the nonquantitative treatment limitations to mental health or substance use disorder benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards and other factors used to apply the nonquantitative treatment limitations to medical or surgical benefits in the benefits classification.

(e) The specific findings and conclusions reached by the insurer with respect to the health insurance coverage, including any results of the analyses described in paragraphs (a) to (d) of this subsection that indicate that the plan or coverage is or is not in compliance with this section.

(f) The number of denials of behavioral health benefits and medical and surgical benefits, the percentage of denials that were appealed, the percentage of appeals that upheld the denial and the percentage of appeals that overturned the denial.

(g) The percentage of claims for behavioral health benefits and medical and surgical benefits that were paid to in-network providers and the percentage of such claims that were paid to out-of-network providers.

(h) The median maximum allowable reimbursement rate for each time-based office visit billing code for each behavioral treatment provider type and each medical provider type.

(i) The reimbursement rate in each geographic region for a time-based office visit and the percentage of the Medicare rate the reimbursement rate represents, paid to:

(A) Psychiatrists.

(B) Psychiatric mental health nurse practitioners.

(C) Psychologists.

(D) Licensed clinical social workers.

(E) Licensed professional counselors.

(F) Licensed marriage and family therapists.

(j) The reimbursement rate in each geographic region for a time-based office visit and the percentage of the Medicare rate the reimbursement rate represents, paid to:

(A) Physicians.

(B) Physician assistants.

(C) Licensed nurse practitioners.

(k) The specific findings and conclusions of the carrier under subsection (2) of this section demonstrating compliance with ORS 743A.168 (Behavioral health treatment) and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343) and rules adopted thereunder.

(L) Other data or information the department deems necessary to assess a carrier’s compliance with mental health parity requirements.

(4) No later than September 15 of each calendar year, the department shall report to the interim committees of the Legislative Assembly related to mental or behavioral health, in the manner provided in ORS 192.245 (Form of report to legislature) , the information reported under subsection (3) of this section, including the department’s overall comparison of carriers’ coverage of mental health treatment and services and substance use disorder treatment and services to carriers’ coverage of medical or surgical treatments or services. [2021 c.629 §2]

Note: The amendments to 743B.427 (Nonquantitative treatment limitations on coverage of behavioral health conditions) by section 7, chapter 629, Oregon Laws 2021, become operative January 1, 2025. See section 9, chapter 629, Oregon Laws 2021. The text that is operative on and after January 1, 2025, is set forth for the user’s convenience.

743B.427 (Nonquantitative treatment limitations on coverage of behavioral health conditions) . (1) As used in this section:

(a) “Behavioral health benefits” means insurance coverage of mental health treatment and services and substance use disorder treatment and services.

(b) “Carrier” has the meaning given that term in ORS 743B.005 (Definitions) .

(c) “Geographic region” means the geographic area of the state established by the Department of Consumer and Business Services for the purpose of determining geographic average rates, as defined in ORS 743B.005 (Definitions) .

(d) “Health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions) .

(e) “Median maximum allowable reimbursement rate” means the median of all maximum allowable reimbursement rates, minus incentive payments, paid for each billing code for each provider type during a calendar year.

(f) “Mental health treatment and services” means the treatment of or services provided to address any condition or disorder that falls under any of the diagnostic categories listed in the mental disorders section of the current edition of the:

(A) International Classification of Disease; or

(B) Diagnostic and Statistical Manual of Mental Disorders.

(g) “Nonquantitative treatment limitation” means a limitation that is not expressed numerically but otherwise limits the scope or duration of behavioral health benefits.

(h) “Substance use disorder treatment and services” means the treatment of or services provided to address any condition or disorder that falls under any of the diagnostic categories listed in the substance use section of the current edition of the:

(A) International Classification of Disease; or

(B) Diagnostic and Statistical Manual of Mental Disorders.

(2) Each carrier that offers an individual or group health benefit plan in this state that provides behavioral health benefits shall conduct an annual analysis of whether the processes, strategies, specific evidentiary standards or other factors the carrier used to design, determine applicability of and apply each nonquantitative treatment limitation to behavioral health benefits within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, specific evidentiary standards or other factors the carrier used to design, determine applicability of and apply each nonquantitative treatment limitation to medical and surgical benefits within the corresponding classification of benefits.

(3) On or before March 1 of each year, all carriers that offer individual or group health benefit plans in this state that provide behavioral health benefits shall report to the Department of Consumer and Business Services, in the form and manner prescribed by the department, the following information:

(a) The specific plan or coverage terms or other relevant terms regarding the nonquantitative treatment limitations and a description of all mental health or substance use disorder and medical or surgical benefits to which each such term applies in each respective benefits classification.

(b) The factors used to determine that the nonquantitative treatment limitations will apply to mental health or substance use disorder benefits and medical or surgical benefits.

(c) The evidentiary standards used for the factors identified in paragraph (b) of this subsection, when applicable, provided that every factor is defined, and any other source or evidence relied upon to design and apply the nonquantitative treatment limitations to mental health or substance use disorder benefits and medical or surgical benefits.

(d) The comparative analyses demonstrating that the processes, strategies, evidentiary standards and other factors used to apply the nonquantitative treatment limitations to mental health or substance use disorder benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards and other factors used to apply the nonquantitative treatment limitations to medical or surgical benefits in the benefits classification.

(e) The specific findings and conclusions reached by the insurer with respect to the health insurance coverage, including any results of the analyses described in paragraphs (a) to (d) of this subsection that indicate that the plan or coverage is or is not in compliance with this section.

(f) Other data or information the department deems necessary to assess a carrier’s compliance with mental health parity requirements.

(4) No later than September 15 of each calendar year, the department shall report to the interim committees of the Legislative Assembly related to mental or behavioral health, in the manner provided in ORS 192.245 (Form of report to legislature) , the information reported under subsection (3) of this section, including the department’s overall comparison of carriers’ coverage of mental health treatment and services and substance use disorder treatment and services to carriers’ coverage of medical or surgical treatments or services.

Note: 743B.427 (Nonquantitative treatment limitations on coverage of behavioral health conditions) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743B.427 — Nonquantitative treatment limitations on coverage of behavioral health conditions , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 733.310 — OR Code / Title 56 / Chapter 733 / Section 733.310
733.310 Interest rates for determining minimum standard for valuation
Status: in_force

(1) The interest rates used in determining the minimum standard for the valuation of the following shall be the calendar year statutory valuation interest rates as defined in this section:

(a) All life insurance policies issued in a particular calendar year, on or after the operative date stated in ORS 743.215 (Calculation of adjusted premiums) for the Standard Nonforfeiture Law for Life Insurance;

(b) All individual annuity and pure endowment contracts issued in a particular calendar year on or after January 1, 1982;

(c) All annuities and pure endowments purchased in a particular calendar year on or after January 1, 1982, under group annuity and pure endowment contracts; and

(d) The net increase, if any, in a particular calendar year after January 1, 1982, in amounts held under guaranteed interest contracts.

(2) Calendar year statutory valuation interest rates shall be established as follows:

(a) Except as provided in paragraph (b) of this subsection, the calendar year statutory valuation interest rates, “I”, shall be determined as follows and the results rounded to the nearer one-quarter of one percent:

(A) For life insurance:

I=0.03+W(R1−0.03)+W/2(R2−0.09)

(B) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and from guaranteed interest contracts with cash settlement options,

I=0.03+W(R−0.03)

where R1 is the lesser of R and 0.09, R2 is the greater of R and 0.09, R is the reference interest rate defined in this section and W is the weighting factor defined in this section.

(C) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on an issue year basis, except as stated in subparagraph (B) of this paragraph, the formula for life insurance stated in subparagraph (A) of this paragraph shall apply to annuities and guaranteed interest contracts with guarantee durations in excess of 10 years and the formula for single premium immediate annuities stated in subparagraph (B) of this paragraph shall apply to annuities and guaranteed interest contracts with guarantee duration of 10 years or less.

(D) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the formula for single premium immediate annuities stated in subparagraph (B) of this paragraph shall apply.

(E) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, the formula for single premium immediate annuities stated in subparagraph (B) of this paragraph shall apply.

(b) If the calendar year statutory valuation interest rate for any life insurance policies issued in any calendar year determined without reference to this paragraph differs from the corresponding actual rate for similar policies issued in the immediately preceding calendar year by less than one-half of one percent, the calendar year statutory valuation interest rate for such life insurance policies shall be equal to the corresponding actual rate for the immediately preceding calendar year. For purposes of applying this paragraph, the calendar year statutory valuation interest rate for life insurance policies issued in a calendar year shall be determined for 1980, using the reference interest rate defined in 1979, and shall be determined for each subsequent calendar year regardless of the operative date of ORS 743.215 (Calculation of adjusted premiums) as part of the Standard Nonforfeiture Law for Life Insurance.

(3) Weighting factors shall be as follows:

(a) The weighting factors referred to in the formulas stated in subsection (2) of this section are given in the following tables:

(A) Weighting Factors for Life Insurance:

Guarantee

Duration Weighting

(Years) Factors

10 or less 0.50

More than 10, but less than 20 0.45

More than 20 0.35

For life insurance, the guarantee duration is the maximum number of years the life insurance can remain in force on a basis guaranteed in the policy or under options to convert to plans of life insurance with premium rates or nonforfeiture values or both that are guaranteed in the original policy.

(B) Weighting factor for single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options is 0.80.

(C) Weighting factors for other annuities and for guaranteed interest contracts, except as stated in subparagraph (B) of this paragraph, shall be as specified in the following tables (i), (ii) and (iii), according to the rules and definitions in the following tables (iv), (v) and (vi):

(i) For annuities and guaranteed interest contracts valued on an issue year basis:

Guarantee Weighting Factor

Duration for Plan Type

(Years) A B C

5 or less: 0.80 0.60 0.50

More than 5, but not more

than 10: 0.75 0.60 0.50

More than 10, but not more

than 20: 0.65 0.50 0.45

More than 20: 0.45 0.35 0.35

(ii) For annuities and guaranteed interest contracts valued on a change in fund basis, the factors shown in table (i) above increased by:

Plan Type

A B C

0.15 0.25 0.05

(iii) For annuities and guaranteed interest contracts valued on an issue year basis, other than those with no cash settlement options, that do not guarantee interest on considerations received more than one year after issue or purchase and for annuities and guaranteed interest contracts valued on a change in fund basis that do not guarantee interest rates on considerations received more than 12 months beyond the valuation date, the factors shown in (i) or derived in (ii) increased by:

Plan Type

A B C

0.05 0.05 0.05

(iv) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the guaranteed duration is the number of years for which the contract guarantees interest rates in excess of the calendar year statutory valuation interest rate for life insurance policies with guarantee duration in excess of 20 years. For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the guaranteed duration is the number of years from the date of issue or date of purchase to the date annuity benefits are scheduled to commence.

(v) Plan type as used in the tables in this subsection is defined as follows:

Plan Type A: At any time the policyholder: (1) may withdraw funds only with an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurer; or (2) may withdraw funds without such adjustment but only in installments over five years or more; or (3) may withdraw funds only as an immediate life annuity; or (4) is not permitted to make a withdrawal.

Plan Type B: Before expiration of the interest rate guarantee, the policyholder: (1) may withdraw funds only with adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurer; or (2) may withdraw funds without such adjustment but only in installments over five years or more; or (3) is not permitted to make a withdrawal. At the end of interest rate guarantee, funds may be withdrawn without such adjustment in a single sum or installments over a period of less than five years.

Plan Type C: Policyholder may withdraw funds before expiration of interest rate guarantee in a single sum or installments over less than five years either: (1) without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurer; or (2) subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund.

(b) An insurer may elect to value guaranteed interest contracts with cash settlement options and annuities with cash settlement options on either an issue year basis or on a change in fund basis. Guaranteed interest contracts with no cash settlement options and other annuities with no cash settlement options must be valued on an issue year basis. As used in this paragraph, an issue year basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard for the entire duration of the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of issue or year of purchase of the annuity or guaranteed interest contract, and the change in fund basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard applicable to each change in the fund held under the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of the change in the fund.

(4) The reference interest rate referred to in subsection (2) of this section is defined as follows:

(a) For all life insurance, the lesser of the average over a period of 36 months and the average over a period of 12 months, ending on June 30 of the calendar year next preceding the year of issue, of the Monthly Average of the Composite Yield on Seasoned Corporate Bonds, as published by Moody’s Investors Service, Inc.

(b) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the average over a period of 12 months, ending on June 30 of the calendar year of issue or year of purchase of the Monthly Average of the Composite Yield on Seasoned Corporate Bonds, as published by Moody’s Investors Service, Inc.

(c) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in paragraph (b) of this subsection, with guarantee duration in excess of 10 years, the lesser of the average over a period of 36 months and the average over a period of 12 months, ending on June 30 of the calendar year of issue or purchase, of the Monthly Average of the Composite Yield on Seasoned Corporate Bonds, as published by Moody’s Investors Service, Inc.

(d) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in paragraph (b) of this subsection, with guarantee duration of 10 years or less, the average over a period of 12 months, ending on June 30 of the calendar year of issue or purchase, of the Monthly Average of the Composite Yield on Seasoned Corporate Bonds, as published by Moody’s Investors Service, Inc.

(e) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the average over a period of 12 months, ending on June 30 of the calendar year of issue or purchase, of the Monthly Average of the Composite Yield on Seasoned Corporate Bonds, as published by Moody’s Investors Service, Inc.

(f) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, except as stated in paragraph (b) of this subsection, the average over a period of 12 months, ending on June 30 of the calendar year of the change in the fund, of the Monthly Average of the Composite Yield on Seasoned Corporate Bonds, as published by Moody’s Investors Service, Inc.

(5) In the event that the Monthly Average of the Composite Yield on Seasoned Corporate Bonds is no longer published by Moody’s Investors Service, Inc. or in the event that the National Association of Insurance Commissioners determines that the Monthly Average of the Composite Yield on Seasoned Corporate Bonds as published by Moody’s Investors Service, Inc. is no longer appropriate for the determination of the reference interest rate, the Director of the Department of Consumer and Business Services by rule may adopt an alternative method for determination of the reference interest rate. The director shall consider the alternative method adopted by the National Association of Insurance Commissioners. An insurer may substitute the alternative method adopted by rule. [1991 c.401 §22]

Source: Section 733.310 — Interest rates for determining minimum standard for valuation , https://www.­oregonlegislature.­gov/bills_laws/ors/ors733.­html (accessed May 26, 2025).
ORS § 744.364 — OR Code / Title 56 / Chapter 744 / Section 744.364
744.364 Life settlement contract requirements
Status: in_force

(1) Intentionally left blank —Ed.

(a) A life settlement provider entering into a life settlement contract shall first obtain:

(A) If the owner is the insured, a written statement from a licensed physician, a naturopathic physician licensed under ORS chapter 685, a physician assistant licensed under ORS 677.505 (Application of provisions governing physician assistants to other health professions) to 677.525 (Fees) or a nurse practitioner licensed under ORS 678.375 (Nurse practitioners) to 678.390 (Authority of nurse practitioner and clinical nurse specialist to write prescriptions or dispense drugs) that the owner is of sound mind and under no constraint or undue influence to enter into a life settlement contract; and

(B) A document in which the insured consents to the release of the insured’s medical records to a licensed life settlement provider, life settlement broker and the insurance company that issued the life insurance policy covering the life of the insured.

(b) Within 20 days after an owner executes documents necessary to transfer any rights under an insurance policy or, if the insured is terminally ill, within 20 days after an owner entering any agreement, option, promise or any other form of understanding, expressed or implied, to transfer the policy for value, the life settlement provider shall give written notice to the insurer that issued the insurance policy that the policy has or will become a settled policy. The notice must be accompanied by the documents required by paragraph (c) of this subsection.

(c) The life settlement provider shall deliver a copy of the medical release required under paragraph (a)(B) of this subsection, a copy of the owner’s application for the life settlement contract, the notice required under paragraph (b) of this subsection and a request for verification of coverage to the insurer that issued the life policy that is the subject of the life transaction. The Director of the Department of Consumer and Business Services shall develop and approve a form for the request for verification.

(d) The insurer shall respond to a request for verification of coverage submitted on an approved form by a life settlement provider or life settlement broker within 30 calendar days of the date the request is received and shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding the validity of the insurance contract or possible fraud. The insurer shall accept a request for verification of coverage made on a form approved by the director. The insurer shall accept an original or facsimile or electronic copy of such request and any accompanying authorization signed by the owner. Failure by the insurer to meet its obligations under this subsection is a violation of the Insurance Code.

(e) Prior to or at the time of execution of the life settlement contract, the life settlement provider shall obtain a witnessed document in which the owner consents to the life settlement contract, represents that the owner has a full and complete understanding of the life settlement contract, that the owner has a full and complete understanding of the benefits of the life insurance policy, acknowledges that the owner is entering into the life settlement contract freely and voluntarily and, for persons with a terminal illness or chronic illness or condition, acknowledges that the insured has a terminal illness or chronic illness and that the terminal illness or chronic illness or condition was diagnosed after the life insurance policy was issued.

(f) If a life settlement broker performs any of the activities required of the life settlement provider, the provider is deemed to have fulfilled the requirements of this section that were performed by the broker.

(2) All medical information solicited or obtained by any licensee is privileged and confidential under ORS 705.137 (Information that is confidential or not subject to disclosure) .

(3) Intentionally left blank —Ed.

(a) All life settlement contracts entered into in this state must provide the owner with an absolute right to rescind the contract before the earlier of 60 calendar days after the date upon which the life settlement contract is executed by all parties or 30 calendar days after the life settlement proceeds have been sent to the owner under subsection (5) of this section.

(b) The life settlement provider may condition rescission upon the owner both giving notice and repaying to the life settlement provider within the rescission period all proceeds of the settlement and any premiums, loans and loan interest paid by or on behalf of the life settlement provider in connection with or as a consequence of the life settlement.

(c) If the insured dies during the rescission period, the life settlement contract is deemed to have been rescinded, subject to repayment within 60 calendar days of the death of the insured to the life settlement provider or purchaser of all life settlement proceeds and any premiums, loans and loan interest that have been paid by the life settlement provider or purchaser.

(d) In the event of any rescission, if the life settlement provider has paid commissions or other compensation to a life settlement broker in connection with the rescinded transaction, the life settlement broker shall refund all such commissions and compensation to the life settlement provider within five business days following receipt of written demand from the life settlement provider. The demand must be accompanied by either the owner’s notice of rescission if rescinded at the election of the owner, or the notice of the death of the insured if rescinded by reason of the death of the insured within the applicable rescission period.

(4) The life settlement purchaser shall have the right to rescind a life settlement contract within three days after the disclosures mandated by ORS 744.354 (Disclosure by life settlement provider, broker or investment agent to policy owner) (7) are received by the purchaser.

(5) Intentionally left blank —Ed.

(a) The life settlement provider shall instruct the owner to send the executed documents required to effect the change in ownership, assignment or change in beneficiary directly to an independent escrow agent selected by the provider.

(b) Within three business days after the date the escrow agent receives the document, or from the date the life settlement provider receives the documents, if the owner erroneously provides the documents directly to the provider, the provider shall pay or transfer the proceeds of the life settlement into an escrow or trust account maintained in a state or federally chartered financial institution whose deposits are insured by the Federal Deposit Insurance Corporation.

(c) Upon payment of the settlement proceeds into the escrow account, the escrow agent shall deliver the original change in ownership, assignment or change in beneficiary forms to the life settlement provider or related provider trust or other designated representative of the life settlement provider. Upon the escrow agent’s receipt of the acknowledgment of the properly completed transfer of ownership, assignment or designation of beneficiary from the insurance company, the escrow agent shall pay the settlement proceeds to the owner.

(6) Failure to pay the owner the full contract amount for the life settlement contract within the time set forth under subsection (5) of this section renders the life settlement contract voidable by the owner until the time full payment is tendered to and accepted by the owner. Funds are deemed sent by a life settlement provider to an owner as of the date that the escrow agent either releases funds for wire transfer to the owner or places a check for delivery to the owner via the United States Postal Service or another nationally recognized delivery service.

(7) Intentionally left blank —Ed.

(a) Contacts with the insured for the purpose of determining the health status of the insured by the life settlement provider or life settlement broker after the life settlement has occurred may be made only by the life settlement provider or broker licensed in this state or its authorized representatives and are limited to once every three months for insureds with a life expectancy of more than one year, and to no more than once per month for insureds with a life expectancy of one year or less.

(b) The limitations set forth in this subsection do not apply to any contacts with an insured for reasons other than determining the insured’s health status. [2009 c.711 §13; 2014 c.45 §77; 2017 c.356 §98]

Source: Section 744.364 — Life settlement contract requirements , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 732.612 — OR Code / Title 56 / Chapter 732 / Section 732.612
732.612 Consideration for membership interest in converting or reorganizing mutual insurer
Status: in_force

(1) In the case of a conversion or in the case of a reorganization that involves the organization of a stock holding company, consideration for the membership interests of the eligible members of a converting mutual insurer consists of one or any combination of the following:

(a) Nontransferable subscription rights to purchase shares of capital stock of the issuer as described in subsection (2) of this section;

(b) Shares of capital stock of the issuer as described in subsection (3) of this section;

(c) Cash;

(d) Premium credits;

(e) In the case of a converting mutual insurer transacting primarily property or casualty insurance, or both, certificates of contribution that bear interest as established in the plan, that are repayable within 10 years or, if approved by the Director of the Department of Consumer and Business Services, within a longer period and that are repayable on terms set forth in the plan;

(f) In the case of individual policies of life insurance, credits to policy account values or other enhancements in policy benefits; and

(g) Any other form of consideration described in the plan and approved by the director.

(2) A plan may provide for allocating to eligible members, without payment, nontransferable subscription rights to purchase shares of capital stock of the issuer. In addition, the plan must:

(a) Allocate the subscription rights in whole shares among the eligible members. In the case of a converting mutual insurer transacting primarily life or health insurance, or both, the subscription rights must be allocated in accordance with subsection (6) of this section. In the case of a converting mutual insurer transacting primarily property or casualty insurance, or both, the subscription rights must be allocated in accordance with subsection (7) of this section.

(b) Specify the expiration date of the subscription rights or authorize the board of directors of the converting mutual insurer to establish the expiration date. An eligible member may exercise the subscription rights, in whole or in part, in the manner described in the plan including, but not limited to, paying the subscription exercise price for the shares purchased. The plan may require an eligible member who exercises subscription rights to purchase a minimum number of shares unless the director determines that a minimum purchase requirement is unreasonable based on the interests of the eligible members, the converted stock insurer and the issuer. The proposed subscription exercise price per share must be set forth in the plan and must be less than the price at which shares of capital stock of the issuer will be first offered in accordance with paragraph (e) of this subsection. The boards of directors of the converting mutual insurer and the issuer shall determine the proposed subscription exercise price per share and the director must approve the proposed price based on the interests of the eligible members, the policyholders, the converted stock insurer and the issuer.

(c) Provide that to the extent an eligible member does not exercise, in whole or in part, subscription rights allocated to the eligible member, the eligible member instead will receive one or more of the forms of consideration described in subsection (1) of this section that are specified in the plan.

(d) Set the pro forma market value of the converted stock insurer, which is the value that is estimated to be necessary to attract full subscription for all shares offered by the issuer. The pro forma market value of the converted stock insurer must be determined by an independent valuation by a qualified person. The price per share at which the shares of capital stock of the issuer are first offered in accordance with paragraph (e) of this subsection must be equal to such pro forma market value of the converted stock insurer divided by the number of shares that would be issued if all subscription rights allocated to the eligible members are exercised.

(e) Further provide that any shares of capital stock of the issuer for which subscription rights are allocated to the eligible members but that the eligible members do not purchase by exercising the members’ subscription rights must be sold in a public offering through an underwriter, unless the number of shares that the eligible members do not purchase is so small in number that the expense of a public offering is not warranted, in which case the plan may provide for the sale of the shares by private placement or through any other fair and equitable means approved by the director. If the director finds that market conditions or other circumstances may cause the interests of the eligible members to be adversely affected, the director may require the offering of shares to be postponed or the terms of the offering to be modified.

(3) A plan may provide for allocating to the eligible members, without payment, shares of capital stock of the issuer. The plan must allocate the shares of capital stock of the issuer in whole shares among the eligible members. In the case of a converting mutual insurer transacting primarily life or health insurance, or both, the shares must be allocated in accordance with subsection (6) of this section. In the case of a converting mutual insurer transacting primarily property or casualty insurance, or both, the shares must be allocated in accordance with subsection (7) of this section. If shares of capital stock of the issuer constitute the only consideration the eligible members will receive and the plan does not provide for selling additional shares of capital stock or other securities of the issuer, the plan does not need to include the valuation of the converting mutual insurer. If the plan provides for allocating to the eligible members, without payment, shares of capital stock of the issuer, the plan may establish a reasonable period within which the eligible members to whom such shares are issued may not dispose of such shares.

(4) If shares of capital stock of the issuer are issued in accordance with subsection (2) or (3) of this section, the issuer must use the issuer’s best efforts to encourage and assist in establishing a public market for the shares unless the director finds that a public market is not feasible or is not in the best interests of the eligible members, the converted stock insurer and the issuer. The director may provide that subscription rights or shares of capital stock of the issuer do not need to be allocated under subsection (2) or (3) of this section to eligible members who reside in a foreign country or other jurisdiction if a small number of eligible members reside in the foreign country or other jurisdiction and any registration, qualification, filing or other compliance matters under the laws of the foreign country or other jurisdiction with respect to the shares of capital stock of the issuer would be impracticable or unduly burdensome upon the issuer.

(5) Regardless of the form of consideration for the membership interests of the eligible members of a converting mutual insurer, the plan may provide for selling additional shares of capital stock or other securities of the issuer to persons other than the eligible members. The issuer shall offer such additional shares or other securities at a price and on terms determined by the boards of directors of the converting mutual insurer and the issuer.

(6) For a converting mutual insurer that transacts primarily life or health insurance, or both, the consideration specified in subsection (1) of this section must be allocated among the eligible members in accordance with a fair and equitable formula. The formula for allocating the consideration among the eligible members must either:

(a) Allocate a fixed component of consideration per capita among the eligible members and allocate a variable component of consideration among the eligible members in proportion to the cash value of policies the eligible members hold; or

(b) Allocate the consideration among the eligible members in any other manner approved by the director.

(7) For a converting mutual insurer transacting primarily property or casualty insurance, or both, the consideration specified in subsection (1) of this section must be allocated among the eligible members in accordance with a fair and equitable formula. The formula for allocating the consideration among the eligible members must either:

(a) Allocate the consideration among the eligible members in the proportion that the aggregate premiums the converting mutual insurer earns on the eligible member’s policies in force during a specified period before the record date described in ORS 732.611 (Eligible member of domestic mutual insurer or mutual holding company) (1) bear to the aggregate premiums that the converting mutual insurer earns during the same period on all eligible members’ policies in force. The specified period must be 36 months unless the plan specifies another period.

(b) Allocate the consideration among the eligible members in any other manner approved by the director.

(8) The form of consideration to be given to a class or category of eligible members may differ from the form of consideration to be given to another class or category of eligible members. The choice of the form of consideration to be given to a class or category of eligible members may take into account the type of policy, size of policy, tax status of the eligible members and other factors that the director determines are appropriate.

(9) In the case of a conversion or in the case of a reorganization that involves the organization of a stock holding company, a member of the converting mutual insurer who is not an eligible member is not entitled to receive any consideration for the member’s membership interest.

(10) In the case of a reorganization that involves the organization of a mutual holding company, the membership interests of the members of the converting mutual insurer, whether or not the members are eligible members, must be merged into the mutual holding company, and consequently the membership interests of the members of the converting mutual insurer must become membership interests in the mutual holding company. [1997 c.771 §6; 2013 c.370 §33]

Source: Section 732.612 — Consideration for membership interest in converting or reorganizing mutual insurer; kinds of consideration; allocation of consideration , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 744.082 — OR Code / Title 56 / Chapter 744 / Section 744.082
744.082 Waiver of requirement for nonresident insurance producer license applicant
Status: in_force

The Director of the Department of Consumer and Business Services shall waive any requirement for a nonresident insurance producer license applicant with a valid resident insurance producer license from the applicant’s home state, except the requirements imposed by ORS 744.063 (Nonresident insurance producer license) , if the applicant’s home state grants nonresident insurance producer licenses to residents of this state on the same basis. [2001 c.191 §18; 2003 c.364 §21]

Source: Section 744.082 — Waiver of requirement for nonresident insurance producer license applicant , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 731.396 — OR Code / Title 56 / Chapter 731 / Section 731.396
731.396 Certificate of authority and good financial condition required to issue variable life insurance or variable annuity policies
Status: in_force

No domestic, foreign or alien insurer shall deliver or issue for delivery in this state variable life insurance or variable annuity policies unless the insurer is authorized to transact life insurance in this state and the Director of the Department of Consumer and Business Services is satisfied that its condition and method of operation in connection with the issuance of such policies will not render its operation hazardous to its policyholders or the public in this state. In making the determination the director shall consider, among other things:

(1) The history and financial condition of the insurer;

(2) The character, responsibility and fitness of the officers and directors of the insurer; and

(3) The laws and rules under which the insurer is authorized by its domicile to issue such policies. [1973 c.435 §4]

Source: Section 731.396 — Certificate of authority and good financial condition required to issue variable life insurance or variable annuity policies , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 744.704 — OR Code / Title 56 / Chapter 744 / Section 744.704
744.704 Exemptions from license requirement
Status: in_force

(1) The following persons are exempt from the licensing requirement for third party administrators in ORS 744.702 (Third party administrator license) and from all other provisions of ORS 744.700 (Definitions for ORS 744.700 to 744.740) to 744.740 (Responsibility of insurer using third party administrator) applicable to third party administrators:

(a) A person licensed under ORS 744.521 (Powers of director to issue, renew, amend, suspend and reinstate licenses) to engage in business as an adjuster, whose activities are limited to adjustment of claims and whose activities do not include the activities of a third party administrator.

(b) A person licensed as an insurance producer as required by ORS 744.053 (Requirements to be licensed as insurance producer for class of insurance) and authorized to transact life or health insurance in this state, whose activities are limited exclusively to the sale of insurance and whose activities do not include the activities of a third party administrator.

(c) An employer acting as a third party administrator on behalf of:

(A) The employer’s employees;

(B) The employees of one or more subsidiary or affiliated corporations of the employer; or

(C) The employees of one or more persons with a dealership, franchise, distributorship or other similar arrangement with the employers.

(d) A union, or an affiliate thereof, acting as a third party administrator on behalf of the union’s or the affiliate’s members.

(e) An insurer that is authorized to transact insurance in this state with respect to a policy issued and delivered in and pursuant to the laws of this state or another state.

(f) A creditor acting on behalf of the creditor’s debtors with respect to insurance covering a debt between the creditor and the creditor’s debtors.

(g) A trust and the trustees, agents and employees of the trust, when acting pursuant to the trust, if the trust is established in conformity with 29 U.S.C. 186.

(h) A trust exempt from taxation under section 501(a) of the Internal Revenue Code, the trust’s trustees and employees acting pursuant to the trust, or a voluntary employees beneficiary association described in section 501(c) of the Internal Revenue Code, the association’s agents and employees and a custodian and the custodian’s agents and employees acting pursuant to a custodian account meeting the requirements of section 401(f) of the Internal Revenue Code.

(i) A financial institution that is subject to supervision or examination by federal or state financial institution regulatory authorities, or a mortgage lender, to the extent the financial institution or mortgage lender collects and remits premiums to licensed insurance producers or authorized insurers in connection with loan payments.

(j) A company that issues credit cards and advances for and collects premiums or charges from the company’s credit card holders who have authorized collection. The exemption under this paragraph applies only if the company does not adjust or settle claims.

(k) A person who adjusts or settles claims in the normal course of practice or employment as an attorney at law. The exemption under this subsection applies only if the person does not collect charges or premiums in connection with life insurance or health insurance coverage.

(L) A person who acts solely as an administrator of one or more bona fide employee benefit plans established by an employer or an employee organization, or both, for which the Insurance Code is preempted pursuant to the Employee Retirement Income Security Act of 1974. A person to whom this paragraph applies must comply with the requirements of ORS 744.714 (Registration of persons exempt from licensure) .

(m) An entity or association owned by or composed of like employers who administer partially or fully self-insured plans for employees of the employers or association members.

(n) A trust established by a cooperative body formed between cities, counties, districts or other political subdivisions of this state, or between any combination of such entities, and the trustees, agents and employees acting pursuant to the trust.

(o) Any person designated by the Director of the Department of Consumer and Business Services by rule.

(2) A third party administrator is not required to be licensed as a third party administrator in this state if the following conditions are met:

(a) The third party administrator has its principal place of business in another state;

(b) The third party administrator is not soliciting business as a third party administrator in this state; and

(c) In the case of any group policy or plan of insurance serviced by the third party administrator, the lesser of five percent or 100 certificate holders reside in this state. [1991 c.812 §4; 2001 c.191 §40; 2003 c.364 §128; 2013 c.698 §31; 2019 c.151 §36]

Source: Section 744.704 — Exemptions from license requirement; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 746.360 — OR Code / Title 56 / Chapter 746 / Section 746.360
746.360 Exceptions to application of unauthorized insurer service of process law
Status: in_force

ORS 746.320 (Service of process equivalent to personal service on unauthorized foreign or alien insurer) to 746.360 (Exceptions to application of unauthorized insurer service of process law) do not apply to an action against an unauthorized insurer arising out of any policy of:

(1) Reinsurance or wet marine and transportation insurance;

(2) Insurance effected in compliance with ORS 735.400 (Purposes of ORS 735.400 to 735.495) to 735.495 (Short title) ;

(3) Insurance against legal liability arising out of ownership, operation or maintenance of any property having a permanent situs outside the state; or

(4) Insurance against loss of or damage to any property having a permanent situs outside this state, where such policy contains a provision designating the Director of the Department of Consumer and Business Services or a bona fide resident of this state as the insurer’s lawful attorney upon whom all process may be served in any action begun by or on behalf of an insured or beneficiary and arising out of policies of insurance between the insurer and persons residing or authorized to do business in this state. [Formerly 736.260; 2005 c.185 §6]

Source: Section 746.360 — Exceptions to application of unauthorized insurer service of process law , https://www.­oregonlegislature.­gov/bills_laws/ors/ors746.­html (accessed May 26, 2025).
ORS § 733.220 — OR Code / Title 56 / Chapter 733 / Section 733.220
733.220 Establishment and regulation of separate accounts to fund life insurance or annuities
Status: in_force

(1) A domestic insurer authorized to transact life insurance may establish one or more separate accounts and may allocate thereto amounts, including but not limited to proceeds applied under optional modes of settlement or under dividend options, to provide for life insurance or annuities or benefits incidental thereto, payable in fixed or variable amounts or both.

(2) The income, gains and losses, realized or unrealized, from assets allocated to a separate account shall be credited to or charged against the account without regard to other income, gains and losses of the insurer.

(3) Except with the approval of the Director of the Department of Consumer and Business Services, and under the conditions the Director may prescribe as to investments and other matters that shall recognize the guaranteed nature of the benefits, assets representing reserves for benefits guaranteed as to dollar amount and duration, and for funds guaranteed as to principal amount or stated rate of interest, shall not be maintained in a separate account.

(4) Unless otherwise approved by the director, and notwithstanding ORS 733.160 (Valuation of assets other than securities) or 733.165 (Valuation of securities) , assets allocated to a separate account shall be valued at their market value on the date of valuation. If there is no readily available market, they shall be valued as provided under the terms of the policy, the rules or other written agreement applicable to the separate account. Except as may be otherwise prescribed by the director under subsection (3) of this section, however, the portion if any of the assets of a separate account equal to the insurer’s reserves for guaranteed benefits and funds shall be valued in accordance with the rules applicable to the insurer’s general assets.

(5) Amounts allocated to a separate account in the exercise of the power granted by this section are owned by the insurer, and the insurer is not, nor shall it hold itself out to be, a trustee with respect to such amounts. If, and to the extent, it is so provided under the applicable policies, the portion of the assets of a separate account which equals the reserves and other policy liabilities for such account shall not be chargeable with liabilities arising out of any other business the insurer conducts.

(6) No sale, exchange or other transfer of assets may be made by an insurer between any of its separate accounts or between any other investment account and one or more of its separate accounts unless:

(a) In the case of a transfer into a separate account, the transfer is made solely to establish the account or to support the operation of the policies applicable to the account;

(b) In the case of other transfers, the director has approved the transfer as being equitable; and

(c) The transfer is made in the form of cash or, with the approval of the director, securities having a readily determinable market value.

(7) The same separate account may not be used for both variable annuities and variable life insurance.

(8) The insurer shall maintain in each separate account assets with a value at least equal to the reserves and other policy liabilities for such account. [1973 c.435 §6; 1993 c.447 §112]

Source: Section 733.220 — Establishment and regulation of separate accounts to fund life insurance or annuities , https://www.­oregonlegislature.­gov/bills_laws/ors/ors733.­html (accessed May 26, 2025).
ORS § 743.010 — OR Code / Title 56 / Chapter 743 / Section 743.010
743.010 Health insurance policy and health benefit plan forms
Status: in_force

(1) In addition to all other powers of the Director of the Department of Consumer and Business Services with respect thereto, the director may issue rules with respect to policy forms and health benefit plan forms described in ORS 742.005 (Grounds for disapproval of policy forms) (6)(a) and (b):

(a) Establishing minimum benefit standards;

(b) Requiring the ratio of benefits to premiums to be not less than a specified percentage in order to be considered reasonable, and requiring the periodic filing of data that will demonstrate the insurer’s compliance;

(c) Establishing requirements intended to discourage duplication or overlapping of coverage and replacement, without regard to the advantage to policyholders, of existing policies by new policies; and

(d) Establishing requirements for carriers offering health benefit plans to spend at least 12 percent of total medical expenditures on payments for primary care.

(2) As used in this section:

(a) “Primary care” means family medicine, general internal medicine, naturopathic medicine, obstetrics and gynecology, pediatrics or general psychiatry.

(b) “Total medical expenditures” means payments to reimburse the cost of physical and mental health care provided to enrollees, excluding prescription drugs, vision care and dental care, whether paid on a fee-for-service basis or as part of a capitated rate or other type of payment mechanism. [1979 c.857 §2; 1997 c.96 §1; 1999 c.987 §4a; 2017 c.489 §§5,15]

Source: Section 743.010 — Health insurance policy and health benefit plan forms; expenditures on primary care; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 733.095 — OR Code / Title 56 / Chapter 733 / Section 733.095
733.095 Unearned premium reserve for home protection insurance
Status: in_force

A home protection insurer shall maintain a reserve for unearned premiums, unpaid losses and claims incurred whether reported or unreported to the insurer and the expenses of adjustment or settlement of such losses and claims, in an aggregate amount of not less than 40 percent of the aggregate of premiums charged on the insurer’s policies currently in force. [1981 c.247 §11]

Source: Section 733.095 — Unearned premium reserve for home protection insurance , https://www.­oregonlegislature.­gov/bills_laws/ors/ors733.­html (accessed May 26, 2025).
ORS § 746.687 — OR Code / Title 56 / Chapter 746 / Section 746.687
746.687 Cancellation of homeowner insurance policy
Status: in_force

(1) Except as provided in subsection (6) of this section, an insurer may cancel a homeowner insurance policy before the expiration of the policy only for one or more of the following reasons:

(a) Nonpayment of premium;

(b) Fraud or material misrepresentation affecting the policy or in the presentation of a claim under the policy;

(c) Violation of any of the terms and conditions of the policy;

(d) Substantial increase in the risk of loss after insurance coverage has been issued or renewed, including but not limited to an increase in exposure due to rules, legislation or court decision; or

(e) Determination by the Director of the Department of Consumer and Business Services that the continuation of a line of insurance or class of business to which the policy belongs will jeopardize an insurer’s solvency or place the insurer in violation of the insurance laws of Oregon or any other state, whether because of a loss or decrease in reinsurance covering the risk or other reason determined by the director.

(2) The insurer shall give the policyholder written notice of the cancellation, including the effective date of the cancellation and the reasons for the cancellation.

(3) The insurer must mail or deliver a notice of cancellation to the policyholder at the address shown in the policy:

(a) At least 10 days prior to the effective date of cancellation, if the cancellation is for the reason described in subsection (1)(a) or (b) of this section.

(b) At least 30 days prior to the effective date of cancellation, if the cancellation is for the reason described in subsection (1)(c), (d) or (e) of this section.

(4) An insurer shall mail or deliver to a policyholder, at the address shown in the policy, a notice of renewal or nonrenewal of a homeowner insurance policy at least 30 days prior to the expiration of the policy period. This subsection does not apply when the policy is in lapse status under the terms of the policy.

(5) Proof of mailing notice of cancellation or nonrenewal to the policyholder at the address shown in the policy is sufficient proof of notice under this section.

(6) This section does not apply to a homeowner insurance policy that has been in effect fewer than 60 days at the time the notice of cancellation is mailed or delivered by the insurer unless it is a renewal policy. An insurer may not use the fact that a claim was filed on the policy within the 60-day period as a basis for canceling the policy within the 60-day period, for increasing the premium rate or for altering the terms of the policy during the current policy term. An insurer may, within the 60-day period, use any other information consistent with the insurer’s rating or underwriting program, including but not limited to, conditions or uses of the property discovered by the insurer, as a basis for cancellation or for offering to continue coverage at an increased rate or on different terms. At renewal of the policy, the insurer may treat a claim that occurred within the 60-day period the same as any other claim occurring during the policy period for the purposes of rating, nonrenewing and altering the terms of the policy. [2005 c.489 §5]

Source: Section 746.687 — Cancellation of homeowner insurance policy , https://www.­oregonlegislature.­gov/bills_laws/ors/ors746.­html (accessed May 26, 2025).
ORS § 731.098 — OR Code / Title 56 / Chapter 731 / Section 731.098
731.098 “Group health insurance.”
Status: in_force

“Group health insurance” means that form of health insurance covering groups of persons described in this section, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or more dependents of such groups of persons, and issued upon one of the following bases:

(1) Under a policy issued to an employer or trustees of a fund established by an employer, who shall be deemed the policyholder, insuring employees of such employer for the benefit of persons other than the employer. As used in this subsection, “employees” includes:

(a) The officers, managers and employees of the employer;

(b) The individual proprietor or partners if the employer is an individual proprietor or partnership;

(c) The officers, managers and employees of subsidiary or affiliated corporations;

(d) The individual proprietors, partners and employees of individuals and firms, if the business of the employer and such individual or firm is under common control through stock ownership, contract or otherwise;

(e) The trustees or their employees, or both, if their duties are principally connected with such trusteeship;

(f) The leased workers of a client employer; and

(g) Elected or appointed officials if a policy issued to insure employees of a public body provides that the term “employees” includes elected or appointed officials.

(2) Under a policy issued to an association, including a labor union, that has an active existence for at least one year, that has a constitution and bylaws and that has been organized and is maintained in good faith primarily for purposes other than that of obtaining insurance, which shall be deemed the policyholder, insuring members, employees or employees of members of the association for the benefit of persons other than the association or its officers or trustees.

(3) Under a policy issued to the trustees of a fund established by two or more employers in the same or related industry or by one or more labor unions or by one or more employers and one or more labor unions or by an association as described in subsection (2) of this section, insuring employees of the employers or members of the unions or of such association, or employees of members of such association for the benefit of persons other than the employers or the unions or such association. As used in this subsection, “employees” may include the officers, managers and employees of the employer, and the individual proprietor or partners if the employer is an individual proprietor or partnership. The policy may provide that the term “employees” includes the trustees or their employees, or both, if their duties are principally connected with such trusteeship.

(4) Under a policy issued to any person or organization to which a policy of group life insurance may be issued or delivered in this state, to insure any class or classes of individuals that could be insured under such group life policy. [2013 c.681 §7]

Note: See note under 731.097 (“Essential health benefits.”) .

Source: Section 731.098 — “Group health insurance.” , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 734.810 — OR Code / Title 56 / Chapter 734 / Section 734.810
734.810 Duties and powers of association
Status: in_force

(1) If a member insurer is an impaired insurer, the Oregon Life and Health Insurance Guaranty Association, in its discretion and subject to any conditions imposed by the association and approved by the Director of the Department of Consumer and Business Services, other than those that impair the contractual obligations of the impaired insurer, may:

(a) Guarantee, assume or reinsure, or cause to be guaranteed, assumed or reinsured, any or all of the covered policies of the impaired insurer.

(b) Provide such moneys, pledges, notes, loans, guarantees or other means as are proper to implement paragraph (a) of this subsection and ensure payment of the contractual obligations of the impaired insurer pending action under paragraph (a) of this subsection.

(2) If a member insurer is an insolvent insurer, the association, in its discretion and subject to the approval of the director, shall take either of the following steps:

(a) Intentionally left blank —Ed.

(A) Guarantee, assume or reinsure, or cause to be guaranteed, assumed or reinsured, the covered policies of the insolvent insurer;

(B) Ensure payment of the contractual obligations of the insolvent insurer; and

(C) Provide such moneys, pledges, notes, loans, guarantees or other means as are reasonably necessary to discharge such duties.

(b) Provide benefits and coverages in accordance with the following provisions:

(A) For life and health insurance policies and annuity contracts, the association shall ensure that the payment of benefits for premiums, except for terms of conversion and renewability, under the replacement coverage provided by the association is identical to the payment of benefits for premiums that would have been payable under the policies or contracts of the insolvent insurer, for claims incurred:

(i) With respect to group policies and contracts, not later than the earlier of the next renewal date under those policies or contracts or 45 days, but in no event less than 30 days, after the date on which the association becomes obligated with respect to the policies or contracts.

(ii) With respect to nongroup policies and contracts, if any, not later than the earlier of the next renewal date under those policies or contracts or one year, but in no event less than 30 days, after the date on which the association becomes obligated with respect to the policies or contracts.

(B) The association shall make diligent efforts to provide a 30-day notice of the termination of the benefits provided under subparagraph (A) of this paragraph to all known insureds or annuitants for nongroup policies and contracts, or to group policyholders or contract owners with respect to group policies and contracts.

(C) For nongroup life and health insurance policies and annuities covered by the association, the association shall make substitute coverage available to each known insured or annuitant, or owner if other than the insured or annuitant. For an individual formerly insured or formerly an annuitant under a group policy who is not eligible for replacement group coverage, the association shall make available substitute coverage on an individual basis in accordance with the provisions of subparagraph (D) of this paragraph, if the insureds or annuitants had a right under law or under the terminated policy or annuity to convert coverage to individual coverage or to continue an individual policy or annuity that was already in force until a specified age or for a specified time, during which the insurer had no right to make changes unilaterally in any provision of the policy or annuity or had a right to make changes only to premiums or to classes of risk.

(D) In providing the substitute coverage required under subparagraph (C) of this paragraph, the association:

(i) May offer either to reissue the terminated coverage or to issue an alternative policy.

(ii) Shall offer alternative or reissued policies without requiring evidence of insurability.

(iii) May not impose any waiting period or exclusion that would not have applied under the terminated policy.

(iv) May reinsure any alternative or reissued policy.

(E) Any alternative policy adopted by the association must:

(i) Be approved by the Director of the Department of Consumer and Business Services and the court. The association may adopt alternative policies of various types for future issuance without regard to any particular impairment or insolvency.

(ii) Contain at least the minimum statutory provisions required in this state and provide benefits that are not unreasonable in relation to the premium charged. The association shall set the premium in accordance with a table of rates adopted by the association. The premium shall reflect the amount of insurance to be provided and the age and class of risk of each insured, but may not reflect any changes in the health of the insured after the original policy was last underwritten.

(iii) Provide coverage of a type similar to that of the policy issued by the insolvent insurer, as determined by the association.

(F) If the association elects to reissue terminated coverage at a premium rate that is different from the premium rate that was charged under the terminated policy, the premium rate shall be set by the association, in accordance with the amount of insurance provided and the age and class of risk, and be subject to approval by the Director of the Department of Consumer and Business Services and the court.

(G) The association’s obligations with respect to coverage under any policy of the insolvent insurer or under any reissued or alternative policy shall cease on the date on which the coverage or policy is replaced by another similar policy by the policyholder, the insured or the association.

(H) When proceeding under this subsection with respect to a policy or contract that carries a guaranteed minimum interest rate, the association shall ensure the payment or crediting of a rate of interest consistent with the provisions of ORS 734.790 (Application) (3).

(3) Nonpayment of premiums within 31 days after the date required under the terms of any guaranteed, assumed, alternative or reissued policy or contract or substitute coverage shall terminate the association’s obligations under the policy, contract or substitute coverage under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) with respect to the policy, contract or substitute coverage, except with respect to any claims incurred or any net cash surrender value or net cash withdrawal value that may be due in accordance with the provisions of ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) .

(4) Premiums due for coverage after entry of an order of liquidation of an insolvent insurer shall belong to and be payable at the direction of the association. At the request of the liquidator of an insolvent insurer, the association shall provide a report to the liquidator regarding any premium collected by the association. The association is liable for unearned premiums due to policyholders or contract owners arising after the entry of the order.

(5) The protection provided by ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) does not apply where any guaranty protection is provided to residents of this state by the laws of the domiciliary state or jurisdiction of the impaired or insolvent insurer other than this state.

(6) Intentionally left blank —Ed.

(a) In carrying out its duties under subsection (2) of this section, the association may impose permanent policy liens or contract liens in connection with any guaranteed, assumption or reinsurance agreement, if the court considering the lien finds that the amounts that can be assessed under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) are less than the amounts needed to ensure full and prompt performance of the insolvent insurer’s contractual obligations or that the economic or financial conditions affecting member insurers are sufficiently adverse to render the imposition of policy or contract liens to be in the public interest, and approves the specific policy liens or contract liens to be used.

(b) In carrying out its duties under subsection (2) of this section, the association may request that there be imposed temporary moratoriums or liens on payments of cash values and policy loans or temporary moratoriums on the right to withdraw funds held in conjunction with the policies or contracts, in addition to any contractual provisions for deferral of cash or policy loan values, and such temporary moratoriums and liens may be imposed if they are approved by the court. In addition, in the event of a temporary moratorium or moratorium charge imposed by the court on payment of cash values or policy loan values, or on any other right to withdraw funds held in conjunction with policies or contracts, out of the assets of the impaired or insolvent insurer, the association may defer the payment of cash values, policy loan values and other rights by the association for the period of the temporary moratorium or moratorium charge that is imposed by the court, except for claims that are covered by the association to be paid in accordance with a hardship procedure that is established by the liquidator or rehabilitator and approved by the court.

(7) If the association fails to act as required in subsection (2) of this section within a reasonable time, the director shall have the powers and duties of the association under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) with respect to insolvent insurers.

(8) The association may render assistance and advice to the director, upon request of the director, concerning rehabilitation, payment of claims, continuance of coverage or the performance of other contractual obligations of any impaired or insolvent insurer.

(9) The association shall have standing to intervene or appear before any court or agency in this state having jurisdiction over an impaired or insolvent insurer concerning which the association is or may become obligated under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) or with jurisdiction over any person or property against which the association has rights through subrogation or otherwise. Such standing shall extend to all matters germane to the powers and duties of the association including, but not limited to, proposals for reinsuring, modifying or guaranteeing the covered policies of the impaired or insolvent insurer and the determination of the covered policies and contractual obligations. The association may also appear or intervene before a court or agency in another state with jurisdiction over an impaired or insolvent insurer for which the association is or may become obligated or with jurisdiction over any person or property against whom the association may have rights through subrogation or otherwise.

(10) Intentionally left blank —Ed.

(a) Any person receiving benefits under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) shall be considered to have assigned the rights under, and any causes of action against any person for losses arising under, resulting from or otherwise relating to, the covered policy to the association to the extent of the benefits received because of ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) , whether the benefits are payments of or on account of contractual obligations or continuation of coverage. The association may require an assignment to the association of such rights by any payee, policyholder, contract owner, beneficiary, insured or annuitant as a condition precedent to the receipt of any rights or benefits conferred by ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) upon such person. The association shall be subrogated to these rights against the assets of any impaired or insolvent insurer.

(b) The subrogation rights of the association under this subsection shall have the same priority against the assets of the impaired or insolvent insurer as that possessed by the person entitled to receive benefits under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) .

(c) In addition to the rights set forth in paragraphs (a) and (b) of this subsection, the association may exercise any common law rights of subrogation or any other equitable or legal remedy that would have been available to the impaired or insolvent insurer or to the policyholder or contract owner, beneficiary or payee of a policy or contract with respect to the policy or contract. In the case of a structured settlement annuity, these rights include but are not limited to any rights of the policyholder or contract owner, beneficiary or payee of the annuity, to the extent of benefits received under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) , against a person originally or by succession responsible for the losses arising from the personal injury relating to the annuity or payment therefor, with the exception of a person responsible solely by reason of serving as an assignee in respect of a qualified assignment under section 130 of the federal Internal Revenue Code.

(d) If the provisions of this subsection are determined by a court to be invalid or ineffective with respect to any person or claim for any reason, the association shall reduce the amount payable by the association with respect to the related covered obligations by the amount realized by any other person with respect to the person or claim that is attributable to the policies or contracts covered by the association.

(e) If the association provides benefits with respect to a covered obligation and a person recovers amounts to which the association has rights as described in this subsection, the person shall pay to the association the portion of the recovery attributable to the policies or contracts covered by the association.

(11) The contractual obligations of the impaired or insolvent insurer for which the association becomes or may become liable may not exceed the least of:

(a) The contractual obligations for which the impaired or insolvent insurer is liable or would have been liable if it were not an impaired or insolvent insurer, unless such obligations are reduced as permitted by subsection (6) of this section;

(b) With respect to any one life, regardless of the number of policies or contracts:

(A) $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance.

(B) $100,000 in health insurance benefits other than basic hospital, medical and surgical insurance, major medical insurance, disability insurance or long term care insurance, including any net cash surrender and net cash withdrawal values.

(C) $300,000 in disability insurance benefits.

(D) $300,000 in long term care insurance benefits.

(E) $500,000 in basic hospital, medical and surgical insurance or major medical insurance.

(F) $250,000 in the present value of annuity benefits, including any net cash surrender and net cash withdrawal values;

(c) With respect to each payee of a structured settlement annuity or the beneficiary of the payee if deceased, $250,000 in the present value of annuity benefits, in the aggregate, including any net cash surrender and net cash withdrawal values; or

(d) $250,000 in the present value of annuity benefits, in the aggregate, including any net cash surrender and net cash withdrawal values, with respect to each individual participating in a governmental retirement plan established under section 401, 403(b) or 457 of the United States Internal Revenue Code covered by an unallocated annuity contract or the beneficiaries of each such individual if deceased.

(12) The association may not be liable for more than:

(a) $300,000 in benefits, in the aggregate, with respect to any one life under subsection (11)(b), (c) and (d) of this section, with the exception of benefits under subsection (11)(b)(E) of this section, in which case the aggregate liability of the association may not exceed $500,000 with respect to any one life.

(b) With respect to one policyholder of multiple nongroup policies of life insurance, regardless of whether the policyholder is an individual, firm, corporation or other person, and whether the persons insured are officers, managers, employees or other persons, $5 million in benefits, regardless of the number of policies and contracts held by the policyholder.

(13) The limitations set forth in subsections (11) and (12) of this section are limitations on the benefits for which the association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the association’s obligations under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) may be met by the use of assets attributable to covered policies or reimbursed to the association under its subrogation and assignment rights.

(14) In performing its obligations to provide coverage under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) , the association is not required to guarantee, assume, reinsure or perform, or cause to be guaranteed, assumed, reinsured or performed, any contractual obligation of the impaired or insolvent insurer or contract owner under a covered policy that does not materially affect the economic values or economic benefits of the covered policy or contract.

(15) The association may:

(a) Enter into such contracts as are necessary or proper to carry out the provisions and purposes of ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) .

(b) Sue or be sued, including taking any legal actions necessary or proper for recovery of any unpaid assessments under ORS 734.815 (Assessment of members) and to settle claims or potential claims against the association.

(c) Borrow money to effect the purposes of ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) . Any notes or other evidence of indebtedness of the association not in default shall be legal investments for member insurers and may be carried as admitted assets.

(d) Employ or retain such persons as are necessary to handle the financial transactions of the association, and to perform such other functions as become necessary or proper under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) .

(e) Negotiate and contract with any liquidator, rehabilitator, conservator or ancillary receiver to carry out the powers and duties of the association.

(f) Take such legal action as may be necessary to avoid payment of improper claims.

(g) Exercise, for the purposes of ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) and to the extent approved by the director, the powers of a member life or health insurer, but in no case may the association issue policies other than those issued to perform the contractual obligations of the impaired or insolvent insurer.

(h) Organize itself as a corporation or other legal form permitted by the laws of this state.

(i) Request information from a person seeking coverage from the association to aid the association in determining its obligations under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) with respect to that person.

(j) Take any other necessary or appropriate action to discharge its duties and obligations and to exercise its powers under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) .

(16) The duties and powers of the association described in this section are in addition to any other duties and powers of the association described in ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) .

(17) Intentionally left blank —Ed.

(a) Within 180 days after the date of the order of liquidation, the association may succeed to the rights and obligations of the ceding member insurer that relate to policies or annuities covered, in whole or in part, by the association, in each case under any one or more reinsurance contracts entered into by the insolvent insurer and its reinsurers and selected by the association. Any such assumption shall be effective as of the date of the order of liquidation. The election shall be effected by the association sending written notice, return receipt requested, to the affected reinsurers.

(b) To facilitate the earliest practicable decision about whether to assume any of the contracts of reinsurance, and in order to protect the financial position of the estate, the receiver and each reinsurer of the ceding member insurer shall make available upon request to the association as soon as possible after commencement of formal delinquency proceedings copies of in-force contracts of reinsurance and all related files and records relevant to the determination of whether such contracts should be assumed, and notices of any defaults under the reinsurance contracts or any known event or condition which with the passage of time could become a default under the reinsurance contracts.

(c) For any reinsurance contracts assumed by the association under paragraphs (a) and (b) of this subsection:

(A) The association is responsible for all unpaid premiums due under the reinsurance contracts for periods both before and after the date of the order of liquidation, and shall be responsible for the performance of all other obligations to be performed after the date of the order of liquidation, related to policies or annuities covered by the reinsurance contract, in whole or in part, by the association. The association may charge policies or annuities covered in part by the association, through reasonable allocation methods, the costs for reinsurance in excess of the obligations of the association and shall provide notice and an accounting of those charges to the liquidator.

(B) The association is entitled to any amounts payable by the reinsurer under the reinsurance contracts with respect to losses or events that occur in periods after the date of the order of liquidation and that relate to policies or annuities covered, in whole or in part, by the association. Upon receipt of any such amounts, the association shall pay the beneficiary under the policy or annuity on account of which the amounts were paid a portion of the amount equal to the lesser of:

(i) The amount received by the association; or

(ii) The amount received by the association that is in excess of the amount equal to the benefits paid by the association on account of the policy or annuity minus the amount retained by the insurer applicable to the loss or event.

(C) Within 30 days following the association’s election, the association and each reinsurer shall calculate the net balance due to or from the association under each reinsurance contract as of the election date with respect to policies or annuities covered, in whole or in part, by the association. The calculation shall give full credit to all items paid by the insurer or its receiver or by the reinsurer prior to the election date. The reinsurer shall pay the receiver any amounts due for losses or events prior to the date of the order of liquidation, subject to any setoff for premiums unpaid for periods prior to that date, and the association or the reinsurer shall pay any remaining balance due to one another. The reinsurer and the association shall make such payments within five days after the completion of the calculation of the net balance due under each reinsurance contract. Any disputes over the amounts due to the association or the reinsurer shall be resolved by arbitration according to the terms of the affected reinsurance contracts or, if the contract contains no arbitration clause, as otherwise provided by law. If the receiver has received any amounts due the association under subparagraph (B) of this paragraph, the receiver shall remit the amounts to the association as promptly as practicable.

(d) If the association, or the receiver on the association’s behalf, within 60 days after the election date pays the unpaid premiums due for periods both before and after the election date that relate to policies or annuities covered, in whole or in part, by the association, the reinsurer may not terminate the reinsurance contracts for failure to pay premiums insofar as the reinsurance contracts relate to policies or annuities covered, in whole or in part, by the association, and may not set off any unpaid amounts due under other contracts, or unpaid amounts due from parties other than the association, against amounts due to the association.

(e) Intentionally left blank —Ed.

(A) During the period from the date of the order of liquidation until the election date or, if the election date does not occur, 180 days after the date of the order of liquidation:

(i) Neither the association nor the reinsurer shall have any rights or obligations under reinsurance contracts that the association has the right to assume under paragraph (a) of this subsection, whether for periods prior to or after the date of the order of liquidation; and

(ii) The reinsurer, the receiver and the association shall, to the extent practicable, provide to each other data and records that are reasonably requested.

(B) After the association has elected to assume a reinsurance contract, the parties’ rights and obligations shall be governed by paragraph (a) of this subsection.

(f) If the association does not elect to assume a reinsurance contract by the election date under paragraph (a) of this subsection, the association shall have no rights or obligations, for periods both before and after the date of the order of liquidation, with respect to the reinsurance contract.

(g) When policies or annuities, or covered obligations related to policies or annuities, are transferred to an assuming insurer, the association may also transfer reinsurance on the policies or annuities for contracts assumed under paragraph (a) of this subsection, subject to the following:

(A) Unless the reinsurer and the assuming insurer agree otherwise, the reinsurance contract transferred may not cover any new policies of insurance or annuities in addition to those transferred;

(B) The obligations described in paragraph (a) of this subsection shall no longer apply with respect to matters arising after the effective date of the transfer; and

(C) The transferring party shall give notice in writing, return receipt requested, to the affected reinsurer not less than 30 days before the effective date of the transfer.

(h) The provisions of this subsection shall supersede any other provision of law or any affected reinsurance contract that provides for or requires any payment of reinsurance proceeds, on account of losses or events that occur in periods after the date of the order of liquidation, to the receiver or any other person. The receiver shall remain entitled to any amounts payable by the reinsurer under the reinsurance contract with respect to losses or events that occur in periods prior to the date of the order of liquidation, subject to applicable setoff provisions.

(i) Except as otherwise provided in this subsection, nothing in this section shall:

(A) Alter or modify the terms and conditions of any reinsurance contract;

(B) Abrogate or limit any rights of any reinsurer to claim that the reinsurer is entitled to rescind a reinsurance contract;

(C) Grant a policyholder, contract owner or beneficiary an independent cause of action against a reinsurer that is not otherwise set forth in the reinsurance contract;

(D) Limit or affect the association’s rights as a creditor of the estate against the assets of the estate; or

(E) Apply to reinsurance agreements covering property or casualty risks.

(18) The board of directors of the association may exercise reasonable business judgment to determine the means by which the association is to provide the benefits under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) in an economical and efficient manner.

(19) If the association has arranged or offered to provide the benefits of ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) to a covered person under a plan or arrangement that fulfills the association’s obligations under this section, the person is not entitled to benefits from the association in addition to or other than those provided under the plan or arrangement.

(20) Venue in a suit against the association arising under ORS 734.750 (Short title) to 734.890 (Association not to be used in sales or solicitation) shall be in the Circuit Court for Marion County.

(21) In carrying out its duties in connection with guaranteeing, assuming or reinsuring policies or contracts under this section, the association may, subject to approval of the court, issue substitute coverage for a policy or contract that provides an interest rate, crediting rate or similar factor determined by use of an index or other external reference stated in the policy or contract for the purpose of calculating returns or changes in value by issuing an alternative policy or contract in accordance with all of the following provisions:

(a) In lieu of the index or other external reference provided for in the original policy or contract, the alternative policy or contract provides for a fixed interest rate, payment of dividends with minimum guarantees, or a different method for calculating interest or changes in value.

(b) There is no requirement for evidence of insurability, waiting period or other exclusion that would not have applied under the original policy or contract.

(c) The alternative policy or contract is substantially similar to the original policy or contract in all other material terms. [1975 c.251 §9; 1991 c.811 §4; 2010 c.26 §1; 2011 c.142 §5; 2019 c.13 §67]

Source: Section 734.810 — Duties and powers of association; termination of obligations; limit of obligations , https://www.­oregonlegislature.­gov/bills_laws/ors/ors734.­html (accessed May 26, 2025).
ORS § 733.750 — OR Code / Title 56 / Chapter 733 / Section 733.750
733.750 Disposal of investments on order of director
Status: in_force

After a hearing, the Director of the Department of Consumer and Business Services may by written order require the disposal of an investment which the director finds to be made or retained in violation of the Insurance Code, or of an investment which the director, for good cause, determines to be prejudicial to, and to impair the security of, the stockholders or policyholders of the insurer. [Formerly 738.355]

Source: Section 733.750 — Disposal of investments on order of director , https://www.­oregonlegislature.­gov/bills_laws/ors/ors733.­html (accessed May 26, 2025).
ORS § 742.510 — OR Code / Title 56 / Chapter 742 / Section 742.510
742.510 Property damage coverage for damage to vehicle caused by uninsured vehicle
Status: in_force

(1) Every insurer issuing motor vehicle liability insurance policies on private passenger motor vehicles or on self-propelled mobile homes for delivery in this state shall have for sale coverage for property damage to a vehicle of the insured caused by an uninsured vehicle. Coverage offered under this section shall be at least the amount prescribed to meet the requirements of ORS 806.070 (Minimum payment schedule) for insurance for injury to or destruction of the property of others in any one accident.

(2) A policy with the coverage described in this section does not cover the first $300 of property damage to the covered motor vehicle as the result of an accident with a hit-and-run vehicle or phantom vehicle. In all other cases the first $200 damage is not covered.

(3) Coverage for property damage described in this section:

(a) Applies only to the amount of damages the insured may be legally entitled to recover.

(b) Does not include coverage for loss of use of the covered vehicle. [Formerly 743.797; 1991 c.768 §5]

Note: See note under 742.508 (Definitions for ORS 742.508 and 742.510) .

Source: Section 742.510 — Property damage coverage for damage to vehicle caused by uninsured vehicle , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 732.425 — OR Code / Title 56 / Chapter 732 / Section 732.425
732.425 Application of insider trading regulation
Status: in_force

The provisions of ORS 732.430 (Filing statement of security ownership with director) , 732.435 (Suit to recover insider profits) and 732.440 (Prohibited sales of securities) do not apply to equity securities of a domestic stock insurer if:

(1) Such securities are registered, or are required to be registered, pursuant to section 12 of the Securities Exchange Act of 1934, as amended; or

(2) Such insurer does not have any class of its equity securities held of record by 100 or more persons on the last business day of the year next preceding the year in which equity securities of the insurer would be subject to the provisions of ORS 732.430 (Filing statement of security ownership with director) , 732.435 (Suit to recover insider profits) and 732.440 (Prohibited sales of securities) except for the provisions of this subsection. [Formerly 738.720]

Source: Section 732.425 — Application of insider trading regulation , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 741.220 — OR Code / Title 56 / Chapter 741 / Section 741.220
741.220 Financial and performance audits of health insurance exchange accounts
Status: in_force

(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 revenues and expenditures in carrying out ORS 741.001 (Health insurance exchange) to 741.540 (Complaints and investigations confidential) . The audit shall include but is not limited to:

(a) A review of the sources and uses of the moneys in the Health Insurance Exchange Fund;

(b) A review of charges and fees imposed and collected pursuant to ORS 741.105 (Charges and fees to be paid by insurers and state programs) ; and

(c) A review of premiums collected and remitted.

(3) Every two years, the Secretary of State shall conduct a performance audit of the exchange.

(4) The Director of the Oregon Health Authority and employees of the authority responsible for administering the health insurance exchange shall cooperate with the Secretary of State in the audits and reviews conducted under subsections (2) and (3) of this section.

(5) The audits shall be conducted using generally accepted accounting principles and any financial integrity requirements of federal authorities.

(6) The cost of the audits required by subsections (2) and (3) of this section shall be paid by the authority.

(7) The Secretary of State shall issue a report to the Governor, the President of the Senate, the Speaker of the House of Representatives, the Oregon Health Authority, the Oregon Health Policy Board and appropriate federal authorities on the results of each audit conducted pursuant to this section, including any recommendations for corrective actions. The report shall be available for public inspection, in accordance with the Secretary of State’s established rules and procedures governing public disclosure of audit documents.

(8) To the extent the audit requirements under this section are similar to any audit requirements imposed on the authority by federal authorities, the Secretary of State and the authority shall make reasonable efforts to coordinate with the federal authorities to promote efficiency and the best use of resources in the timing and provision of information.

(9) Not later than the 90th day after the Secretary of State completes and delivers an audit report issued under subsection (7) of this section, the director shall notify the Secretary of State in writing of the corrective actions taken or to be taken, if any, in response to any recommendations in the report. The Secretary of State may extend the 90-day period for good cause. [2011 c.415 §21; 2012 c.38 §6; 2012 c.107 §93; 2015 c.3 §20; 2021 c.569 §25]

Source: Section 741.220 — Financial and performance audits of health insurance exchange accounts; report of audit , https://www.­oregonlegislature.­gov/bills_laws/ors/ors741.­html (accessed May 26, 2025).
ORS § 737.526 — OR Code / Title 56 / Chapter 737 / Section 737.526
737.526 Interchange of data
Status: in_force

(1) Reasonable rules and plans may be promulgated by the Director of the Department of Consumer and Business Services for the interchange of data necessary for the application of rating plans.

(2) In order to further uniform administration of rate regulatory laws, the director and every insurer and rating organization may exchange information and experience data with insurance supervisory officials, insurers and rating organizations in other states and may consult and cooperate with them with respect to rate making and the application of rating systems. [1967 c.359 §331]

Source: Section 737.526 — Interchange of data; rules; promoting uniformity of rating laws , https://www.­oregonlegislature.­gov/bills_laws/ors/ors737.­html (accessed May 26, 2025).
ORS § 732.814 — OR Code / Title 56 / Chapter 732 / Section 732.814
732.814 Authority of director over controlling producer and controlled insurer
Status: in_force

(1) If the Director of the Department of Consumer and Business Services believes that the controlling producer or any other person has not complied with ORS 732.810 (Definitions for ORS 732.810 to 732.814) to 732.814 (Authority of director over controlling producer and controlled insurer) or any rule adopted or order issued thereunder, the director may order the controlling producer to cease placing insurance with the controlled insurer.

(2) If the director finds that the controlled insurer or any policyholder of the controlled insurer has suffered any loss or damage because the controlling producer or any other person has not complied with ORS 732.810 (Definitions for ORS 732.810 to 732.814) to 732.814 (Authority of director over controlling producer and controlled insurer) or any rule adopted or issued thereunder, the director may maintain a civil action or intervene in an action brought by or on behalf of the insurer or policyholder for recovery of compensatory damages for the benefit of the insurer or policyholder or other appropriate relief.

(3) If an order for liquidation or rehabilitation of the controlled insurer has been entered pursuant to ORS chapter 734 and the receiver appointed under that order believes that the controlling producer or any other person has not complied with ORS 732.810 (Definitions for ORS 732.810 to 732.814) to 732.814 (Authority of director over controlling producer and controlled insurer) or any rule adopted or order issued thereunder, and if the insurer suffered any loss or damage because of the noncompliance, the receiver may maintain a cause of action for recovery of damages or other appropriate sanctions for the benefit of the insurer.

(4) This section does not affect the authority of the director to take any other administrative action under the Insurance Code.

(5) This section does not alter or affect the rights of policyholders, claimants, creditors or other third parties. [1993 c.447 §62]

Note: See note under 732.810 (Definitions for ORS 732.810 to 732.814) .

Source: Section 732.814 — Authority of director over controlling producer and controlled insurer , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 742.244 — OR Code / Title 56 / Chapter 742 / Section 742.244
742.244 Coverage for loss from nuclear reaction or radiation
Status: in_force

Insurers issuing the standard fire insurance policy pursuant to ORS 742.202 (Standard fire insurance policy) are authorized to affix thereto or include therein a written statement that the policy does not cover loss or damage caused by nuclear reaction or nuclear radiation or radioactive contamination, all whether directly or indirectly resulting from an insured peril under said policy. However, nothing contained in this section shall be construed to prohibit the attachment to any such policy of an indorsement or indorsements specifically assuming coverage for loss or damage caused by nuclear reaction or nuclear radiation or radioactive contamination. [Formerly 744.125 and then 743.666]

Source: Section 742.244 — Coverage for loss from nuclear reaction or radiation , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 743b.260 — OR Code / Title 56 / Chapter 743b / Section 743b.260
743B.260 Claims and appeals of adverse benefit determinations under disability income insurance policies
Status: in_force

(1) As used in this section:

(a) “Adverse benefit determination” means a denial, reduction, termination of or failure to provide or pay, in whole or in part, for a benefit, including:

(A) A denial, reduction, termination of or failure to provide or pay for a benefit that is based on a determination of a participant’s or beneficiary’s eligibility to participate in a policy; and

(B) A rescission of coverage with respect to a participant or beneficiary.

(b) “Claim procedure” means an insurer’s procedure for filing benefit claims, providing notice of benefit determinations and appealing adverse benefit determinations.

(2) An insurer that offers, issues or renews a disability income insurance policy in this state may not:

(a) Unduly delay, inhibit or hamper a claimant’s submission of a claim for benefits under the disability income insurance policy or the insurer’s processing, consideration or determination of the claim;

(b) Require a claimant to request more than two appeals of an adverse benefit determination to exhaust the insurer’s appeals process; or

(c) Require mandatory arbitration of an adverse benefit determination unless the arbitration:

(A) Constitutes one of the appeals described in paragraph (b) of this subsection and complies with the requirements that apply to an appeal; and

(B) Does not preclude the claimant from challenging the result of the arbitration under applicable law.

(3) An insurer that issues or renews a disability income insurance policy in this state shall:

(a) Describe and provide to each person eligible for benefits under the policy a written summary of all claim procedures, timelines and deadlines that apply to claims under the policy.

(b) Permit an authorized representative of a claimant to act on the claimant’s behalf in making a claim or appealing an adverse benefit determination, subject to the insurer’s reasonable determination as to whether the claimant has in fact authorized the representative to act on the claimant’s behalf.

(c) Establish and administer processes and safeguards to ensure and verify that the insurer:

(A) Determines benefit claims in accordance with the provisions of the policy and all other applicable laws, regulations and procedures; and

(B) Applies policy provisions consistently among claims.

(d) Determine and adjudicate all claims and appeals in a manner that ensures the independence and impartiality of the individuals who make the determinations or adjudications.

(e) Notify each claimant of an adverse benefit determination not later than 45 days after receiving a claim, except that an insurer may extend the time within which the insurer may give the notification for a maximum of two additional 30-day periods if the insurer determines that the insurer needs additional information from the claimant or the delay is the result of circumstances beyond the insurer’s control and:

(A) The insurer notifies the claimant of each extension before the expiration of the initial 45-day period or the first extension, as appropriate; and

(B) The insurer explains, describes or states, as appropriate, in each notification of an extension:

(i) The standards that apply to the determination;

(ii) Any unresolved issues that prevent a determination;

(iii) Any additional information the claimant must provide for the determination, giving a date not later than 45 days from the date of the notification for the claimant to provide the information; and

(iv) The date by which the insurer expects to make the determination.

(f) Notify the claimant in writing, by printed or electronic means, of the details of each adverse benefit determination, including any adverse benefit determination that follows an appeal of a previous adverse benefit determination. The Director of the Department of Consumer and Business Services may adopt rules that specify:

(A) The form and format of the notification; and

(B) Contents of the notification that include, at a minimum:

(i) The specific reason for the adverse benefit determination;

(ii) The specific policy provisions on which the insurer based the adverse benefit determination;

(iii) A description of any additional information the claimant must provide to complete a claim or appeal and an explanation of why the information is necessary;

(iv) A description of the insurer’s claim procedures and time limits within which a claimant must request an appeal, along with a statement that the claimant has a right to bring a civil action following the adverse benefit determination once the claimant exhausts the claimant’s remedies under the insurer’s appeals process;

(v) An explanation of the insurer’s determination that includes, if applicable:

(I) Reasons why the insurer did not agree with or follow advice, opinions or recommendations from vocational consultants or health care providers who evaluated or treated the claimant and that the claimant included in the claim, or why the insurer disagreed with a determination by the United States Social Security Administration; and

(II) The advice, opinions and recommendations of the insurer’s medical or vocational consultants, even if the insurer did not rely on the advice, opinions or recommendations in making the adverse benefit determination;

(vi) Specific summaries or citations of the insurer’s claim procedures, internal rules, guidelines, protocols, standards or other criteria on which the insurer relied in making the adverse benefit determination, or a statement that the insurer does not have or did not use specific claim procedures, rules, guidelines, protocols, standards or other criteria; and

(vii) A statement that explains the claimant’s reasonable right of access, upon request and free of charge, to copies of all documents, records and other information that are related to the claim and the adverse benefit determination, along with procedures for obtaining the documents, records and other information.

(g) Establish and maintain a claim procedure under which a claimant has a reasonable opportunity to appeal an adverse benefit determination under conditions that ensure a full and fair consideration of the claim and the adverse benefit determination. The insurer in the claim procedure shall give the claimant:

(A) At least 180 days after the date of the adverse benefit determination within which to appeal;

(B) An opportunity to submit written comments, documents, records and other information related to the claim;

(C) Upon request and free of charge, reasonable access to and copies of all of the insurer’s documents, records and other information related to the claim;

(D) Due consideration of the comments, documents, records and other information the claimant submits during the appeal, without regard to whether the claimant submitted the comments, documents, records or other information for the initial determination;

(E) A proceeding in which the official that conducts the proceeding:

(i) Does not defer to the adverse benefit determination;

(ii) Is not the official who made the adverse benefit determination or a subordinate of the official; and

(iii) Consults with a health care provider who has appropriate training and experience to make an informed medical judgment concerning the claim, if a determination of the claim requires a medical judgment, but who is not a health care provider who participated in the adverse benefit determination, or a subordinate of the health care provider; and

(F) The identities of medical providers or vocational consultants from whom the insurer obtained advice, opinions or recommendations concerning the adverse benefit determination, even if the insurer did not rely on the advice, opinions or recommendations in making the adverse benefit determination.

(4) Intentionally left blank —Ed.

(a) If in an appeal of an adverse benefit determination an insurer intends to consider evidence or a rationale that the insurer did not previously consider in making the adverse benefit determination, the insurer shall, as soon as possible and before making a determination in the appeal, notify the claimant of the evidence and the rationale and in the notification provide the claimant with copies of the evidence and an explanation of the rationale, free of any charge. The insurer’s notification must allow the claimant a reasonable time within which to respond to the evidence or rationale.

(b) An insurer shall complete an appeal of an adverse benefit determination and notify the claimant of the insurer’s determination of the appeal not later than 45 days after receiving the claimant’s request for the appeal, except that the insurer may extend for not more than an additional 45 days the time within which the insurer may complete the appeal if the insurer:

(A) Determines that special circumstances require the delay; and

(B) Gives the claimant:

(i) Notice of the extension before the expiration of the initial 45-day period;

(ii) An explanation of the special circumstances that caused the delay; and

(iii) A date by which the insurer expects to make and give the claimant notice of a determination of the appeal.

(5) The period of time within which an insurer must make a determination on a claim or an appeal begins when the insurer receives notice of the claim or appeal, even if the notice does not include all information necessary to make a determination with respect to the claim or appeal. If the insurer must extend the period within which the insurer must make a determination because the claimant failed to submit necessary information, the period is tolled from the date on which the insurer notifies the claimant of the need for additional information until the date on which the claimant responds to the notice.

(6) Intentionally left blank —Ed.

(a) Except as provided in paragraph (b) of this subsection, a claimant has exhausted the claimant’s administrative remedies with respect to a claim or appeal of an adverse benefit determination if the insurer does not adhere strictly to the requirements of this section.

(b) An insurer’s failure to adhere strictly to the requirements of this section that is de minimis and does not or is not likely to cause prejudice or harm to the claimant does not constitute a claimant’s exhaustion of the claimant’s administrative remedies with respect to a claim or appeal if the failure is not part of a pattern or practice of failures by the insurer and the insurer demonstrates that the failure:

(A) Was for good cause or was a result of circumstances beyond the insurer’s control; and

(B) Occurred in the context of an ongoing, good-faith exchange of information between the insurer and the claimant.

(c) A claimant may request from the insurer a written explanation of the failure, which the insurer must provide within 10 days after receiving the request. In the explanation, the insurer must specify the basis for any assertion by the insurer that the failure does not constitute an exhaustion of the claimant’s administrative remedies with respect to the claim or appeal. [2021 c.73 §2]

Note: 743B.260 (Claims and appeals of adverse benefit determinations under disability income insurance policies) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

OUT-OF-POCKET COSTS

Source: Section 743B.260 — Claims and appeals of adverse benefit determinations under disability income insurance policies; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 743.204 — OR Code / Title 56 / Chapter 743 / Section 743.204
743.204 Standard Nonforfeiture Law for Life Insurance
Status: in_force

(1) ORS 743.204 (Standard Nonforfeiture Law for Life Insurance) to 743.222 (Policy benefits and premiums that shall be disregarded in calculating cash surrender values and paid-up nonforfeiture benefits) may be cited as the Standard Nonforfeiture Law for Life Insurance.

(2) The operative date of the Standard Nonforfeiture Law for Life Insurance as to any policy is the earlier of:

(a) January 1, 1948; or

(b) The date specified in a written notice, filed with the Director of the Department of Consumer and Business Services by the insurer, of election to comply with the Standard Nonforfeiture Law for Life Insurance as to such policy as of the specified date.

(3) The Standard Nonforfeiture Law for Life Insurance shall not apply to:

(a) Any reinsurance, group insurance, pure endowment, annuity or reversionary annuity policy.

(b) Any term policy or renewal thereof, of uniform amount, which provides no guaranteed nonforfeiture or endowment benefits, of 20 years or less expiring before age 71, for which uniform premiums are payable during the entire term of the policy. For this purpose, the age at death for a joint term life insurance policy shall be the age at death of the oldest life.

(c) Any term policy of decreasing amount, which provides no guaranteed nonforfeiture or endowment benefits, if each adjusted premium, calculated as specified in ORS 743.215 (Calculation of adjusted premiums) and 743.216 (Adjusted premiums) , is less than the adjusted premium so calculated on a term policy or renewal thereof of uniform amount, which provides no guaranteed nonforfeiture benefits or endowment benefits, which is issued at the same age, for the same initial amount of insurance and for a term of 20 years or less that expires before age 71 and for which uniform premiums are payable during the entire term of the policy. For this purpose, the age at death for a joint term life insurance policy shall be the age at death of the oldest life.

(d) Any policy which provides no guaranteed nonforfeiture or endowment benefits, and for which policy the cash surrender value or present value of paid-up nonforfeiture benefit calculated for the beginning of any policy year as specified in ORS 743.210 (Determination of cash surrender values) , 743.213 (Determination of paid-up nonforfeiture benefits) , 743.215 (Calculation of adjusted premiums) and 743.216 (Adjusted premiums) does not exceed two and one-half percent of the amount of insurance at the beginning of such year. [Formerly 739.340; 1977 c.320 §13; 1981 c.609 §12]

Source: Section 743.204 — Standard Nonforfeiture Law for Life Insurance; applicability , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 742.150 — OR Code / Title 56 / Chapter 742 / Section 742.150
742.150 Approval by director
Status: in_force

(1) A domestic insurer shall not enter a transaction in which the domestic insurer assumes or transfers obligations or risks on policies under an assumption reinsurance agreement as defined in this section, unless the Director of the Department of Consumer and Business Services first approves the transaction. A domestic insurer must submit with its request for approval a proposed notice of transfer required in ORS 742.156 (Notice of transfer under assumption reinsurance agreement) .

(2) A domestic insurer shall not assume obligations or risks on policies issued to or owned by policyholders residing in any other state unless it is authorized or licensed in the other state to transact insurance or unless the insurance regulatory official of that state has approved the assumption.

(3) An authorized insurer shall not transfer obligations or risks on policies issued to or owned by residents of this state to any unauthorized insurer.

(4) If each authorized foreign insurer entering an assumption reinsurance agreement that transfers the obligations or risks on policies issued to or owned by residents of this state is domiciled in a state that imposes requirements on an assumption reinsurance agreement that are substantially similar to requirements of this state, then when each such insurer enters the agreement, the insurer shall file or cause to be filed with the director the following:

(a) The assumption certificate.

(b) A copy of the notice of transfer required to be sent to policyholders.

(c) An affidavit that the transaction is subject to substantially similar requirements in the state or states of domicile of both the transferring and assuming insurers.

(5) If any authorized foreign insurer entering an assumption reinsurance agreement that transfers the obligations or risks on policies issued to or owned by residents of this state is domiciled in a state that does not impose requirements on an assumption reinsurance agreement that are substantially similar to requirements of this state, each insurer entering into the agreement shall obtain prior approval of the director and is otherwise subject to all other requirements of ORS 742.156 (Notice of transfer under assumption reinsurance agreement) and 742.158 (Rejection of transfer by policyholder) with respect to residents of this state.

(6) For purposes of this section, “assumption reinsurance agreement” means a contract that both:

(a) Transfers insurance obligations or risks of existing or in-force policies from a transferring insurer to an assuming insurer that acquires the obligations or risks from the transferring insurer; and

(b) Is intended to effect a novation of the transferred policies with the result that the assuming insurer becomes directly liable to the policyholders of the transferring insurer and the insurance obligations and risks of the transferring insurer under the policies are extinguished. [1995 c.30 §2]

Source: Section 742.150 — Approval by director; limitations on authority of insurer; definition , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 731.508 — OR Code / Title 56 / Chapter 731 / Section 731.508
731.508 Approved reinsurance
Status: in_force

(1) An insurer may accept reinsurance only of such risks, and retain risk thereon within such limits, as it is otherwise authorized to insure.

(2) Except as provided in ORS 731.512 (Withdrawal of insurer) , 732.517 (Purpose of ORS 732.517 to 732.546) to 732.546 (Severability) or 742.150 (Approval by director) to 742.162 (Transfer and novation of policy effected by director) , an insurer may reinsure risks with an insurer authorized to transact such insurance in this state, or in any other solvent insurer approved or accepted by the Director of the Department of Consumer and Business Services for the purpose of such reinsurance. The director shall not approve or accept any such reinsurance by a ceding domestic insurer in an unauthorized insurer which the director finds for good cause would be contrary to the interests of the policyholders or stockholders of such domestic insurer.

(3) Credit shall not be allowed, as an asset or as a deduction from liability, to any ceding insurer for reinsurance unless the reinsurance contract provides, in substance, that in the event of the insolvency of the ceding insurer, the reinsurance shall be payable under a contract or contracts reinsured by the assuming insurer on the basis of reported claims allowed by the court hearing the liquidation proceeding, without diminution because of the insolvency of the ceding insurer. Such payments shall be made directly to the ceding insurer or to its domiciliary liquidator except:

(a) When the contract or other written agreement specifically provides another payee of the reinsurance in the event of the insolvency of the ceding insurer; or

(b) When the assuming insurer, with the consent of the direct insured or insureds, has assumed the policy obligations of the ceding insurer as direct obligations of the assuming insurer to the payees under such policies and in substitution for the obligations of the ceding insurer to such payees.

(4) For the purposes of subsection (3) of this section, the reinsurance agreement may provide that the domiciliary liquidator of an insolvent ceding insurer shall, within a reasonable time after the claim is filed in the liquidation proceeding, give written notice to the assuming insurer of the pendency of a claim against the ceding insurer on the contract reinsured. During the pendency of the claim, an assuming insurer may investigate the claim and interpose, at its own expense, in the proceeding in which the claim is to be adjudicated any defenses that the assuming insurer determines to be available to the ceding insurer or its liquidator. The expense may be filed as a claim against the insolvent ceding insurer to the extent of a proportionate share of the benefit that may accrue to the ceding insurer solely as a result of the defense undertaken by the assuming insurer. When two or more assuming insurers are involved in the same claim and a majority in interest elect to interpose one or more defenses to the claim, the expense shall be apportioned in accordance with the terms of the reinsurance agreement as though the expense had been incurred by the ceding insurer.

(5) The director may disallow credit that would otherwise be allowed if the director determines that allowing credit would be contrary to accurate financial reporting or proper financial management, or may be hazardous to policyholders of the insurer or the insurance-buying public generally. The director may make such a determination only according to standards established by the director by rule. This subsection applies only to insurers who transact life insurance or health insurance, or both.

(6) Upon request of the director, a ceding insurer promptly shall inform the director in writing of the cancellation or any other material change of any of its reinsurance treaties or arrangements.

(7) This section does not apply to wet marine and transportation insurance. [1967 c.359 §104; 1993 c.447 §68; 1995 c.30 §9; 1995 c.638 §1; 2001 c.318 §14]

Source: Section 731.508 — Approved reinsurance , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 731.158 — OR Code / Title 56 / Chapter 731 / Section 731.158
731.158 “Casualty insurance.”
Status: in_force

“Casualty insurance” means:

(1) Insurance against legal, contractual or assumed liability for death, injury or disability of any human, or for damage to property; and provision for medical, hospital, surgical and disability benefits to injured persons including insurance against the risk of economic loss assumed under a less than fully insured employee health benefit plan and funeral and death benefits to dependents, beneficiaries or personal representatives of persons killed, irrespective of legal liability of the insured, when issued as coverage for personal injury protection benefits under a motor vehicle liability policy or as an incidental coverage with or supplemental to liability insurance;

(2) Motor vehicle physical damage, burglary and theft, glass, boiler and machinery, credit and livestock insurance;

(3) Insurance of the obligations accepted by, imposed upon or assumed by employers under law for death, disablement or occupational diseases of employees;

(4) Insurance which undertakes to perform or provide repair or replacement service or indemnification therefor for the operational or structural failure of specified real or personal property or property components; and

(5) Insurance against any other kind of loss, damage or liability properly a subject of insurance and not within any other class of insurance otherwise defined, if such insurance is not disapproved by the Director of the Department of Consumer and Business Services as being contrary to law or public policy. [1967 c.359 §34; 1981 c.247 §2; 1993 c.649 §5; 2007 c.241 §22]

Source: Section 731.158 — “Casualty insurance.” , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 743.231 — OR Code / Title 56 / Chapter 743 / Section 743.231
743.231 “Profit-sharing policy” defined
Status: in_force

“Profit-sharing policy” means:

(1) A life insurance policy which by its terms expressly provides that the policyholder will participate in the distribution of earnings or surplus other than earnings or surplus attributable, by reasonable and nondiscriminatory standards, to the participating policies of the insurer and allocated to the policyholder on reasonable and nondiscriminatory standards; or

(2) A life insurance policy the provisions of which, through sales material or oral presentations, are interpreted by the insurer to prospective policyholders as entitling the policyholder to the benefits described in subsection (1) of this section. [Formerly 739.705]

Source: Section 743.231 — “Profit-sharing policy” defined , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 742.532 — OR Code / Title 56 / Chapter 742 / Section 742.532
742.532 Benefits may be more favorable than those required by ORS 742.520, 742.524 and 742.530
Status: in_force

Nothing in ORS 742.518 (Definitions for ORS 742.518 to 742.542) to 742.542 (Effect of personal injury protection benefits paid) is intended to prevent an insurer from providing more favorable benefits than the personal injury protection benefits described in ORS 742.520 (Personal injury protection benefits for motor vehicle liability policies) , 742.524 (Contents of personal injury protection benefits) and 742.530 (Exclusions from coverage) . [Formerly 743.820]

Source: Section 742.532 — Benefits may be more favorable than those required by ORS 742.520, 742.524 and 742.530 , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 743b.504 — OR Code / Title 56 / Chapter 743b / Section 743b.504
743B.504 Third party contracts for dental care services
Status: in_force

(1) As used in this section:

(a) “Dental insurer” means an insurer that offers a policy or certificate of insurance or other contract, that provides only a dental benefit.

(b) Intentionally left blank —Ed.

(A) “Material modification” includes, but is not limited to, changes to the terms or conditions of a contract that alter:

(i) Reimbursement rates paid to dental care providers;

(ii) Fee schedules for dental care providers; or

(iii) Dental benefits or covered procedures under a plan for which a dental care provider is a network provider.

(B) “Material modification” does not include adding a new third party to an existing third party network contract without any material modification to the third party network contract.

(c) “Provider network contract” means a contract entered into between a dental care provider and a dental insurer for the provision of services to enrollees in plans offered by the dental insurer.

(d) “Third party” means an entity that enters into a third party network contract with a dental insurer.

(e) “Third party network contract” means a contract entered into between a dental insurer and third party insurer to gain access to the dental care services and discounted rates of a dental care provider under the dental insurer’s provider network contract with the dental care provider.

(2) A dental insurer may enter into a third party network contract to provide access to the dental care services and discounted rates of a dental care provider under a provider network contract only if:

(a) The dental care provider in the network chooses to allow the third party to access the dental care provider’s services and discounted rates:

(A) At the time the contract is entered into or renewed; and

(B) Whenever there is a material modification to the third party network contract;

(b) The dental insurer allows the dental care provider to contract directly with the third party instead of allowing the third party to access the dental care provider’s services and discounted rates; and

(c) The third party network contract obligates the third party to comply with all applicable terms, limitations and conditions of the provider network contract.

(3) A dental insurer may not cancel or otherwise terminate a network provider contract with a dental care provider on the grounds that the dental care provider refuses to allow access by a third party to the dental care services and discounted rates of the dental care provider.

(4) A dental insurer that contracts with a third party to provide access to the services and discounted rates of a dental care provider under a provider network contract shall:

(a) At the time a provider network contract is entered into, renewed or extended, give to the provider, in writing or electronically, a list of all third parties known by the dental insurer to which the dental insurer has or will provide access to the dental care services and discounted rates of the provider under the provider network contract;

(b) Maintain an Internet website through which the provider may obtain a list, updated at least every 90 days, of all third parties that have access to the provider’s dental care services and discounted rates under the provider network contract;

(c) Require a third party to identify on each remittance or explanation of payment sent to a provider the source of any contractual discount in rates taken by the third party under the provider network contract;

(d) Notify the provider no less than 30 days prior to the effective date of a new third party network contract;

(e) Notify each third party described under paragraph (a) or (b) of this subsection of the termination of the provider network contract no later than 30 days prior to the effective date of the termination; and

(f) Make available to a provider within 30 days of the provider’s request a copy of the provider network contract currently in force that was relied upon by the dental insurer in the adjudication of the provider’s claim.

(5) The notice required under subsection (4)(d) and (e) of this section can be provided by any reasonable means, including but not limited to written notice, electronic communication or an update to an electronic database.

(6) Subject to any applicable continuity of care requirements, agreements or contractual provisions, a third party’s right to access a dental care provider’s services and discounted rates under a provider network contract shall terminate on the date the provider network contract is terminated.

(7) The requirements of this section may not be waived by agreement. Any contract provision that purports to waive the requirements of this section or that conflicts with the requirements of this section is null and void.

(8) This section does not apply to:

(a) Contracts between a dental insurer and a licensee or affiliate of the dental insurer.

(b) The state medical assistance program.

(c) A dental insurer that relies only on employees of the insurer to provide dental care. [2023 c.425 §3]

Note: 743B.504 (Third party contracts for dental care services) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743B.504 — Third party contracts for dental care services , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 746.640 — OR Code / Title 56 / Chapter 746 / Section 746.640
746.640 Access to recorded personal information
Status: in_force

(1) If any individual, after proper identification, submits a written request to an insurer, insurance producer or insurance-support organization for access to recorded personal information about the individual that is reasonably described by the individual and reasonably locatable and retrievable by the insurer, insurance producer or insurance-support organization, the insurer, insurance producer or insurance-support organization within 30 business days from the date the request is received shall:

(a) Inform the individual of the nature and substance of the recorded personal information in writing, by telephone or by other oral communication, whichever the insurer, insurance producer or insurance-support organization prefers;

(b) Permit the individual to see and copy, in person, the recorded personal information or to obtain a copy of the recorded personal information by mail, whichever the individual prefers, unless the recorded personal information is in coded form, in which case an accurate translation in plain language shall be provided in writing;

(c) Disclose to the individual the identity, if recorded, of the persons to whom the insurer, insurance producer or insurance-support organization has disclosed the recorded personal information within two years prior to the request, and if such identity is not recorded, the names of the insurers, insurance producers, insurance-support organizations and other persons to whom such information is normally disclosed; and

(d) Provide the individual with a summary of the procedures by which the individual may request correction, amendment or deletion of recorded personal information.

(2) Any personal information provided pursuant to this section must identify the source of the information if the source is an institutional source.

(3) If an individual requests individually identifiable health information supplied by a health care provider, the insurer, insurance producer or insurance-support organization shall provide the information, including the identity of the health care provider either directly to the individual or to a health care provider designated by the individual and licensed to provide health care with respect to the condition to which the information relates, whichever the insurer, insurance producer or insurance-support organization prefers. If the insurer, insurance producer or insurance-support organization elects to disclose the information to a health care provider designated by the individual, the insurer, insurance producer or insurance-support organization shall notify the individual, at the time of the disclosure, that the insurer, insurance producer or insurance-support organization has provided the information to the health care provider.

(4) Except for personal information provided under ORS 746.650 (Reasons for adverse underwriting decisions) , an insurer, insurance producer or insurance-support organization may charge a reasonable fee to cover the costs incurred in providing a copy of recorded personal information to an individual.

(5) The obligations imposed by this section upon an insurer or insurance producer may be satisfied by another insurer or insurance producer authorized to act on its behalf. With respect to the copying and disclosure of recorded personal information pursuant to a request under this section, an insurer, insurance producer or insurance-support organization may make arrangements with an insurance-support organization or a consumer reporting agency to copy and disclose recorded personal information on its behalf.

(6) The rights granted to individuals by this section shall extend to all natural persons to the extent personal information about them is collected and maintained by an insurer, insurance producer or insurance-support organization in connection with an insurance transaction. The rights granted to all natural persons by this subsection shall not extend to personal information about them that relates to and is collected in connection with or in reasonable anticipation of a claim or a civil or criminal proceeding involving them.

(7) For purposes of this section, the term “insurance-support organization” does not include “consumer reporting agency.” [1981 c.649 §10; 2003 c.87 §13; 2003 c.364 §159a]

Source: Section 746.640 — Access to recorded personal information , https://www.­oregonlegislature.­gov/bills_laws/ors/ors746.­html (accessed May 26, 2025).
ORS § 732.564 — OR Code / Title 56 / Chapter 732 / Section 732.564
732.564 Registration for affiliated insurers
Status: in_force

The Director of the Department of Consumer and Business Services may allow an authorized insurer that is part of an insurance holding company system to register on behalf of an affiliated insurer that is required to register under ORS 732.551 (Registration of insurer members of holding company systems) and to file all information and material required to be filed under the registration requirements of ORS 732.517 (Purpose of ORS 732.517 to 732.546) to 732.596 (Request by insurance holding company system for determination or acknowledgement of group-wide supervisor) . [Formerly 732.675]

Source: Section 732.564 — Registration for affiliated insurers , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 743b.109 — OR Code / Title 56 / Chapter 743b / Section 743b.109
743B.109 Short term health insurance policies
Status: in_force

(1) An insurer offering a short term health insurance policy in this state shall include in any policy document, application materials or advertisements related to the policy a notice informing an insured or prospective insured under the policy that:

(a) The policy is not subject to certain federal requirements for health insurance, including requirements in the Patient Protection and Affordable Care Act (P.L. 111-148) as amended by the Health Care and Education Reconciliation Act (P.L. 111-152);

(b) The insured or prospective insured should carefully review the policy documents; and

(c) If the policy expires or an insured loses coverage under the policy, the insured may have to wait until the next annual open enrollment period to enroll in another policy of health insurance.

(2) The Department of Consumer and Business Services may adopt rules to implement this section, including rules prescribing the form or manner of the notice described in subsection (1) of this section or any additional information that must be included in the notice. [2021 c.205 §2]

Note: 743B.109 (Short term health insurance policies) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743B.109 — Short term health insurance policies; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 743b.601 — OR Code / Title 56 / Chapter 743b / Section 743b.601
743B.601 Synchronization of prescription drug refills
Status: in_force

(1) As used in this section:

(a) “Health plan” means:

(A) A “health benefit plan” as defined in ORS 743B.005 (Definitions) ; and

(B) A self-insured health plan offered by the Oregon Health and Science University.

(b) “Synchronization policy” means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently.

(2) A health plan that includes prescription drug coverage shall implement a synchronization policy for the dispensing of prescription drugs to the plan’s enrollees.

(3) A health plan shall reimburse the cost of prescription drugs dispensed in accordance with the plan’s synchronization policy.

(4) If a drug is dispensed in less than a 30-day supply for the purpose of synchronizing a patient’s prescription drug refills, a health plan shall:

(a) Prorate the copayment; or

(b) Adjust the copayment using a method approved by the Department of Consumer and Business Services.

(5) A health plan shall fully reimburse the dispensing fee for partially filled or refilled prescription drugs.

(6) This section does not apply to prescription drugs that:

(a) Are in unit-of-use packaging for which synchronization is not possible;

(b) Are controlled substances; or

(c) Have been identified by the United States Drug Enforcement Administration as having a high risk of diversion.

(7) The coverage required by this section may be limited by formulary restrictions applied to a prescription drug by a health plan.

(8) Intentionally left blank —Ed.

(a) This section does not apply to a prepaid group practice health plan with at least 200,000 enrollees in this state.

(b) As used in this subsection, “prepaid group practice health plan” means a health care service contractor that provides physician services to its enrollees through an integrated health care delivery system using, primarily, a single group of physicians contracted on a prepaid, capitated basis. [2014 c.25 §2; 2015 c.800 §1; 2017 c.309 §6]

Note: 743B.601 (Synchronization of prescription drug refills) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743B.601 — Synchronization of prescription drug refills , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 737.207 — OR Code / Title 56 / Chapter 737 / Section 737.207
737.207 Commercial liability insurance rate filings
Status: in_force

(1) As used in this section, a market may be a line, subline or classification of commercial liability insurance.

(2) Filings of commercial liability insurance rates for markets specified by the Director of the Department of Consumer and Business Services shall be submitted by an insurer or rating organization to the director for review prior to the effective date if the average annual rate level increase or decrease for each market exceeds 15 percent. Factors to be considered by the director in specifying a market to be subject to this section may include:

(a) The nature and extent of competition;

(b) The size and significance of the coverage provided;

(c) Reinsurance availability;

(d) The volume of cancellations and nonrenewals; and

(e) Changing conditions in the economic, judicial and social environment.

(3) Except as otherwise provided in ORS 737.209 (Hearing on rate filings under ORS 737.207) , the effective date of a commercial liability insurance filing required by subsection (2) of this section to be submitted to the director for review shall be the date specified therein but not earlier than the 30th day after the filing is received by the director. After review of the filing, the director may authorize an earlier effective date, if appropriate. The 30-day waiting period may be extended to 60 days if the director gives written notice within such waiting period to the insurer or rating organization which made the filing that the extended period is needed for consideration of the filing. A filing subject to subsection (2) of this section that has not been approved or disapproved within the waiting period, or any extension thereof, shall be deemed approved.

(4) Supporting actuarial data shall accompany every filing of commercial liability insurance rates. The data shall be in sufficient detail to justify the rate level change and shall demonstrate compliance with ORS 737.310 (Method of rate making) governing the making of rates. [1987 c.774 §48]

Source: Section 737.207 — Commercial liability insurance rate filings; prior approval by director , https://www.­oregonlegislature.­gov/bills_laws/ors/ors737.­html (accessed May 26, 2025).
ORS § 735.400 — OR Code / Title 56 / Chapter 735 / Section 735.400
735.400 Purposes of ORS 735.400 to 735.495
Status: in_force

ORS 735.400 (Purposes of ORS 735.400 to 735.495) to 735.495 (Short title) shall be liberally construed and applied to promote its underlying purposes which include:

(1) Protecting persons seeking insurance in this state;

(2) Permitting surplus lines insurance to be placed with reputable and financially sound nonadmitted insurers and exported from this state pursuant to ORS 735.400 (Purposes of ORS 735.400 to 735.495) to 735.495 (Short title) ;

(3) Establishing a system of regulation which will permit orderly access to surplus lines insurance in this state and encourage admitted insurers to provide new and innovative types of insurance available to consumers in this state; and

(4) Protecting revenues of this state. [1987 c.774 §117]

Source: Section 735.400 — Purposes of ORS 735.400 to 735.495 , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 742.278 — OR Code / Title 56 / Chapter 742 / Section 742.278
742.278 Prohibition on uses of map of wildfire risk or exposure
Status: in_force

An insurance company may not use a map published by an agency of this state that identifies areas of wildfire risk or exposure as a basis for:

(1) Canceling or declining to renew a homeowner insurance policy; or

(2) Increasing a premium for a homeowner insurance policy. [2023 c.67 §4]

Note: See note under 742.277 (Notice of cancellation, nonrenewal or rate change related to wildfire risk) .

Source: Section 742.278 — Prohibition on uses of map of wildfire risk or exposure , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 744.812 — OR Code / Title 56 / Chapter 744 / Section 744.812
744.812 Prohibitions on actions of reinsurance intermediary managers
Status: in_force

A reinsurance intermediary manager may not do any of the following:

(1) Cede retrocessions on behalf of the reinsurer that the reinsurance intermediary manager represents, except that the reinsurance intermediary manager may cede facultative retrocessions pursuant to obligatory facultative agreements if the contract with the reinsurer contains reinsurance underwriting guidelines for the retrocessions. The guidelines must include:

(a) A list of reinsurers with which the automatic agreements are in effect;

(b) For each such reinsurer, the coverages and amounts or percentages that may be reinsured; and

(c) For each such reinsurer, the commission schedules.

(2) Commit the reinsurer to participate in reinsurance syndicates.

(3) Appoint an insurance producer, reinsurance intermediary broker or reinsurance intermediary manager without assuring that the insurance producer, reinsurance intermediary broker or reinsurance intermediary manager is lawfully licensed to transact the type of reinsurance for which the appointment is made.

(4) Without prior approval of the reinsurer, pay or commit the reinsurer to pay a claim, net of retrocessions, that exceeds the lesser of an amount specified by the reinsurer or one percent of the combined capital and surplus of the reinsurer as of December 31 of the last complete calendar year.

(5) Collect any payment from a retrocessionaire or commit the reinsurer to any claim settlement with a retrocessionaire, without prior approval of the reinsurer. If prior approval is given, the reinsurance intermediary manager must promptly forward a report to the reinsurer.

(6) Jointly employ an individual who is employed by the reinsurer, unless the reinsurance intermediary manager is under common control with the reinsurer subject to ORS 732.517 (Purpose of ORS 732.517 to 732.546) to 732.596 (Request by insurance holding company system for determination or acknowledgement of group-wide supervisor) .

(7) Appoint a reinsurance subintermediary manager. [1993 c.447 §80; 2003 c.364 §33]

Source: Section 744.812 — Prohibitions on actions of reinsurance intermediary managers , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 734.350 — OR Code / Title 56 / Chapter 734 / Section 734.350
734.350 Voidable transfers
Status: in_force

(1) Any transfer of, or lien upon, the property of an insurer, other than as provided in ORS 734.320 (Attachment and garnishment of assets) which is made or created within four months prior to the commencement of a delinquency proceeding with the intent of giving to any creditor, or of enabling the creditor to obtain, a greater percentage of the debt than any other creditor of the same class, and which is accepted by such creditor having reasonable cause to believe that such a preference will occur, shall be voidable.

(2) Every director, officer, employee, stockholder, member, subscriber, and any other person acting on behalf of such insurer who shall be concerned in any such act or deed and every person receiving thereby any property of such insurer or the benefit thereof, shall be personally liable therefor and shall be bound to account to the Director of the Department of Consumer and Business Services.

(3) The director, as receiver in any proceeding under this chapter, may avoid any transfer of, or lien upon, the property of an insurer which any creditor, stockholder, subscriber or member of such insurer might have avoided, and may recover the property so transferred, unless such person was a bona fide holder for value prior to the commencement of the delinquency proceeding. Such property or its value may be recovered from anyone who has received it, except a bona fide holder for value as specified in this subsection. [1967 c.359 §289]

Source: Section 734.350 — Voidable transfers , https://www.­oregonlegislature.­gov/bills_laws/ors/ors734.­html (accessed May 26, 2025).
ORS § 742.536 — OR Code / Title 56 / Chapter 742 / Section 742.536
742.536 Notice of claim or legal action to insurer
Status: in_force

(1) If an authorized motor vehicle liability insurer has furnished personal injury protection benefits, or an authorized health insurer has furnished benefits, to a person who was injured in a motor vehicle accident and the injured person makes a claim, or brings legal action, for damages for injuries against any other person, the injured person shall give notice of the claim or legal action to the insurer by personal service or by registered or certified mail. Service of a copy of the summons and complaint or copy of other process served in connection with the legal action is sufficient notice to the insurer, in which case a return showing service of the notice must be filed with the clerk of the court but is not a part of the record except to give notice.

(2) An insurer may elect to seek reimbursement as provided in this section for benefits the insurer has furnished to the injured person out of any recovery the injured person obtains from a claim or legal action if the insurer has not been a party under ORS 742.534 (Reimbursement of other insurers paying benefits) to an interinsurer reimbursement proceeding with respect to benefits the insurer furnished to the injured person and the insurer is entitled by the terms of the insurer’s policy to the benefit of this section. The insurer shall give written notice of an election under this subsection by personal service or by registered or certified mail within 30 days after receiving the notice or knowledge of the claim or legal action to the person who made the claim or brought the legal action and to the person against whom the injured person made a claim or brought legal action. In the case of a legal action, a return showing service of the notice of election must be filed with the clerk of the court but is not a part of the record except to give notice to the claimant and the defendant of the lien of the insurer.

(3) If the insurer serves a written notice of the insurer’s election under subsection (2) of this section and, if applicable, files a return showing service:

(a) Subject to ORS 742.544 (Reimbursement for benefits paid) , an insurer has a lien, for not more than the amount of benefits the insurer furnished, against an injured person’s recovery in an action for damages, less a proportionate amount of not more than 100 percent of the expenses, costs and attorney fees the injured person incurred in connection with the recovery. The proportionate amount must be calculated as the ratio between the amount of the lien before a reduction under this paragraph and the amount of the recovery.

(b) The injured person shall include the benefits the insurer furnished as damages in a claim or legal action.

(c) In the case of a legal action, the action must be taken in the name of the injured person.

(4) As used in this section, “makes a claim” means delivers a written demand for a specific amount of damages that meets requirements reasonably established by the director’s rule. [Formerly 743.828; 2019 c.460 §1]

Source: Section 742.536 — Notice of claim or legal action to insurer; insurer to elect manner of recovery of benefits furnished; lien of insurer , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 743b.105 — OR Code / Title 56 / Chapter 743b / Section 743b.105
743B.105 Requirements for group health benefit plans other than small employer plans
Status: in_force

The following requirements apply to all group health benefit plans other than small employer health benefit plans covering two or more certificate holders:

(1) A carrier offering a group health benefit plan may not decline to offer coverage to any eligible prospective enrollee and may not impose different terms or conditions on the coverage, premiums or contributions of any enrollee in the group that are based on the actual or expected health status of the enrollee.

(2) A group health benefit plan may not apply a preexisting condition exclusion to any enrollee but may impose:

(a) An affiliation period that does not exceed two months for an enrollee or three months for a late enrollee; or

(b) A group eligibility waiting period for late enrollees that does not exceed 90 days.

(3) Each group health benefit plan shall contain a special enrollment period during which eligible employees and dependents may enroll for coverage, as provided by federal law and rules adopted by the Department of Consumer and Business Services.

(4) Intentionally left blank —Ed.

(a) A carrier shall issue to a group any of the carrier’s group health benefit plans offered by the carrier for which the group is eligible, if the group applies for the plan, agrees to make the required premium payments and agrees to satisfy the other requirements of the plan.

(b) The department may waive the requirements of this subsection if the department finds that issuing a plan to a group or groups would endanger the carrier’s ability to fulfill the carrier’s contractual obligations or result in financial impairment of the carrier.

(5) Each group health benefit plan shall be renewable with respect to all eligible enrollees at the option of the policyholder unless:

(a) The policyholder fails to pay the required premiums.

(b) The policyholder or, with respect to coverage of individual enrollees, an enrollee or a representative of an enrollee engages in fraud or makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan.

(c) The number of enrollees covered under the plan is less than the number or percentage of enrollees required by participation requirements under the plan.

(d) The policyholder fails to comply with the contribution requirements under the plan.

(e) The carrier discontinues both offering and renewing, all of the carrier’s group health benefit plans in this state or in a specified service area within this state. In order to discontinue plans under this paragraph, the carrier:

(A) Must give notice of the decision to the department and to all policyholders covered by the plans;

(B) May not cancel coverage under the plans for 180 days after the date of the notice required under subparagraph (A) of this paragraph if coverage is discontinued in the entire state or in a specified service area, except that:

(i) The carrier shall cancel coverage in accordance with subparagraph (C) of this paragraph if the cancellation is for a specified service area in the circumstances described in subparagraph (C) of this paragraph; and

(ii) The Director of the Department of Consumer and Business Services may specify a cancellation date other than the cancellation date specified in this subparagraph if the carrier is subject to a delinquency proceeding, as defined in ORS 734.014 (Definitions) ; and

(C) May not cancel coverage under the plans for 90 days after the date of the notice required under subparagraph (A) of this paragraph if coverage is discontinued in a specified service area because of an inability to reach an agreement with the health care providers or organization of health care providers to provide services under the plans within the service area.

(f) The carrier discontinues both offering and renewing a group health benefit plan in a specified service area within this state because of an inability to reach an agreement with the health care providers or organization of health care providers to provide services under the plan within the service area. In order to discontinue a plan under this paragraph, the carrier:

(A) Must give notice of the decision to the department and to all policyholders covered by the plan;

(B) May not cancel coverage under the plan for 90 days after the date of the notice required under subparagraph (A) of this paragraph; and

(C) Must offer in writing to each policyholder covered by the plan, all other group health benefit plans that the carrier offers in the specified service area. The carrier shall offer the plans at least 90 days prior to discontinuation.

(g) The carrier discontinues both offering and renewing a group health benefit plan, other than a grandfathered health plan, for all groups in this state or in a specified service area within this state, other than a plan discontinued under paragraph (f) of this subsection.

(h) The carrier discontinues both offering and renewing a grandfathered health plan for all groups in this state or in a specified service are within this state, other than a plan discontinued under paragraph (f) of this subsection.

(i) With respect to plans that are being discontinued under paragraph (g) or (h) of this subsection, the carrier must:

(A) Offer in writing to each policyholder covered by the plan, one or more health benefit plans that the carrier offers to groups in the specified service area.

(B) Offer the plans at least 90 days prior to discontinuation.

(C) Act uniformly without regard to the claims experience of the affected policyholders or the health status of any current or prospective enrollee.

(j) The director orders the carrier to discontinue coverage in accordance with procedures specified or approved by the director upon finding that the continuation of the coverage would:

(A) Not be in the best interests of the enrollees; or

(B) Impair the carrier’s ability to meet contractual obligations.

(k) In the case of a group health benefit plan that delivers covered services through a specified network of health care providers, there is no longer any enrollee who lives, resides or works in the service area of the provider network.

(L) In the case of a health benefit plan that is offered in the group market only to one or more bona fide associations, the membership of an employer in the association ceases and the termination of coverage is not related to the health status of any enrollee.

(6) A carrier may modify a group health benefit plan at the time of coverage renewal. The modification is not a discontinuation of the plan under subsection (5)(e), (g) and (h) of this section.

(7) Notwithstanding any provision of subsection (5) of this section to the contrary, a carrier may not rescind the coverage of an enrollee under a group health benefit plan unless:

(a) The enrollee:

(A) Performs an act, practice or omission that constitutes fraud; or

(B) Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan;

(b) The carrier provides at least 30 days’ advance written notice, in the form and manner prescribed by the department, to the enrollee; and

(c) The carrier provides notice of the rescission to the department in the form, manner and time frame prescribed by the department by rule.

(8) Notwithstanding any provision of subsection (5) of this section to the contrary, a carrier may not rescind a group health benefit plan unless:

(a) The plan sponsor or a representative of the plan sponsor:

(A) Performs an act, practice or omission that constitutes fraud; or

(B) Makes an intentional misrepresentation of a material fact as prohibited by the terms of the plan;

(b) The carrier provides at least 30 days’ advance written notice, in the form and manner prescribed by the department, to each plan enrollee who would be affected by the rescission of coverage; and

(c) The carrier provides notice of the rescission to the department in the form, manner and time frame prescribed by the department by rule.

(9) A group health benefit plan may not impose annual or lifetime limits on the dollar amount of essential health benefits. [Formerly 743.754; 2017 c.479 §17]

Source: Section 743B.105 — Requirements for group health benefit plans other than small employer plans , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 746.100 — OR Code / Title 56 / Chapter 746 / Section 746.100
746.100 Misrepresentation in insurance applications or transactions
Status: in_force

No person shall make a false or fraudulent statement or representation on or relative to an application for insurance, or for the purpose of obtaining a fee, commission, money or benefit from an insurer or insurance producer. [Formerly 736.460; 2003 c.364 §138]

Source: Section 746.100 — Misrepresentation in insurance applications or transactions , https://www.­oregonlegislature.­gov/bills_laws/ors/ors746.­html (accessed May 26, 2025).
ORS § 735.210 — OR Code / Title 56 / Chapter 735 / Section 735.210
735.210 Formation of market assistance plans
Status: in_force

(1) After a public hearing, the Director of the Department of Consumer and Business Services may by rule require insurers authorized to write and writing commercial liability insurance in this state to form a market assistance plan to assist businesses and service providers unable to purchase specified classes of commercial liability insurance in adequate amounts from either the admitted or nonadmitted market.

(2) The market assistance plan shall operate under a plan of operations prepared by admitted insurers, eligible surplus line insurers and insurance producers, and approved by the director. [1987 c.774 §75; 2003 c.364 §90]

Source: Section 735.210 — Formation of market assistance plans; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 746.611 — OR Code / Title 56 / Chapter 746 / Section 746.611
746.611 Personal representative of deceased person
Status: in_force

If no person has been appointed as a personal representative under ORS chapter 113 or a person appointed as a personal representative under ORS chapter 113 has been discharged, the personal representative of a deceased individual shall be the first of the following persons, in the following order, who may be located upon reasonable effort by the covered entity and who is willing to serve as the personal representative:

(1) A person appointed as guardian under ORS 125.305 (Order of appointment) , 419B.372 (Guardianship as incident of custody) , 419C.481 (Guardianship and legal custody of adjudicated youth committed to Oregon Youth Authority) or 419C.555 (Authority to appoint guardian) with authority to make medical and health care decisions at the time of the individual’s death.

(2) The individual’s spouse.

(3) An adult designated in writing by the persons listed in this section, if no person listed in this section objects to the designation.

(4) A majority of the adult children of the individual who can be located.

(5) Either parent of the individual or an individual acting in loco parentis to the individual.

(6) A majority of the adult siblings of the individual who can be located.

(7) Any adult relative or adult friend. [2005 c.253 §5]

Source: Section 746.611 — Personal representative of deceased person , https://www.­oregonlegislature.­gov/bills_laws/ors/ors746.­html (accessed May 26, 2025).
ORS § 733.530 — OR Code / Title 56 / Chapter 733 / Section 733.530
733.530 “Corporation,” “sovereign,” “political subdivision” defined
Status: in_force

As used in ORS 733.510 (Investments of insurers) to 733.780 (Prohibited investments) :

(1) “Corporation” means a corporation, joint stock association or business trust organized and existing under the laws of a sovereign.

(2) “Sovereign” means the United States, or a state, or Canada or a province thereof.

(3) “Political subdivision” means an incorporated county, city, town, village, municipality, or subdivision thereof, or a public corporation, district, agency, commission, authority or instrumentality, or subdivision thereof. [1967 c.359 §231]

Source: Section 733.530 — “Corporation,” “sovereign,” “political subdivision” defined , https://www.­oregonlegislature.­gov/bills_laws/ors/ors733.­html (accessed May 26, 2025).
ORS § 731.069 — OR Code / Title 56 / Chapter 731 / Section 731.069
731.069 “Certificate,” “certificate holder.”
Status: in_force

(1) “Certificate” means a written statement evidencing the coverage of a person insured under a group insurance policy.

(2) “Certificate holder” means an employee or member of a group insured under a group insurance policy. [1981 c.752 §11]

Source: Section 731.069 — “Certificate,” “certificate holder.” , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 744.852 — OR Code / Title 56 / Chapter 744 / Section 744.852
744.852 Limited license for rental companies
Status: in_force

(1) The Director of the Department of Consumer and Business Services shall adopt rules to specify information that rental companies must submit in applying for a limited license.

(2) A rental company that intends to offer insurance as described in ORS 744.854 (Kinds of insurance authorized by limited license) shall file a limited license application with the director in such form and containing such information as the director requires.

(3) After receiving an application, the director may issue a limited license to the rental company if the director is satisfied that the application is complete. A limited license that the director issues to the rental company under this section is also a limited license for an employee or designated agent of the rental company to offer and sell insurance in accordance with ORS 744.854 (Kinds of insurance authorized by limited license) for vehicles that the rental company rents. [1999 c.485 §3; 2015 c.524 §1]

Note: See note under 744.850 (Definitions for ORS 744.850 to 744.858) .

Source: Section 744.852 — Limited license for rental companies; application; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).