ORS § 743.652 — OR Code / Title 56 / Chapter 743 / Section 743.652
743.652 Definitions for ORS 743.650 to 743.665
Status: in_force

As used in ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements) , unless the context requires otherwise:

(1) “Applicant” means:

(a) In the case of an individual long term care insurance policy, the person who seeks to contract for benefits; and

(b) In the case of a group long term care insurance policy, the proposed certificate holder.

(2) “Benefit trigger” means a contractual provision in a long term care insurance policy that conditions the payment of benefits on an insured’s inability to perform activities of daily living or on an insured’s cognitive impairment. For qualified long term care insurance, the “benefit trigger” is the determination that an insured is a chronically ill individual, as defined in section 7702B(c) of the Internal Revenue Code.

(3) “Certificate” means any certificate issued under a group long term care insurance policy, if the policy has been delivered or issued for delivery in this state.

(4) “Group long term care insurance” means a long term care insurance policy that is delivered or issued for delivery in this state and issued to:

(a) One or more employers or labor organizations, or to a trust or to the trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations;

(b) Any professional, trade or occupational association for its members or former or retired members, or combination thereof, if such association:

(A) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and

(B) Has been maintained in good faith for purposes other than obtaining insurance;

(c) Intentionally left blank —Ed.

(A) An association or a trust or the trustee of a fund established, created or maintained for the benefit of members of one or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations shall file evidence with the director that the association or associations have been organized and maintained in good faith for purposes other than that of obtaining insurance; have been in active existence for at least one year; and have a constitution and bylaws that provide that:

(i) The association or associations hold regular meetings not less than annually to further purposes of the members;

(ii) Except for credit unions, the association or associations collect dues or solicit contributions from members; and

(iii) The members have voting privileges and representation on the governing board and committees; and

(B) Sixty days after the filing, the association or associations shall be considered to satisfy the organizational requirements, unless the director makes a finding that the association or associations do not satisfy those organizational requirements; or

(d) A group other than as described in paragraphs (a), (b) and (c) of this subsection, subject to a finding by the director that:

(A) The issuance of the group policy is not contrary to the best interest of the public;

(B) The issuance of the group policy would result in economies of acquisition or administration; and

(C) The benefits are reasonable in relation to the premiums charged.

(5) “Long term care insurance” means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than 24 consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis; for one or more necessary or medically necessary services, including but not limited to nursing, diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care services, provided in a setting other than an acute care unit of a hospital. “Long term care insurance” includes group and individual annuities and life insurance policies or riders that provide directly or supplement long term care insurance. “Long term care insurance” also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity, and qualified long term care insurance contracts. Long term care insurance may be issued by insurers; fraternal benefit societies; nonprofit health, hospital and medical service corporations; prepaid health plans; or health maintenance organizations, health care service contractors or any similar organization to the extent they are otherwise authorized to issue life or health insurance. “Long term care insurance” does not include any insurance policy that is offered primarily to provide basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income or related asset protection coverage, catastrophic coverage, accident only coverage, specified disease or specified accident coverage or limited benefit coverage. With regard to life insurance, “long term care insurance” does not include life insurance policies that accelerate the death benefit specifically for one or more of the qualifying events of terminal illness, medical conditions requiring extraordinary medical intervention or permanent institutional confinement, and that provide the option of a lump-sum payment for those benefits and when neither the benefits nor the eligibility for the benefits is conditioned upon the receipt of long term care. Notwithstanding any other provision of ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements) , any product advertised, marketed or offered as long term care insurance is subject to ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements) .

(6) “Policy” means any policy, contract, subscriber agreement, rider or indorsement delivered or issued for delivery in this state by an insurer; fraternal benefit society; nonprofit health, hospital or medical service corporation; prepaid health plan; or health maintenance organization, health care service contractor or any similar organization.

(7) “Qualified long term care insurance” means:

(a) The portion of a life insurance contract that provides long term care insurance coverage by rider or as part of the contract and that satisfies the requirements of section 7702B(b) and (e) of the Internal Revenue Code; or

(b) Individual or group long term care insurance as defined in this section that meets all of the following requirements of section 7702B(b) of the Internal Revenue Code:

(A) The only insurance protection provided under the contract is coverage of qualified long term care services. A contract shall not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate.

(B) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act, or would be reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subparagraph do not apply to expenses that are reimbursable under Title XVIII of the Social Security Act only as a secondary payer. A contract does not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate.

(C) The contract is guaranteed renewable within the meaning of section 7702B(b)(1)(C) of the Internal Revenue Code.

(D) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subparagraph (E) of this paragraph.

(E) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract.

(F) The contract meets the consumer protection provisions set forth in section 7702B(g) of the Internal Revenue Code. [1989 c.1022 §4; 1993 c.744 §30; 1995 c.79 §364; 2007 c.486 §2; 2011 c.69 §3; 2016 c.11 §3]

Source: Section 743.652 — Definitions for ORS 743.650 to 743.665 , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 737.510 — OR Code / Title 56 / Chapter 737 / Section 737.510
737.510 Advisory organizations
Status: in_force

(1) Every advisory organization shall file with the Director of the Department of Consumer and Business Services:

(a) A copy of its constitution, its articles of agreement or association or its certificate of incorporation and of its bylaws, rules and regulations governing its activities.

(b) A list of its members.

(c) The name and address of a resident of this state upon whom notices may be served.

(d) An agreement that the director may examine such advisory organization in accordance with ORS 737.515 (Examination of rating, advisory and other organizations) .

(2) Any insurer which makes its own filings or any rating organization may support its filings by statistics or adopt rate-making recommendations furnished to it by an advisory organization which has complied with this section. If, after a hearing, the director finds that the furnishing of such information or assistance involves any act or practice which is unfair or unreasonable or otherwise inconsistent with this chapter, the director may issue a written order specifying in what respects such act or practice is unfair or unreasonable or otherwise inconsistent with this chapter. If the act or practice thus specified is not modified to comply with such order, the director may issue an order requiring any insurer which makes its own filings or any rating organization to discontinue the use of the statistics or rate-making recommendations furnished to it by such advisory organization. [Amended by 1967 c.359 §328; 1969 c.690 §23]

Source: Section 737.510 — Advisory organizations; registration; jurisdiction of director to restrict unfair practices , https://www.­oregonlegislature.­gov/bills_laws/ors/ors737.­html (accessed May 26, 2025).
ORS § 743b.800 — OR Code / Title 56 / Chapter 743b / Section 743b.800
743B.800 Risk adjustment procedures
Status: repealed

(1) As used in this section, “health benefit plan” means a health benefit plan, as defined in ORS 743B.005 (Definitions) , that is offered in the individual or small group market.

(2) The Department of Consumer and Business Services may establish by rule a procedure for adjusting risk between insurers. If a procedure is established:

(a) The procedure may include:

(A) An assessment imposed on an insurer if the actuarial risk of the enrollees in the insurer’s health benefit plans is less than the average actuarial risk of all enrollees in all health benefit plans in this state; and

(B) Payments to insurers if the actuarial risk of the enrollees in the insurer’s health benefit plans is greater than the average actuarial risk of all enrollees in all health benefit plans in this state.

(b) The methodology for adjusting risk between insurers must be consistent with 42 U.S.C. 18063 and regulations adopted by the Secretary of the United States Department of Health and Human Services to carry out 42 U.S.C. 18063 that are in effect on January 1, 2019. [Formerly 743.923; 2017 c.152 §14; 2019 c.285 §10]

Note: 743B.800 (Risk adjustment procedures) 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.

Note: Sections 1 to 8, 17 to 21 and 48, chapter 538, Oregon Laws 2017, provide:

Sec. 1. Sections 2 to 8 of this 2017 Act are added to and made a part of the Insurance Code. [2017 c.538 §1]

Sec. 2. (1) The Health System Fund is established in the State Treasury, separate and distinct from the General Fund. Interest earned by the Health System Fund shall be credited to the fund.

(2) Amounts in the Health System Fund are continuously appropriated to the Department of Consumer and Business Services for the purposes of:

(a) Administering the Oregon Reinsurance Program established in section 18 of this 2017 Act; and

(b) Transferring moneys to the Oregon Health Authority to:

(A) Provide medical assistance and other health services under ORS chapter 414.

(B) Pay refunds due under section 11 of this 2017 Act.

(C) Pay administrative costs incurred by the authority to administer the assessment described in section 9 of this 2017 Act. [2017 c.538 §2]

Sec. 3. (1) As used in this section:

(a) “Insured” means an eligible employee or family member, as defined in ORS 243.105 (Definitions for ORS 243.105 to 243.285) , who is enrolled in a self-insured health benefit plan under ORS 243.105 (Definitions for ORS 243.105 to 243.285) to 243.285 (Salary deductions) .

(b) “Premium equivalent” means a claim for reimbursement of the cost of a health care item or service provided to an insured, other than a dental or vision care item or service, and the administrative costs associated with the claim.

(2) No later than 45 days following the end of a calendar quarter, the Public Employees’ Benefit Board shall pay an assessment at the rate of two percent on the gross amount of premium equivalents received during the calendar quarter.

(3) The assessment shall be paid to the Department of Consumer and Business Services and shall be accompanied by a verified report, on a form prescribed by the department, together with any information required by the department.

(4) The assessment imposed under this section is in addition to and not in lieu of any tax, surcharge or other assessment imposed on the board.

(5) If the department determines that the assessment paid by the board under this section is incorrect, the department shall charge or credit to the board the difference between the correct amount of the assessment and the amount paid by the board.

(6) The board is entitled to notice and an opportunity for a contested case hearing under ORS chapter 183 to contest an action of the department taken pursuant to subsection (5) of this section.

(7) Moneys received by the department under this section shall be paid into the State Treasury and credited to the Health System Fund established under section 2, chapter 538, Oregon Laws 2017. [2017 c.538 §3; 2019 c.2 §4]

Sec. 4. Section 3, chapter 538, Oregon Laws 2017, applies to premium equivalents received by the Public Employees’ Benefit Board, or a third party administrator that contracts with the board to administer a self-insured health benefit plan, during the period from January 1, 2020, through December 31, 2026. [2017 c.538 §4; 2019 c.2 §5]

Sec. 5. (1) As used in this section:

(a) “Gross amount of premiums” has the meaning given that term in ORS 731.808 (“Gross amount of premiums” defined) .

(b) “Health plan” means:

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

(B) Insurance described in ORS 742.065 (Insurance against risk of loss assumed under less than fully insured employee health benefit plan) .

(2) No later than 45 days following the end of a calendar quarter, an insurer shall pay an assessment at the rate of two percent of the gross amount of premiums earned by the insurer during that calendar quarter that were derived from health plans delivered or issued for delivery in Oregon.

(3) The assessment shall be paid to the Department of Consumer and Business Services and shall be accompanied by a verified form prescribed by the department together with any information required by the department, that reports:

(a) All health plans issued or renewed by the insurer during the calendar quarter for which the assessment is paid; and

(b) The gross amount of premiums by line of insurance, derived by the insurer from all health plans issued or renewed by the insurer during the calendar quarter for which the assessment is paid.

(4) The assessment imposed under this section is in addition to and not in lieu of any tax, surcharge or other assessment imposed on an insurer.

(5) Any rate filed for the department’s approval may include amounts paid by the insurer under this section as a valid element of administrative expense or retention.

(6) Moneys received by the department under this section shall be paid into the State Treasury and credited to the Health System Fund established under section 2, chapter 538, Oregon Laws 2017. [2017 c.538 §5; 2019 c.2 §6]

Sec. 6. (1) If the Public Employees’ Benefit Board fails to timely file a verified form or to pay an assessment required under section 3, chapter 538, Oregon Laws 2017, the Department of Consumer and Business Services shall impose a penalty on the board of up to $500 per day of delinquency. The total amount of penalties imposed under this section for a calendar quarter may not exceed five percent of the assessment due for that calendar quarter.

(2) If an insurer fails to timely file a verified form or to pay an assessment required under section 5, chapter 538, Oregon Laws 2017, the department shall impose a penalty on the insurer of the greater of:

(a) An amount determined under ORS 731.988 (Civil penalties) ; or

(b) Five percent of the assessment due for the calendar quarter.

(3) Any penalty imposed under this section is in addition to and not in lieu of the assessment imposed under sections 3 and 5, chapter 538, Oregon Laws 2017. [2017 c.538 §6; 2019 c.2 §7]

Sec. 7. (1) If the Department of Consumer and Business Services determines that the assessment paid by the insurer under section 5 of this 2017 Act is incorrect, the department shall charge or credit to the insurer the difference between the correct amount of the assessment and the amount paid by the insurer.

(2) An insurer that is aggrieved by an action of the department taken pursuant to subsection (1) of this section shall be entitled to notice and an opportunity for a contested case hearing under ORS chapter 183. [2017 c.538 §7]

Sec. 8. Section 5, chapter 538, Oregon Laws 2017, applies to premiums earned by an insurer for the period beginning January 1, 2020, and ending December 31, 2026. [2017 c.538 §8; 2019 c.2 §8]

Sec. 17. Sections 18 to 21 of this 2017 Act are added to and made a part of the Insurance Code. [2017 c.538 §17]

Sec. 18. The Oregon Reinsurance Program is established in the Department of Consumer and Business Services for the purposes of stabilizing the rates and premiums for individual health benefit plans and providing greater financial certainty to consumers of health insurance in this state. [2017 c.538 §18]

Sec. 19. (1) As used in this section:

(a) “Attachment point” means the threshold dollar amount, adopted by the Department of Consumer and Business Services by rule, for claims costs incurred by a reinsurance eligible health benefit plan for an insured individual’s covered benefits in a benefit year, after which threshold the claims costs for the benefits are eligible for reinsurance payments.

(b) “Coinsurance rate” means the rate, adopted by the department by rule, at which the department will reimburse a reinsurance eligible health benefit plan for claims costs incurred for an insured individual’s covered benefits in a benefit year after the attachment point and before the reinsurance cap.

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

(d) “Reinsurance cap” means the threshold dollar amount, adopted by the department by rule, for claims costs incurred by a reinsurance eligible health benefit plan for an insured individual’s covered benefits in a benefit year, after which threshold the claims costs for the benefits are no longer eligible for state reinsurance payments.

(e) “Reinsurance eligible health benefit plan” means a health benefit plan providing individual coverage that:

(A) Is delivered or issued for delivery in this state; and

(B) Is not a grandfathered health plan as defined in ORS 743B.005 (Definitions) .

(f) “Reinsurance eligible individual” means an individual who is insured in a reinsurance eligible health benefit plan.

(2) An issuer of a reinsurance eligible health benefit plan becomes eligible for a reinsurance payment when the claims costs for a reinsurance eligible individual’s covered benefits in a calendar year exceed the attachment point. The amount of the payment shall be the product of the coinsurance rate and the issuer’s claims costs for the reinsurance eligible individual that exceed the attachment point, up to the reinsurance cap.

(3) After the department adopts by rule the attachment point, reinsurance cap or coinsurance rate, the department may, only if necessary to pay out the full amount of funding budgeted for the Oregon Reinsurance Program when claims received are less than the amount of claims that were projected:

(a) Change the attachment point during that benefit year; or

(b) Increase the coinsurance rate during the benefit year.

(4) The department may adopt rules necessary to carry out the provisions of this section including, but not limited to, rules prescribing:

(a) The amount, manner and frequency of reinsurance payments; and

(b) Reporting requirements for issuers of reinsurance eligible health benefit plans. [2017 c.538 §19; 2019 c.2 §1]

Sec. 20. (1) As used in this section:

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

(b) “Oregon Reinsurance Program” means the program established in section 18 of this 2017 Act.

(c) “Reinsurance eligible individual” has the meaning given that term in section 19 of this 2017 Act.

(2) An insurer that offers a health benefit plan must report to the Department of Consumer and Business Services, in the form and manner prescribed by the department by rule, information about reinsurance eligible individuals insured by the health benefit plan as necessary for the department to calculate reinsurance payments under the Oregon Reinsurance Program. [2017 c.538 §20]

Sec. 21. In a rate filing under ORS 743.018 (Filing of rates for life and health insurance) , an insurer must identify the impact of reinsurance payments under section 19 of this 2017 Act on projected claims costs and in the development of rates. [2017 c.538 §21]

Sec. 48. Sections 18 to 22, chapter 538, Oregon Laws 2017, are repealed on January 2, 2028. [2017 c.538 §48; 2019 c.2 §3]

Note: Section 2, chapter 26, Oregon Laws 2016, provides:

Sec. 2. The Department of Consumer and Business Services shall have sole authority to apply for a waiver for state innovation under 42 U.S.C. 18052. The department shall apply for a waiver to receive funding to implement the Oregon Reinsurance Program established in section 18, chapter 538, Oregon Laws 2017, and apply for subsequent renewals of the waiver to continue the program as long as revenue from the assessment under section 5, chapter 538, Oregon Laws 2017, is available. [2016 c.26 §2; 2017 c.538 §24; 2019 c.2 §2]

Source: Section 743B.800 — Risk adjustment procedures; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 732.594 — OR Code / Title 56 / Chapter 732 / Section 732.594
732.594 Director’s determination or acknowledgment of appropriate group-wide supervisor for internationally active insurance group
Status: in_force

(1) The Director of the Department of Consumer and Business Services shall:

(a) Act, in accordance with the provisions of this section, as the group-wide supervisor for any internationally active insurance group; or

(b) Acknowledge another regulatory official as the group-wide supervisor for an internationally active insurance group if the internationally active insurance group:

(A) Does not have substantial insurance operations in the United States;

(B) Has substantial insurance operations in the United States but not in this state; or

(C) Has substantial insurance operations in this state but the director determines under criteria set forth in subsections (2) and (6) of this section that the other regulatory official is the appropriate group-wide supervisor.

(2) The director, in cooperation with other state, federal and international regulatory agencies, shall identify a single group-wide supervisor for each internationally active insurance group. The director may determine that the director is the appropriate group-wide supervisor for an internationally active insurance group with substantial insurance operations in this state or the director may determine that another regulatory official is the appropriate group-wide supervisor. In making the determination, the director shall consider:

(a) Where the insurers that have the largest share of the internationally active insurance group’s written premiums, assets or liabilities are domiciled;

(b) Where the top-tier insurers within the internationally active insurance group’s insurance holding company system are domiciled;

(c) Where the internationally active insurance group has executive offices or the group’s largest operational offices;

(d) Whether another regulatory official is acting, or seeks to act, as the group-wide supervisor for the internationally active insurance group under a regulatory system that the director determines is:

(A) Substantially similar to the regulations set forth in the Insurance Code; or

(B) Otherwise sufficient to enable the regulatory official to engage in group-wide supervision and enterprise risk analysis and to cooperate with other regulatory officials; and

(e) Whether another regulatory official that is acting, or seeks to act, as the group-wide supervisor provides the director with a reasonable degree of reciprocal acknowledgment and cooperation.

(3) A regulatory official that the director determines under subsection (2) of this section is the appropriate group-wide supervisor for an internationally active insurance group may in turn acknowledge a different regulatory official as the appropriate group-wide supervisor. Before acknowledging another regulatory official as an appropriate group-wide supervisor, a regulatory official shall:

(a) Consider the criteria set forth in subsection (2) of this section;

(b) Cooperate with and obtain acknowledgment from other regulatory officials with responsibility for supervising the internationally active insurance group; and

(c) Consult with the internationally active insurance group.

(4) Notwithstanding any other provision of this section or ORS 732.596 (Request by insurance holding company system for determination or acknowledgement of group-wide supervisor) , the director shall acknowledge another regulatory official that is acting as a group-wide supervisor for an internationally active insurance group unless a material change in the internationally active insurance group requires the director to make a determination under subsection (2) of this section as to the appropriate group-wide supervisor for the internationally active insurance group. For purposes of this determination, a material change is:

(a) Insurers domiciled within this state come to hold the largest share of the internationally active insurance group’s written premiums, assets or liabilities; or

(b) The top-tier insurers within the internationally active insurance group’s insurance holding company system become domiciled in this state.

(5) The director, in accordance with ORS 732.584 (Examinations) , may order an insurer registered under ORS 732.551 (Registration of insurer members of holding company systems) to produce any information the director requires to determine whether the director may act as, or must acknowledge another regulatory official as, the group-wide supervisor for an internationally active insurance group. Before determining that the director is the appropriate group-wide supervisor for an internationally active insurance group, the director shall inform the insurer that provided the information and the controlling entity within the internationally active insurance group, and give the internationally active insurance group at least 30 days in which to provide any additional information that may relate to the director’s determination. The director shall identify internationally active insurance groups for which the director acts as the group-wide supervisor on the Department of Consumer and Business Services website.

(6) As the group-wide supervisor for an internationally active insurance group, the director may:

(a) Assess enterprise risks within the internationally active insurance group to evaluate whether persons who manage members of the internationally active insurance group that are engaged in transacting insurance have identified the members’ material financial condition and liquidity risks and have established reasonable and effective mitigation measures;

(b) Request from any member of an internationally active insurance group subject to the director’s supervision information that is necessary and appropriate to enable the director to assess enterprise risk for the member, including information about the member’s:

(A) Governance, risk assessment and management;

(B) Capital adequacy; and

(C) Material intercompany transactions;

(c) Require members of internationally active insurance groups to develop and implement reasonable measures to enable the members to timely recognize and mitigate enterprise risks and, if necessary, assist the members or ask regulatory officials in jurisdictions in which the members are domiciled to compel the members to develop and implement the measures;

(d) Communicate and share information, including through a supervisory college described in ORS 732.571 (Supervisory college for domestic insurer) , with other state, federal and international regulatory agencies that have authority over members of internationally active insurance groups, subject to the confidentiality provisions of ORS 705.137 (Information that is confidential or not subject to disclosure) , 705.138 (Confidential and privileged documents) , 705.139 (Agreements with other agencies regarding sharing and use of confidential information) and 732.586 (Confidentiality of information) ;

(e) Enter into agreements with, or obtain information from, any insurer registered under ORS 732.551 (Registration of insurer members of holding company systems) , any member of an internationally active insurance group or any other state, federal or international regulatory agency with authority over the internationally active insurance group in order to clarify or provide a basis for the director’s authority as a group-wide supervisor, provided that the agreements or information:

(A) Enable the director to resolve disputes with other regulatory officials; and

(B) Will not serve as evidence in any proceeding that an insurer or person within an insurance holding company system that is not domiciled or organized in this state is transacting insurance in this state or is otherwise subject to the jurisdiction of this state; or

(f) Perform any other activities the director deems necessary to exercise the functions of a group-wide supervisor, provided the activities are consistent with the authority and the purposes set forth in this section.

(7) Intentionally left blank —Ed.

(a) The director may cooperate, including through a supervisory college described in ORS 732.571 (Supervisory college for domestic insurer) , with another regulatory official from a jurisdiction that the National Association of Insurance Commissioners has not accredited in the regulatory official’s role as a group-wide supervisor if:

(A) The director acknowledges the regulatory official as a group-wide supervisor;

(B) The director’s cooperation complies with the laws of this state; and

(C) The regulatory official cooperates with the director’s activities as a group-wide supervisor for other internationally active insurance groups as appropriate.

(b) The director may refuse to acknowledge and cooperate with a regulatory official who does not reciprocate the director’s acknowledgment and cooperation under this subsection.

(8) The director may enter into agreements with or obtain information from an insurer registered under ORS 732.551 (Registration of insurer members of holding company systems) , an affiliate of the insurer and any other state, federal or international regulatory agency if the agreement or information clarifies or provides the basis for a regulatory official’s authority as a group-wide supervisor.

(9) An insurer that is subject to this section, or that is a member of an internationally active insurance group that is subject to this section, shall pay the director’s reasonable expenses of administering this section, including expenses associated with engaging attorneys, actuaries or other professionals and reasonable travel expenses. [2017 c.479 §2]

Source: Section 732.594 — Director’s determination or acknowledgment of appropriate group-wide supervisor for internationally active insurance group; requirement for insurer to produce needed information; director’s powers; cooperation with other regulatory officials , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 732.538 — OR Code / Title 56 / Chapter 732 / Section 732.538
732.538 Effect of merger or consolidation
Status: in_force

(1) When a merger or consolidation becomes effective, the effect on the insurers and other parties to the merger or consolidation is as follows:

(a) The several insurers and other parties to the plan of merger or consolidation shall be a single insurer or other corporation, which, in the case of a merger, shall be that insurer or other corporation designated in the plan of merger as the surviving insurer or corporation, and, in the case of a consolidation, shall be the new insurer or other corporation provided for in the plan of consolidation.

(b) The separate existence of all insurers and other corporations party to the plan of merger or consolidation, except the surviving or new insurer or other corporation, shall cease.

(c) The surviving or new insurer or other corporation shall have all the rights, privileges, immunities and powers and shall be subject to all the duties and liabilities of an insurer organized under this chapter. If the surviving corporation is a health care service contractor, the corporation shall be subject to all the duties and liabilities of a health care service contractor under the Insurance Code.

(d) The surviving or new insurer or other corporation shall thereupon and thereafter possess all the rights, privileges, immunities and franchises, as well of a public as of a private nature, of each of the merging or consolidating insurers and other corporations. All property, real, personal and mixed, and all debts due on whatever account, including subscriptions to shares, and all other choses in action, and all and every other interest, of or belonging to or due to each of the insurers and other corporations so merged or consolidated, shall be taken and deemed to be transferred to and vested in the single insurer or corporation without further act or deed. The title to any real estate, or any interest therein, vested in any of such insurers and other corporations shall not revert or be in any way impaired by reason of the merger or consolidation.

(e) The surviving or new insurer or other corporation shall thenceforth be responsible and liable for all the liabilities and obligations of each of the insurers and other corporations so merged or consolidated. Any claim existing or action or proceeding pending by or against any of such insurers or other corporations may be prosecuted as if the merger or consolidation had not taken place, or such surviving or new insurer or other corporation may be substituted in its place. Neither the rights of creditors nor any liens upon the property of any such insurer or other corporation shall be impaired by such merger or consolidation.

(f) In the case of a merger, the articles of incorporation of the surviving insurer or other corporation shall be deemed to be amended to the extent, if any, that changes in its articles of incorporation are stated in the plan of merger. In the case of a consolidation, the statements set forth in the articles of consolidation that are required or permitted to be set forth in the articles of incorporation of corporations organized under ORS chapter 60 shall be deemed to be the original articles of incorporation of the new corporation.

(2) Subject to any shareholder rights under ORS 60.554 (Right to dissent) and 60.557 (Dissent by nominees and beneficial owners) , when a merger or consolidation becomes effective, in the case of an insurer or other corporation that has ceased to exist because of a merger or consolidation, the shares of that insurer or other corporation that are to be converted under the plan of merger or consolidation are void.

(3) As of the date on which a merger or consolidation becomes effective, the holders of converted shares are entitled only to the shares, obligations, other securities, cash or other property into which the shares have been converted in accordance with the plan of merger or consolidation.

(4) In the event of reinsurance pursuant to the plan, the applicable provisions of the Insurance Code shall govern the effects thereof. [Formerly 732.570; 1999 c.362 §66]

Source: Section 732.538 — Effect of merger or consolidation , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 743a.264 — OR Code / Title 56 / Chapter 743a / Section 743a.264
743A.264 Disease outbreaks, epidemics and conditions of public health importance
Status: repealed

(1) As used in this section:

(a) “Condition of public health importance” has the meaning given that term in ORS 431A.005 (Definitions) .

(b) “Disease outbreak” has the meaning given that term in ORS 431A.005 (Definitions) .

(c) “Enrollee” means an individual residing in this state who:

(A) Is enrolled in a health benefit plan; and

(B) The Public Health Director determines may be affected by a disease outbreak, epidemic or other condition of public health importance.

(d) “Epidemic” has the meaning given that term in ORS 431A.005 (Definitions) .

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

(f) “Insurer” means a person with a certificate of authority to transact insurance in this state.

(g) “Utilization review” has the meaning given that term in ORS 743B.001 (Definitions) .

(2) If the director determines that there exists a disease outbreak, epidemic or other condition of public health importance in a geographic area of this state or statewide, an insurer shall, for enrollees in a health benefit plan offered by the insurer, cover the cost of necessary antitoxins, serums, vaccines, immunizing agents, antibiotics, antidotes and other pharmaceutical agents, medical supplies or other prophylactic measures approved by the United States Food and Drug Administration that the director deems necessary to prevent the spread of the disease, epidemic or other condition of public health importance.

(3) An insurer may not restrict coverage under subsection (2) of this section by:

(a) Requiring that the health services be administered by an in-network provider;

(b) Imposing cost-sharing requirements that are greater than the cost-sharing requirements for similar covered services;

(c) Requiring prior authorization or other utilization review measures; or

(d) Limiting coverage in any manner that prevents an enrollee from accessing the necessary health services. [2017 c.719 §2; 2019 c.284 §7]

Note: See 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) .

Note: 743A.264 (Disease outbreaks, epidemics and conditions of public health importance) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Note: Sections 2 and 22, chapter 771, Oregon Laws 2013, provide:

Sec. 2. (1) As used in this section and section 3a, chapter 771, Oregon Laws 2013:

(a) Intentionally left blank —Ed.

(A) “Applied behavior analysis” means the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce significant improvement in human social behavior, including the use of direct observation, measurement and functional analysis of the relationship between environment and behavior, that is provided by:

(i) A licensed health care professional as defined in ORS 676.802 (Definitions for ORS 676.802 to 676.830) ;

(ii) A behavior analyst or assistant behavior analyst licensed under ORS 676.810 (Board duties) ; or

(iii) A behavior analysis interventionist registered under ORS 676.815 (Behavior analysis interventionists) who receives ongoing training and supervision by a licensed behavior analyst, by a licensed assistant behavior analyst or by a licensed health care professional.

(B) “Applied behavior analysis” does not mean psychological testing, neuropsychology, psychotherapy, cognitive therapy, sex therapy, psychoanalysis, hypnotherapy and long-term counseling as treatment modalities.

(b) “Autism spectrum disorder” has the meaning given that term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.

(c) “Diagnosis” means medically necessary assessment, evaluation or testing.

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

(e) “Medically necessary” means in accordance with the definition of medical necessity that is specified in the policy or certificate for the health benefit plan and that applies to all covered services under the plan.

(f) “Treatment for autism spectrum disorder” includes applied behavior analysis for up to 25 hours per week and any other mental health or medical services identified in the individualized treatment plan, as described in subsection (6) of this section.

(2) A health benefit plan shall provide coverage of:

(a) The screening for and diagnosis of autism spectrum disorder by a licensed neurologist, pediatric neurologist, developmental pediatrician, psychiatrist or psychologist, who has experience or training in the diagnosis of autism spectrum disorder; and

(b) Medically necessary treatment for autism spectrum disorder and the management of care, for an individual who begins treatment before nine years of age, subject to the requirements of this section.

(3) This section does not require coverage for:

(a) Services provided by a family or household member;

(b) Services that are custodial in nature or that constitute marital, family, educational or training services;

(c) Custodial or respite care, equine assisted therapy, creative arts therapy, wilderness or adventure camps, social counseling, telemedicine, music therapy, neurofeedback, chelation or hyperbaric chambers;

(d) Services provided under an individual education plan in accordance with the Individuals with Disabilities Education Act, 20 U.S.C. 1400 et seq.;

(e) Services provided through community or social programs; or

(f) Services provided by the Department of Human Services or the Oregon Health Authority, other than employee benefit plans offered by the department and the authority.

(4) An insurer may not terminate coverage or refuse to issue or renew coverage for an individual solely because the individual has received a diagnosis of autism spectrum disorder or has received treatment for autism spectrum disorder.

(5) Coverage under this section may be subject to utilization controls that are reasonable in the context of individual determinations of medical necessity. An insurer may require:

(a) An autism spectrum disorder diagnosis by a professional described in subsection (2)(a) of this section if the original diagnosis was not made by a professional described in subsection (2)(a) of this section.

(b) Prior authorization for coverage of a maximum of 25 hours per week of applied behavior analysis recommended in an individualized treatment plan approved by a professional described in subsection (2)(a) of this section for an individual with autism spectrum disorder, as long as the insurer makes a prior authorization determination no later than 30 calendar days after receiving the request for prior authorization, notwithstanding ORS 743B.423 (Utilization review requirements for insurers offering health benefit plan) .

(6) If an individual is receiving applied behavior analysis, an insurer may require submission of an individualized treatment plan, which shall include all elements necessary for the insurer to appropriately determine coverage under the health benefit plan. The individualized treatment plan must be based on evidence-based screening criteria. An insurer may require an updated individualized treatment plan, not more than once every six months, that includes observed progress as of the date the updated plan was prepared, for the purpose of performing utilization review and medical management. The insurer may require the individualized treatment plan to be approved by a professional described in subsection (2)(a) of this section, and to include the:

(a) Diagnosis;

(b) Proposed treatment by type;

(c) Frequency and anticipated duration of treatment;

(d) Anticipated outcomes stated as goals, including specific cognitive, social, communicative, self-care and behavioral goals that are clearly stated, directly observed and continually measured and that address the characteristics of the autism spectrum disorder; and

(e) Signature of the treating provider.

(7) Intentionally left blank —Ed.

(a) Once coverage for applied behavior analysis has been approved, the coverage continues as long as:

(A) The individual continues to make progress toward the majority of the goals of the individualized treatment plan; and

(B) Applied behavior analysis is medically necessary.

(b) An insurer may require periodic review of an individualized treatment plan, as described in subsection (6) of this section, and modification of the individualized treatment plan if the review shows that the individual receiving the treatment is not making substantial clinical progress toward the goals of the individualized treatment plan.

(8) Coverage under this section may be subject to requirements and limitations no more restrictive than those imposed on coverage or reimbursement of expenses arising from the treatment of other medical conditions under the policy or certificate, including but not limited to:

(a) Requirements and limitations regarding in-network providers; and

(b) Provisions relating to deductibles, copayments and coinsurance.

(9) This section applies to coverage for up to 25 hours per week of applied behavior analysis for an individual if the coverage is first requested when the individual is under nine years of age. This section does not limit coverage for any services that are otherwise available to an individual under ORS 743A.168 (Behavioral health treatment) or 743A.190 (Children with pervasive developmental disorder) , including but not limited to:

(a) Treatment for autism spectrum disorder other than applied behavior analysis or the services described in subsection (3) of this section;

(b) Applied behavior analysis for more than 25 hours per week; or

(c) Applied behavior analysis for an individual if the coverage is first requested when the individual is nine years of age or older.

(10) Coverage under this section includes treatment for autism spectrum disorder provided in the individual’s home or a licensed health care facility or, for treatment provided by a licensed health care professional as defined in ORS 676.802 (Definitions for ORS 676.802 to 676.830) or a behavior analyst or assistant behavior analyst licensed under ORS 676.810 (Board duties) or a behavior analysis interventionist registered under ORS 676.815 (Behavior analysis interventionists) , in a setting approved by the health care professional, behavior analyst or assistant behavior analyst.

(11) An insurer that provides coverage of applied behavior analysis in accordance with a decision of an independent review organization that was made prior to January 1, 2016, shall continue to provide coverage, subject to modifications made in accordance with subsection (7) of this section.

(12) ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) does not apply to this section. [2013 c.771 §2; 2015 c.674 §9; 2019 c.284 §11; 2023 c.500 §6]

Sec. 22. Section 2, chapter 771, Oregon Laws 2013, is repealed January 2, 2030. [2013 c.771 §22; 2021 c.650 §1]

Source: Section 743A.264 — Disease outbreaks, epidemics and conditions of public health importance , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html (accessed May 26, 2025).
ORS § 744.077 — OR Code / Title 56 / Chapter 744 / Section 744.077
744.077 Conditions under which person licensed as insurance producer and consultant may accept commission or fee
Status: in_force

(1) The Director of the Department of Consumer and Business Services shall establish by rule the conditions under which a person who is licensed as an insurance producer and as an insurance consultant may accept a commission or a fee, or both, in a transaction or in related transactions. The director may establish different conditions for such products as employee benefit plans, insurance for personal, family or household purposes and insurance for commercial purposes, and for any other insurance product as determined appropriate by the director. In developing rules under this subsection, the director shall take into account the requirements and characteristics of the different insurance products and the varying degrees of trade practice regulation needed.

(2) Except as otherwise provided by rule, an insurance producer who is not licensed as an insurance consultant may receive only commission. [Formerly 744.039; 2003 c.364 §17]

Source: Section 744.077 — Conditions under which person licensed as insurance producer and consultant may accept commission or fee; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 735.637 — OR Code / Title 56 / Chapter 735 / Section 735.637
735.637 License term
Status: in_force

A license obtained under ORS 735.634 (License application) is effective for one year, or for a longer period if the Director of the Department of Consumer and Business Services so prescribes by rule. The director shall prescribe by rule conditions and procedures under which a licensee may renew a license that has expired. [Formerly 742.430]

Note: See note under 735.631 (Definitions for ORS 735.631 to 735.643) .

Source: Section 735.637 — License term; renewal; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 735.340 — OR Code / Title 56 / Chapter 735 / Section 735.340
735.340 Insurance Code enforcement authority subject to federal law
Status: in_force

The director is authorized to make use of any of the powers established under the Insurance Code to enforce the laws of this state so long as those powers are not specifically preempted by the federal Product Liability Risk Retention Act of 1981, as amended by the Risk Retention Amendments of 1986. This includes, but is not limited to, the director’s administrative authority to investigate, issue subpoenas, conduct depositions and hearings, issue orders and impose penalties. With regard to any investigation, administrative proceedings or litigation, the director may rely on the procedural law and rules of the state. The injunctive authority of the director in regard to risk retention groups is restricted by the requirement that any injunction be issued by a court of competent jurisdiction. [1987 c.774 §106]

Source: Section 735.340 — Insurance Code enforcement authority subject to federal law , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 746.662 — OR Code / Title 56 / Chapter 746 / Section 746.662
746.662 Filing of insurance scoring models
Status: in_force

(1) An insurer may not use credit history to determine personal insurance eligibility, premiums or rates for coverage unless the insurer has filed the insurance scoring models used by the insurer with the Director of the Department of Consumer and Business Services. An insurance scoring model includes all attributes and factors used in the calculation of an insurance score.

(2) Insurance scoring models filed with the director under subsection (1) of this section are confidential and not subject to disclosure under ORS 192.311 (Definitions for ORS 192.311 to 192.478) to 192.478 (Exemption for Judicial Department) . [2003 c.788 §5]

Source: Section 746.662 — Filing of insurance scoring models , https://www.­oregonlegislature.­gov/bills_laws/ors/ors746.­html (accessed May 26, 2025).
ORS § 742.585 — OR Code / Title 56 / Chapter 742 / Section 742.585
742.585 Definitions for ORS 742.585 to 742.600
Status: in_force

As used in ORS 742.585 (Definitions for ORS 742.585 to 742.600) to 742.600 (Limitation on insurance policy reclassification for personal vehicle sharing program vehicle) :

(1) “Owner’s insurance policy” means a private passenger motor vehicle liability insurance policy that includes:

(a) All coverage necessary to comply with the financial or future responsibility requirements of ORS chapter 806;

(b) The personal injury protection coverage required under ORS 742.518 (Definitions for ORS 742.518 to 742.542) to 742.542 (Effect of personal injury protection benefits paid) ;

(c) The uninsured motorist coverage required under ORS 742.500 (Definitions for ORS 742.500 to 742.506) to 742.506 (Allocation of responsibility among insurers) ; and

(d) Any optional coverage selected by the owner.

(2) “Personal vehicle sharing” means the use of a private passenger motor vehicle by persons other than the vehicle’s registered owner in connection with a personal vehicle sharing program.

(3) “Personal vehicle sharing program” means a legal entity qualified to do business in this state engaged in the business of facilitating the sharing of private passenger motor vehicles for noncommercial use by individuals within this state.

(4) “Private passenger motor vehicle” means a four-wheel passenger or station wagon type motor vehicle insured under a motor vehicle liability insurance policy covering a single individual or individuals residing in the same household as the named insured.

(5) “Program insurance policy” means a motor vehicle liability insurance policy that is obtained by the personal vehicle sharing program and that:

(a) Includes all coverage needed to comply with the financial or future responsibility requirements of ORS chapter 806;

(b) Includes the personal injury protection coverage required under ORS 742.518 (Definitions for ORS 742.518 to 742.542) to 742.542 (Effect of personal injury protection benefits paid) ;

(c) Includes the uninsured motorist coverage required under ORS 742.500 (Definitions for ORS 742.500 to 742.506) to 742.506 (Allocation of responsibility among insurers) ;

(d) Includes comprehensive property damage coverage for the vehicle;

(e) Includes collision property damage coverage for the vehicle; and

(f) Does not include any other optional coverage selected by the owner of the vehicle and included in the owner’s insurance policy. [2011 c.457 §2]

Note: 742.585 (Definitions for ORS 742.585 to 742.600) to 742.600 (Limitation on insurance policy reclassification for personal vehicle sharing program vehicle) were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 742 or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 742.585 — Definitions for ORS 742.585 to 742.600 , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 743b.250 — OR Code / Title 56 / Chapter 743b / Section 743b.250
743B.250 Required notices to applicants and enrollees
Status: in_force

All insurers offering a health benefit plan in this state shall:

(1) Provide to all enrollees directly or in the case of a group policy to the employer or other policyholder for distribution to enrollees, to all applicants, and to prospective applicants upon request, the following information:

(a) The insurer’s written policy on the rights of enrollees, including the right:

(A) To participate in decision making regarding the enrollee’s health care.

(B) To be treated with respect and with recognition of the enrollee’s dignity and need for privacy.

(C) To have grievances handled in accordance with this section.

(D) To be provided with the information described in this section.

(b) An explanation of the procedures described in subsection (2) of this section for making coverage determinations and resolving grievances. The explanation must be culturally and linguistically appropriate, as prescribed by the Department of Consumer and Business Services by rule, and must include:

(A) The procedures for requesting an expedited response to an internal appeal under subsection (2)(d) of this section or for requesting an expedited external review of an adverse benefit determination;

(B) A statement that if an insurer does not comply with the decision of an independent review organization under ORS 743B.256 (Duties of independent review organizations) , the enrollee may sue the insurer under ORS 743B.258 (Private right of action) ;

(C) The procedure to obtain assistance available from the insurer, if any, and from the Department of Consumer and Business Services in filing grievances; and

(D) A description of the process for filing a complaint with the department.

(c) A summary of benefits and an explanation of coverage in a form and manner prescribed by the department by rule.

(d) A summary of the insurer’s policies on prescription drugs, including:

(A) Cost-sharing differentials;

(B) Restrictions on coverage;

(C) Prescription drug formularies;

(D) Procedures by which a provider with prescribing authority may prescribe clinically appropriate drugs not included on the formulary;

(E) Procedures for the coverage of clinically appropriate prescription drugs not included on the formulary; and

(F) A summary of the criteria for determining whether a drug is experimental or investigational.

(e) A list of network providers and how the enrollee can obtain current information about the availability of providers and how to access and schedule services with providers, including clinic and hospital networks. The list must be available online and upon request in printed format.

(f) Notice of the enrollee’s right to select a primary care provider and specialty care providers.

(g) How to obtain referrals for specialty care in accordance with ORS 743B.227 (Referrals to specialists) .

(h) Restrictions on services obtained outside of the insurer’s network or service area.

(i) The availability of continuity of care as required by ORS 743B.225 (Continuity of care) .

(j) Procedures for accessing after-hours care and emergency services as required by ORS 743A.012 (Emergency services) .

(k) Cost-sharing requirements and other charges to enrollees.

(L) Procedures, if any, for changing providers.

(m) Procedures, if any, by which enrollees may participate in the development of the insurer’s corporate policies.

(n) A summary of how the insurer makes decisions regarding coverage and payment for treatment or services, including a general description of any prior authorization and utilization review requirements that affect coverage or payment.

(o) Disclosure of any risk-sharing arrangement the insurer has with physicians or other providers.

(p) A summary of the insurer’s procedures for protecting the confidentiality of medical records and other enrollee information and the requirement under ORS 743B.555 (Confidential communications) that a carrier or third party administrator send communications containing protected health information only to the enrollee who is the subject of the protected health information.

(q) An explanation of assistance provided to non-English-speaking enrollees.

(r) Notice of the information available from the department that is filed by insurers as required under ORS 743B.200 (Requirements for insurers offering managed health insurance) , 743B.202 (Requirements for insurers offering managed health or preferred provider organization insurance) and 743B.423 (Utilization review requirements for insurers offering health benefit plan) .

(2) Establish procedures, in accordance with requirements adopted by the department, for making coverage determinations and resolving grievances that provide for all of the following:

(a) Timely notice of adverse benefit determinations.

(b) A method for recording all grievances, including the nature of the grievance and significant action taken.

(c) Written decisions.

(d) An expedited response to a request for an internal appeal that accommodates the clinical urgency of the situation.

(e) At least one but not more than two levels of internal appeal for group health benefit plans and one level of internal appeal for individual health benefit plans and for any denial of an exception to a prescription drug formulary. If an insurer provides:

(A) Two levels of internal appeal, a person who was involved in the consideration of the initial denial or the first level of internal appeal may not be involved in the second level of internal appeal; and

(B) No more than one level of internal appeal, a person who was involved in the consideration of the initial denial may not be involved in the internal appeal.

(f) Intentionally left blank —Ed.

(A) An external review that meets the requirements of ORS 743B.252 (External review) , 743B.254 (Required statements regarding external reviews) and 743B.255 (Enrollee application for external review) , after the enrollee has exhausted internal appeals or after the enrollee has been deemed to have exhausted internal appeals.

(B) An enrollee shall be deemed to have exhausted internal appeals if an insurer fails to strictly comply with this section and federal requirements for internal appeals.

(g) The opportunity for the enrollee to receive continued coverage of an approved and ongoing course of treatment under the health benefit plan pending the conclusion of the internal appeal process.

(h) The opportunity for the enrollee or any authorized representative chosen by the enrollee to:

(A) Submit for consideration by the insurer any written comments, documents, records and other materials relating to the adverse benefit determination; and

(B) Receive from the insurer, upon request and free of charge, reasonable access to and copies of all documents, records and other information relevant to the adverse benefit determination.

(3) Establish procedures for notifying affected enrollees of:

(a) A change in or termination of any benefit; and

(b) Intentionally left blank —Ed.

(A) The termination of a primary care delivery office or site; and

(B) Assistance available to enrollees in selecting a new primary care delivery office or site.

(4) Provide the information described in subsection (2) of this section and ORS 743B.254 (Required statements regarding external reviews) at each level of internal appeal to an enrollee who is notified of an adverse benefit determination or to an enrollee who files a grievance.

(5) Upon the request of an enrollee, applicant or prospective applicant, provide:

(a) The insurer’s annual report on grievances and internal appeals submitted to the department under subsection (8) of this section.

(b) A description of the insurer’s efforts, if any, to monitor and improve the quality of health services.

(c) Information about the insurer’s procedures for credentialing network providers.

(6) In addition to the requirements in ORS 743B.423 (Utilization review requirements for insurers offering health benefit plan) and 743B.602 (Step therapy) , provide, upon the request of an enrollee, a written summary of information that the insurer may consider in its utilization review of a particular condition or disease, to the extent the insurer maintains such criteria. This subsection does not require an insurer to advise an enrollee how the insurer would cover or treat that particular enrollee’s disease or condition. Utilization review criteria that are proprietary shall be subject to oral disclosure only.

(7) Maintain for a period of at least six years written records that document all grievances described in ORS 743B.001 (Definitions) (8)(a) and make the written records available for examination by the department or by an enrollee or authorized representative of an enrollee with respect to a grievance made by the enrollee. The written records must include but are not limited to the following:

(a) Notices and claims associated with each grievance.

(b) A general description of the reason for the grievance.

(c) The date the grievance was received by the insurer.

(d) The date of the internal appeal or the date of any internal appeal meeting held concerning the appeal.

(e) The result of the internal appeal at each level of appeal.

(f) The name of the covered person for whom the grievance was submitted.

(8) Provide to the department, in the format prescribed by the department, an annual summary of the insurer’s aggregate data regarding:

(a) Grievances;

(b) Internal appeals;

(c) Requests for external review; and

(d) The following information about requests for prior authorization received by the insurer:

(A) The number of requests received;

(B) The number of requests that were initially denied and the reasons for the denials, including, but not limited to, lack of medical necessity or failure to provide additional clinical information requested by the insurer;

(C) The number of requests that were initially approved; and

(D) The number of denials that were reversed by internal appeals or external reviews.

(9) Allow the exercise of any rights described in this section or ORS 743B.252 (External review) or 743B.255 (Enrollee application for external review) by an authorized representative.

(10) Procedures adopted under subsection (2) of this section for health benefit plans other than grandfathered health plans must be consistent with 42 U.S.C. 300-gg-19 and rules adopted by the United States Department of Health and Human Services implementing 42 U.S.C. 300-gg-19.

(11) An adverse benefit determination under subsection (2)(a) of this section that is provided to an enrollee in a health benefit plan other than a grandfathered health plan must:

(a) Be provided in a culturally and linguistically appropriate manner;

(b) Be consistent with federal requirements regarding the manner and content for notices of benefit determinations and federal requirements for the full and fair review of adverse benefit determinations; and

(c) Include the information required by subsection (4) of this section and:

(A) Information sufficient to identify the claim involved, the date of services, the health care provider and, if applicable, the claim amount;

(B) A statement describing the availability, upon request, of the information described in subsection (12) of this section;

(C) The specific reason for the adverse benefit determination, a reference to the specific plan provisions on which the determination is based, the denial code and the meaning of the denial code and a description of the standard that was used to make the determination, if any;

(D) A description of available internal appeals and external reviews, including expedited appeals and reviews, and instructions on how to initiate an appeal or review; and

(E) Contact information for the office of consumer assistance within the Department of Consumer and Business Services.

(12) Upon the request of an enrollee, an insurer that makes an adverse benefit determination with respect to the enrollee under a health benefit plan other than a grandfathered health plan must provide the enrollee with the diagnosis code, the meaning of the diagnosis code, the treatment code and the meaning of the treatment code that are associated with the adverse benefit determination.

(13) An adverse benefit determination issued to an enrollee following the final level of internal appeals by an insurer under a health benefit plan other than a grandfathered health plan must, in addition to the requirements under subsection (11) of this section, include:

(a) An explanation and discussion of the decision to uphold the initial adverse benefit determination; and

(b) An authorization form, or other document that complies with state and federal privacy laws and is approved by the department, with which an enrollee that requests an external review under ORS 743B.255 (Enrollee application for external review) may authorize the insurer and the enrollee’s treating health care provider to disclose medical records or other protected health information pertinent to the external review. [Formerly 743.804; 2017 c.152 §11; 2019 c.284 §9; 2021 c.154 §2; 2021 c.205 §7]

Source: Section 743B.250 — Required notices to applicants and enrollees; grievances, internal appeals and external reviews , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 731.186 — OR Code / Title 56 / Chapter 731 / Section 731.186
731.186 “Surety insurance.”
Status: in_force

“Surety insurance” means insurance guaranteeing the fidelity of persons holding places of trust, the performance of duties, contracts, bonds and undertakings, including the signing thereof as surety, and insuring the performance of obligations of employers under workers’ compensation laws by surety bond. [1967 c.359 §41]

Source: Section 731.186 — “Surety insurance.” , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 743b.288 — OR Code / Title 56 / Chapter 743b / Section 743b.288
743B.288 Balance billing prohibited for labor and delivery services rendered by out-of-network provider to which insured was diverted during public health emergency
Status: in_force

(1) As used in this section:

(a) “In-network provider” means an individual or facility that contracts with a health benefit plan or health care service contractor to provide health care services to an individual insured under the health benefit plan or health care service contract.

(b) “Out-of-network provider” means an individual or facility that does not contract with a health benefit plan or health care service contractor to provide health care services to an individual insured under the health benefit plan or health care service contract.

(2) An out-of-network provider that is licensed or certified in this state may not bill an individual insured under a health benefit plan or a health care service contract for the costs of labor or delivery services provided by the out-of-network provider if the services are provided by the out-of-network provider due solely to the diversion of the individual from an in-network provider during a state or federally declared public health emergency.

(3) Subsection (2) of this section does not prohibit any provider from billing an individual insured under a health benefit plan or health care service contract for coinsurance, copayments or deductibles applicable to labor and delivery services provided by in-network providers under the terms of the health benefit plan or health care service contract. [2022 c.72 §4]

Note: 743B.288 (Balance billing prohibited for labor and delivery services rendered by out-of-network provider to which insured was diverted during public health emergency) was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 743B or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743B.288 — Balance billing prohibited for labor and delivery services rendered by out-of-network provider to which insured was diverted during public health emergency , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 746.515 — OR Code / Title 56 / Chapter 746 / Section 746.515
746.515 Return of unearned premiums on cancellation
Status: in_force

(1) Whenever a financed insurance policy is canceled, the insurer who has been notified as provided in ORS 746.475 (Premium finance agreements) (4) shall return whatever gross unearned premiums are due under the insurance policy to the premium finance company for the account of the insured or insureds not later than the 30th day after the date of cancellation. If the insurer elects to return the premium through the insurance producer, the insurance producer shall transmit the unearned premium to the premium finance company within the 30-day period. The insurer, on written notice of any failure of the insurance producer to transmit the premium and not later than the 30th day after the notice, shall pay the amount of return premium directly to the premium finance company.

(2) In calculating the gross unearned premium due under a financed insurance policy, the insurer shall use the prorate method of calculation.

(3) In the event that the crediting of return premiums to the account of the insured results in a surplus over the amount due from the insured, the premium finance company shall refund such excess to the insured provided that no such refund shall be required if it amounts to less than $1. [1969 c.639 §13; 1983 c.239 §7; 2003 c.364 §150]

Source: Section 746.515 — Return of unearned premiums on cancellation , https://www.­oregonlegislature.­gov/bills_laws/ors/ors746.­html (accessed May 26, 2025).
ORS § 743.022 — OR Code / Title 56 / Chapter 743 / Section 743.022
743.022 Premium rates for individual health benefit plans
Status: in_force

Premium rates for individual health benefit plans shall be subject to the following provisions:

(1) Each carrier must file the carrier’s initial geographic average rate and any changes to the geographic average rate for its individual health benefit plans with the Director of the Department of Consumer and Business Services.

(2) The premium rates charged during a rating period for individual health benefit plans issued to individuals shall not vary from the individual geographic average rate, except that the premium rate may be adjusted to reflect differences in benefit design, age, tobacco use and family composition. For age adjustments to the individual plans, a carrier shall apply uniformly its schedule of age adjustments for individual health benefit plans as approved by the director.

(3) A carrier may not increase the rates of an individual health benefit plan more than once in a 12-month period except as approved by the director. Annual rate increases shall be effective on the anniversary date of the individual health benefit plan’s issuance. The percentage increase in the premium rate charged for an individual health benefit plan for a new rating period may not exceed the sum of the following:

(a) The percentage change in the carrier’s geographic average rate for its individual health benefit plan measured from the first day of the prior rating period to the first day of the new period; and

(b) Any adjustment attributable to differences in benefit design, age, tobacco use and family composition.

(4) A carrier offering an individual health benefit plan in this state shall include:

(a) In one risk pool, all of the insureds residing in this state who are covered in the carrier’s individual health benefit plans that are not grandfathered health plans or student health plans; and

(b) In a separate risk pool, all of the insureds residing in this state who are covered in the carrier’s individual grandfathered health plans. [Formerly 743.767]

Note: Definitions for 743.022 (Premium rates for individual health benefit plans) may be found in 743B.005 (Definitions) .

Source: Section 743.022 — Premium rates for individual health benefit plans , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 744.732 — OR Code / Title 56 / Chapter 744 / Section 744.732
744.732 Contingent fee agreements
Status: in_force

(1) A third party administrator shall not enter into any agreement or understanding with an insurer the effect of which is to make the amount of the third party administrator’s commissions, fees or charges contingent upon savings effected in the adjustment, settlement and payment of losses covered by the obligations of the insurer.

(2) This section does not prohibit:

(a) A third party administrator from receiving performance-based compensation for providing hospital or other auditing services; or

(b) A third party administrator from receiving compensation based on premiums or charges collected or on the number of claims processed.

(3) The third party administrator shall disclose to the insurer all charges, fees and commissions received from all sources in connection with the provision of administrative services for the insurer, including any fees or commissions paid by insurers providing reinsurance. [1991 c.812 §18]

Source: Section 744.732 — Contingent fee agreements , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 744.621 — OR Code / Title 56 / Chapter 744 / Section 744.621
744.621 Qualifications for nonresident insurance consultant’s license
Status: in_force

(1) The Director of the Department of Consumer and Business Services may issue a license to engage in business as an insurance consultant to a person who resides in another state or province of Canada and is licensed in that state or province as an insurance consultant or is registered under a regulatory program of the other state or province that the director determines is similar to the regulatory program for insurance consultants under this chapter, if the state or province in which the person resides gives the same privilege to a resident insurance consultant.

(2) An applicant for a license to engage in business as a nonresident insurance consultant shall apply for the license as provided in ORS 744.611 (License application) and must:

(a) Have at least five years’ experience in the insurance business that relates to the categories of insurance business or classes of insurance that the applicant intends to transact under the license or have equivalent education or qualifications that the director specifies by rule;

(b) Provide satisfactory evidence to the director that the applicant has procured and has in effect the insurance required under ORS 744.635 (Errors and omissions insurance) ; and

(c) Pass an examination that the director by rule recognizes as adequately testing the applicant’s qualifications, competence and knowledge of the categories of insurance business and classes of insurance that the applicant intends to transact under a license and the applicant’s knowledge of an insurance consultant’s duties and responsibilities under the Insurance Code and other laws of this state. The requirement in this paragraph does not apply to an insurance producer who holds a license to transact the categories of insurance business or classes of insurance that the insurance producer intends to transact as an insurance consultant.

(3) In addition to the requirements set forth in subsection (2) of this section, an applicant must satisfy any other requirement the director specifies by rule. [1989 c.701 §58; 1991 c.810 §18; 2003 c.364 §125; 2019 c.151 §33]

Source: Section 744.621 — Qualifications for nonresident insurance consultant’s license; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 750.685 — OR Code / Title 56 / Chapter 750 / Section 750.685
750.685 Indemnification insurance or bond required
Status: in_force

(1) Except as otherwise provided in this section, no legal expense plan shall be issued, sold or offered for sale in this state unless the organization offering the plan is insured under an insurance contract that provides indemnification for the services under the plan, or reimbursement for services performed under a service contract, in the event of default of the organization. Any such insurance shall be issued only by an insurer authorized to do business in this state.

(2) Instead of holding insurance under subsection (1) of this section, an organization offering an access plan described in subsection (5) of this section may post a bond or provide evidence of deposit pursuant to this subsection. The bond or other deposit is to be held in trust to the Director of the Department of Consumer and Business Services for the protection of members of the plan and other affected persons. The initial security bond or other deposit required for an access plan for at least the first full year of operation shall be in the amount of $10,000. The amount of deposit shall be adjusted annually and shall be in an amount equal to 10 percent of the gross written prepaid fees collected from plan members in the preceding calendar year, to a maximum of $50,000. The bond or other deposit is to be held in a bank authorized to do business in this state and insured by the Federal Deposit Insurance Corporation or in a savings and loan association insured by the Federal Deposit Insurance Corporation.

(3) Instead of holding insurance under subsection (1) of this section, an organization offering a comprehensive plan described in subsection (5) of this section may post a bond or provide evidence of deposit pursuant to this subsection. The bond or other deposit is to be held in trust to the director for the protection of members of the plan and other affected persons. The initial security bond or other deposit required for a comprehensive plan for at least the first full year of operation shall be in the amount of $25,000. The amount of deposit shall be adjusted annually and shall be in an amount equal to 10 percent of the gross written prepaid fees collected from plan members in the preceding calendar year, to a maximum of $100,000. The bond or other deposit is to be held in a bank authorized to do business in this state and insured by the Federal Deposit Insurance Corporation or in a savings and loan association insured by the Federal Deposit Insurance Corporation.

(4) Property used as security shall be held in trust and shall remain unencumbered, and shall have at all times a market value of at least 95 percent of the amount specified. Any bond issued in lieu of security shall be cancelable only upon 30 days’ advance written notice filed with the director. Securities or bonds deposited pursuant to this section shall be for the benefit of and subject to action thereon in the event of insolvency of the plan by any person sustaining actionable injury due to failure of the organization to faithfully perform its obligations to its members.

(5) For purposes of this section:

(a) “Access plan” means a plan that provides legal advice or consultation on legal matters that can be reasonably handled over the phone or by a limited review of routine legal documents.

(b) “Comprehensive plan” means a plan that provides legal advice and consultation regarding more complex or time-consuming matters and may include advice and representation in and regarding administrative and civil or criminal judicial proceedings. [1989 c.331 §19; 1999 c.107 §18]

Source: Section 750.685 — Indemnification insurance or bond required , https://www.­oregonlegislature.­gov/bills_laws/ors/ors750.­html (accessed May 26, 2025).
ORS § 734.142 — OR Code / Title 56 / Chapter 734 / Section 734.142
734.142 Cooperation with director in delinquency proceedings
Status: in_force

(1) Each officer, manager, director, trustee, owner, employee or agent of an insurer, and any other person with authority over or in charge of any portion of the insurer’s affairs, including any person who exercises control directly or indirectly over activities of the insurer through a holding company or other affiliate of the insurer, shall cooperate with the Director of the Department of Consumer and Business Services in any delinquency proceeding or any investigation preliminary to the proceeding. For purposes of this section, cooperation with the director includes at least the following:

(a) Replying promptly in writing to any inquiry from the director requesting such a reply; and

(b) Making available to the director any books, accounts, documents or other records, information or property of or pertaining to the insurer and in the possession, custody or control of the insurer.

(2) A person shall not obstruct or interfere with the director in the conduct of any delinquency proceeding or any investigation preliminary or incidental thereto.

(3) This section shall not be construed to abridge otherwise existing legal rights, including the right to resist a petition for liquidation or other delinquency proceedings, or other orders. [1993 c.447 §94]

Note: 734.142 (Cooperation with director in delinquency proceedings) and 734.144 (Immunity of certain persons from civil liability) were added to and made a part of ORS chapter 734 by legislative action but were not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 734.142 — Cooperation with director in delinquency proceedings , https://www.­oregonlegislature.­gov/bills_laws/ors/ors734.­html (accessed May 26, 2025).
ORS § 743.423 — OR Code / Title 56 / Chapter 743 / Section 743.423
743.423 Notice of claim
Status: in_force

(1) A health insurance policy shall contain a provision as follows: “NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at ___ (insert the location of such office as the insurer may designate for the purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer.”

(2) In a policy providing a loss-of-time benefit which may be payable for at least two years, an insurer may at its option insert the following between the first and second sentences of the provision set forth in subsection (1) of this section: “Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, the insured shall, at least once in every six months after having given notice of claim, give to the insurer notice of continuance of such disability, except in the event of legal incapacity. The period of six months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured’s right to any indemnity which would otherwise have accrued during the period of six months preceding the date on which such notice is actually given.” [1967 c.359 §433]

Source: Section 743.423 — Notice of claim , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 744.866 — OR Code / Title 56 / Chapter 744 / Section 744.866
744.866 Training program
Status: in_force

(1) Intentionally left blank —Ed.

(a) A licensee must provide a training program for the licensee’s employees or agents that sell insurance on the licensee’s behalf. The training program must instruct the employees or agents about the coverage the insurance provides and about the provisions of ORS 744.860 (Definitions for ORS 744.860 to 744.870) to 744.870 (Compensation, bonuses and incentives) .

(b) The licensee each year shall submit to the Director of the Department of Consumer and Business Services for the director’s approval an outline of, and copies of materials the licensee uses in, the training program.

(c) A licensee each year shall certify to the director that the licensee’s employees or agents that sell insurance have completed or will complete the training program the licensee provides under paragraph (a) of this subsection before the employees or agents sell insurance.

(d) An employee or agent that has completed the training program under paragraph (a) of this subsection is not required to undergo continuing education in the topics covered in the training program.

(2) The director may audit the licensee’s compliance with the provisions of subsection (1) of this section.

(3) Intentionally left blank —Ed.

(a) An employee or agent of a licensee may act on behalf and under the supervision of the licensee in matters within the scope of a license issued under ORS 744.862 (Limited license to sell insurance) .

(b) For purposes of ORS 744.860 (Definitions for ORS 744.860 to 744.870) to 744.870 (Compensation, bonuses and incentives) , the conduct of a licensee’s agent or employee who is acting within the scope of the employee’s or agent’s duties toward the licensee is the conduct of the licensee. [2013 c.280 §5]

Source: Section 744.866 — Training program; approval of training materials; certification of training; auditing , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 741.510 — OR Code / Title 56 / Chapter 741 / Section 741.510
741.510 Confidential information
Status: in_force

(1) Except as provided in subsection (3) of this section, documents, materials or other information that is in the possession or control of the Oregon Health Authority for the purpose of carrying out ORS 741.002 (Duties, powers and functions of Oregon Health Authority) , 741.310 (Requirements for purchase of insurance through exchange and for participation of insurers in exchange) and 741.500 (Required documentation) or complying with federal health insurance exchange requirements, and that is protected from disclosure by state or federal law, remains confidential and is not subject to disclosure under ORS 192.311 (Definitions for ORS 192.311 to 192.478) to 192.478 (Exemption for Judicial Department) or subject to subpoena or discovery or admissible into evidence in any private civil action in which the authority is not a named party. The authority may use confidential documents, materials or other information without further disclosure in order to carry out the duties described in ORS 741.002 (Duties, powers and functions of Oregon Health Authority) , 741.310 (Requirements for purchase of insurance through exchange and for participation of insurers in exchange) and 741.500 (Required documentation) or to take any legal or regulatory action authorized by law.

(2) Documents, materials and other information to which subsection (1) of this section applies is subject to the public officer privilege described in ORS 40.270 (Rule 509. Public officer privilege) .

(3) The Director of the Oregon Health Authority may:

(a) Authorize the sharing of confidential documents, materials or other information that is subject to subsection (1) of this section within the authority and subject to any conditions on further disclosure, for the purpose of carrying out the duties and functions of the authority under ORS 741.002 (Duties, powers and functions of Oregon Health Authority) , 741.310 (Requirements for purchase of insurance through exchange and for participation of insurers in exchange) and 741.500 (Required documentation) or complying with federal health insurance exchange requirements.

(b) Authorize the sharing of confidential documents, materials or other information that is subject to subsection (1) of this section or that is otherwise confidential under ORS 192.345 (Public records conditionally exempt from disclosure) or 192.355 (Public records exempt from disclosure) with other state or federal health insurance exchanges or regulatory authorities, the Department of Consumer and Business Services, the Department of Revenue, law enforcement agencies and federal authorities, if required or authorized by state or federal law and if the recipient agrees to maintain the confidentiality of the documents, materials or other information.

(c) Receive documents, materials or other information, including documents, materials or other information that is otherwise confidential, from other state or federal health insurance exchanges or regulatory authorities, the Department of Consumer and Business Services, the Department of Revenue, law enforcement agencies or federal authorities. The authority shall maintain the confidentiality requested by the sender of the documents, materials or other information received under this section as necessary to comply with the laws of the jurisdiction from which the documents, materials or other information was received and originated.

(4) The disclosure of documents, materials or other information to the authority under this section, or the sharing of documents, materials or other information as authorized in subsection (3) of this section, does not waive any applicable privileges or claims of confidentiality in the documents, materials or other information.

(5) This section does not prohibit the authority from releasing to a database or other clearinghouse service maintained by federal authorities a final, adjudicated order, including a certification, recertification, suspension or decertification of a qualified health plan under ORS 741.002 (Duties, powers and functions of Oregon Health Authority) , if the order is otherwise subject to public disclosure. [2011 c.415 §15; 2015 c.3 §31; 2021 c.569 §32]

Source: Section 741.510 — Confidential information; public officer privilege; permitted uses of confidential information , https://www.­oregonlegislature.­gov/bills_laws/ors/ors741.­html (accessed May 26, 2025).
ORS § 743.018 — OR Code / Title 56 / Chapter 743 / Section 743.018
743.018 Filing of rates for life and health insurance
Status: in_force

(1) Except for group life and health insurance, and except as provided in ORS 743.015 (Filing and approval of credit life and credit health insurance forms) , every insurer shall file with the Director of the Department of Consumer and Business Services all schedules and tables of premium rates for life and health insurance to be used on risks in this state, and shall file any amendments to or corrections of such schedules and tables. Premium rates are subject to approval, disapproval or withdrawal of approval by the director as provided in ORS 742.003 (Filing and approval of policy forms) , 742.005 (Grounds for disapproval of policy forms) , 742.007 (Director’s withdrawal of approval) and, for health benefit plans as defined in ORS 743B.005 (Definitions) , ORS 743.019 (Procedure for review of proposed rates for health benefit plans) .

(2) Except as provided in ORS 743B.013 (Requirements for small employer health benefit plans) and subsection (3) of this section, a rate filing by a carrier for any of the following health benefit plans subject to ORS 743.004 (Submission of information by carriers offering health benefit plans) , 743.022 (Premium rates for individual health benefit plans) , 743.535 (Health benefit coverage for guaranteed association) and 743B.003 (Purposes) to 743B.127 (Rules for ORS 743.022, 743B.125 and 743B.126) shall be available for public inspection immediately upon submission of the filing to the director:

(a) Health benefit plans for small employers.

(b) Individual health benefit plans.

(3) The director may by rule:

(a) Specify all information a carrier must submit as part of a rate filing under this section; and

(b) Identify the information submitted that will be exempt from disclosure under this section because the information constitutes a trade secret and would, if disclosed, harm competition.

(4) The director, after conducting an actuarial review of the rate filing, may approve a proposed premium rate for a health benefit plan for small employers or for an individual health benefit plan if, in the director’s discretion, the proposed rates are:

(a) Actuarially sound;

(b) Reasonable and not excessive, inadequate or unfairly discriminatory; and

(c) Based upon reasonable administrative expenses.

(5) In order to determine whether the proposed premium rates for a health benefit plan for small employers or for an individual health benefit plan are reasonable and not excessive, inadequate or unfairly discriminatory, the director may consider:

(a) The insurer’s financial position, including but not limited to profitability, surplus, reserves and investment savings.

(b) Historical and projected administrative costs and medical and hospital expenses, including expenses for drugs reported under ORS 743.025 (Annual report of information related to prescription drugs covered by health benefit plans) .

(c) Historical and projected loss ratio between the amounts spent on medical services and earned premiums.

(d) Any anticipated change in the number of enrollees if the proposed premium rate is approved.

(e) Changes to covered benefits or health benefit plan design.

(f) Changes in the insurer’s health care cost containment and quality improvement efforts since the insurer’s last rate filing for the same category of health benefit plan.

(g) Whether the proposed change in the premium rate is necessary to maintain the insurer’s solvency or to maintain rate stability and prevent excessive rate increases in the future.

(h) Any public comments received under ORS 743.019 (Procedure for review of proposed rates for health benefit plans) pertaining to the standards set forth in subsection (4) of this section and this subsection.

(6) The director shall require insurers to charge the same premium for a plan sold through the health insurance exchange as the insurer charges for the identical plan sold outside of the exchange.

(7) The requirements of this section do not supersede other provisions of law that require insurers, health care service contractors or multiple employer welfare arrangements providing health insurance to file schedules or tables of premium rates or proposed premium rates with the director or to seek the director’s approval of rates or changes to rates. [1967 c.359 §340; 2007 c.391 §1; 2009 c.595 §31; 2013 c.681 §11; 2015 c.88 §2; 2018 c.7 §8; 2019 c.441 §2; 2021 c.569 §37]

Source: Section 743.018 — Filing of rates for life and health insurance; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 735.360 — OR Code / Title 56 / Chapter 735 / Section 735.360
735.360 Rules
Status: in_force

The director may adopt rules that the director determines are necessary for carrying out ORS 735.300 (Purpose of ORS 735.300 to 735.365) to 735.365 (Short title) . [1987 c.774 §110; 1989 c.700 §11]

Source: Section 735.360 — Rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 742.454 — OR Code / Title 56 / Chapter 742 / Section 742.454
742.454 Liabilities that need not be covered
Status: in_force

The motor vehicle liability insurance policy required by ORS 806.010 (Driving uninsured prohibited) , 806.060 (Methods of compliance) , 806.080 (Insurance) , 806.240 (Proof of compliance with future responsibility filing requirement) or 806.270 (Certificate of insurance) need not insure any liability under any workers’ compensation law; nor any liability on account of bodily injury to or death of an employee of the insured while engaged in the employment, other than domestic, of the insured, or while engaged in the operation, maintenance or repair of a vehicle; nor any liability for damage to property owned by, rented to, in charge of, or transported by the insured. [Formerly 486.546 and then 743.778]

Source: Section 742.454 — Liabilities that need not be covered , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 731.486 — OR Code / Title 56 / Chapter 731 / Section 731.486
731.486 Exemption from definition of “transact insurance” for group health and life policies
Status: in_force

(1) The exemption in ORS 731.146 (“Transact insurance.”) (2)(b) does not apply to an insurer that offers coverage under a group health insurance policy or a group life insurance policy in this state unless the Director of the Department of Consumer and Business Services determines that the exemption applies.

(2) The insurer shall submit evidence to the director that the exemption applies. When a master policy is delivered or issued for delivery outside this state to trustees of a fund for two or more employers, for one or more labor unions, for one or more employers and one or more labor unions or for an association, the insurer shall also submit evidence showing compliance with:

(a) ORS 743.526 (Determination of whether trustees are policyholders) , for a policy of group health insurance; or

(b) ORS 743.354 (Requirements for certain group life policies issued to trustees of certain funds) , for a policy of group life insurance.

(3) The director shall review the evidence submitted and may request additional evidence as needed.

(4) An insurer shall submit to the director any changes in the evidence submitted under subsection (2) of this section.

(5) The director may order an insurer to cease offering a policy or coverage under a policy if the director determines that the exemption under ORS 731.146 (“Transact insurance.”) (2)(b) is no longer satisfied.

(6) Coverage under a master group life or health insurance policy delivered or issued for delivery outside this state that does not qualify for the exemption in ORS 731.146 (“Transact insurance.”) (2)(b) may be offered in this state if the director determines that the state in which the policy was delivered or issued for delivery has requirements that are substantially similar to those established under ORS 743.360 (Alternative group life insurance coverage) or 743.522 (Additional groups designated by director) (2) and that the policy satisfies those requirements.

(7) This section does not apply to any master policy issued to a multistate employer or labor union.

(8) The director may adopt rules to carry out this section. [1989 c.784 §3; 2001 c.943 §1; 2005 c.22 §486; 2007 c.752 §§3,8]

Source: Section 731.486 — Exemption from definition of “transact insurance” for group health and life policies; master group health and life insurance coverage; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 741.802 — OR Code / Title 56 / Chapter 741 / Section 741.802
741.802 Authority to produce written informational materials
Status: in_force

The Oregon Health Authority shall produce written materials containing information for consumers about the requirements for paying the premiums for qualified health plans. The authority shall distribute the materials to health care providers upon request. [2015 c.580 §4; 2021 c.569 §35]

Source: Section 741.802 — Authority to produce written informational materials , https://www.­oregonlegislature.­gov/bills_laws/ors/ors741.­html (accessed May 26, 2025).
ORS § 743.372 — OR Code / Title 56 / Chapter 743 / Section 743.372
743.372 Applicability of credit life and credit health insurance provisions
Status: in_force

(1) All life or health insurance in connection with loans or other credit transactions shall be subject to ORS 743.371 (Definitions for credit life and credit health insurance provisions) to 743.380 (Claim report and payment) , except:

(a) Insurance in connection with a loan or other credit transaction of more than 10 years’ duration; or

(b) Insurance, the issuance of which is an isolated transaction on the part of the insurer not related to an agreement or a plan for insuring debtors of the creditor.

(2) Notwithstanding subsection (1) of this section, credit life and credit health insurance may be issued for up to 10 years in connection with a loan or other credit transaction of any duration. [Formerly 739.570 and then 743.564]

Source: Section 743.372 — Applicability of credit life and credit health insurance provisions , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 743.655 — OR Code / Title 56 / Chapter 743 / Section 743.655
743.655 Rules
Status: in_force

(1) Intentionally left blank —Ed.

(a) The Director of the Department of Consumer and Business Services shall adopt rules that include standards for full and fair disclosure setting forth the manner, content and required disclosures for the sale of long term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, program for public understanding, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, underwriting at time of application, requirements for replacement, recurrent conditions and definitions of terms and that include required procedures for internal and external review of whether the conditions of a benefit trigger have been met.

(b) In adopting rules under this section, the Director of the Department of Consumer and Business Services must give timely notice to, and shall consider recommendations from the Director of Human Services.

(2) A long term care insurance policy may not:

(a) Be canceled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder;

(b) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder;

(c) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care;

(d) Exclude coverage for Alzheimer’s disease and related dementias;

(e) Be nonrenewed or otherwise terminated for nonpayment of premiums until 31 days overdue and then only after notice of nonpayment is given the policyholder prior to expiration of the 31 days, except as otherwise provided by rule; or

(f) Be sold to provide less than 24 months’ coverage.

(3) Intentionally left blank —Ed.

(a) A long term care insurance policy or certificate other than a policy or certificate issued to a group described in ORS 743.652 (Definitions for ORS 743.650 to 743.665) (4)(a), (b) or (c) may not use a definition of “preexisting condition” that is more restrictive than the following: “Preexisting condition” means a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person.

(b) A long term care insurance policy or certificate other than a policy or certificate thereunder issued to a group described in ORS 743.652 (Definitions for ORS 743.650 to 743.665) (4)(a), (b) or (c) may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person.

(c) The Director of the Department of Consumer and Business Services may extend the limitation periods set forth in paragraphs (a) and (b) of this subsection as to specific age group categories or specific policy forms upon findings that the extension is in the best interest of the public.

(d) The definition of preexisting condition does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, over the 10 years immediately prior to the date of application, and, on the basis of the answers on the application, from underwriting in accordance with that insurer’s established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in paragraph (b) of this subsection expires. A long term care insurance policy or certificate may not exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in paragraph (b) of this subsection.

(4) A long term care insurance policy may not be delivered or issued for delivery in this state if the policy:

(a) Conditions eligibility for any benefits on a prior hospitalization requirement;

(b) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or

(c) Conditions eligibility for any benefits other than waiver of premium or post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement.

(5) Intentionally left blank —Ed.

(a) A long term care insurance policy containing post-confinement, post-acute care or recuperative benefits must clearly label in a separate paragraph of the policy or certificate titled “Limitations or Conditions of Eligibility for Benefits” all such limitations or conditions, including any required number of days of confinement.

(b) A long term care insurance policy or rider that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days.

(6) Individual long term care insurance applicants shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Long term care insurance policies and certificates must have a notice prominently printed on the first page or attached thereto stating in substance that the applicant has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, other than a certificate issued pursuant to a policy issued to a group described in ORS 743.652 (Definitions for ORS 743.650 to 743.665) (4)(a), the applicant is not satisfied for any reason. This subsection also applies to denials of applications. Any refund must be made within 30 days of the return or denial.

(7)(a)(A) An outline of coverage shall be delivered to a prospective applicant for long term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose.

(B) The Director of the Department of Consumer and Business Services by rule must prescribe a standard format, including style, arrangement and overall appearance, and the content of an outline of coverage.

(C) In the case of solicitations by an insurance producer, the insurance producer must deliver the outline of coverage prior to the presentation of an application or enrollment form.

(D) In the case of direct response solicitations, the outline of coverage must be presented in conjunction with any application or enrollment form.

(E) In the case of a policy issued to a group described in ORS 743.652 (Definitions for ORS 743.650 to 743.665) (4)(a), an outline of coverage is not required to be delivered as long as the information described in paragraph (b) of this subsection is contained in other materials related to the enrollment. Upon request, these other materials must be made available to the Director of the Department of Consumer and Business Services.

(b) The outline of coverage must include:

(A) A description of the principal benefits and coverage provided in the policy;

(B) A statement of the principal exclusions, reductions and limitations contained in the policy;

(C) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premium. Continuation or conversion provisions of group coverage shall be specifically described;

(D) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;

(E) A description of the terms under which the policy or certificate may be returned and premium refunded;

(F) A brief description of the relationship of cost of care and benefits; and

(G) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be qualified long term care insurance as defined in ORS 743.652 (Definitions for ORS 743.650 to 743.665) .

(8) A certificate issued pursuant to a group long term care insurance policy if the policy is delivered or issued for delivery in this state shall include:

(a) A description of the principal benefits and coverage provided in the policy;

(b) A statement of the principal exclusions, reductions and limitations contained in the policy; and

(c) A statement that the group master policy determines governing contractual provisions.

(9) If an application for a long term care insurance policy or certificate is approved, the insurer must deliver the policy or certificate to the applicant no later than 30 days after the date of approval.

(10) At the time of policy delivery, a policy summary must be delivered for an individual life insurance policy that provides long term care benefits within the policy or by rider. In the case of direct response solicitations, the insurer must deliver the policy summary upon the applicant’s request, but regardless of request must make delivery not later than at the time of policy delivery. In addition to complying with all applicable requirements, the summary must also include the provisions required in this subsection. The required provision may be incorporated into a basic illustration or into the life insurance policy summary if required by rule. The following provisions must be included in the summary:

(a) An explanation of how the long term care benefit interacts with other components of the policy, including deductions from death benefits;

(b) An illustration of the amount of benefits, the length of benefits and the guaranteed lifetime benefits, if any, for each covered person;

(c) Any exclusions, reductions and limitations on benefits of long term care;

(d) A statement that any long term care inflation protection option required by rule is not available under the policy; and

(e) If applicable to the policy type, the following:

(A) A disclosure of the effects of exercising other rights under the policy;

(B) A disclosure of guarantees related to long term care costs of insurance charges; and

(C) Current and projected maximum lifetime benefits.

(11) When a long term care benefit that is funded through a life insurance policy by an acceleration of the death benefit is in benefit payment status, the insurer must provide a monthly report to the policyholder. The report must include:

(a) Any long term care benefits paid out during the month;

(b) An explanation of any changes in the policy, such as death benefits or cash values, owing to payment of long term care benefits; and

(c) The amount of long term care benefits existing or remaining.

(12) If a claim under a long term care insurance policy is denied, then not later than the 60th day after the date of a written request by the policyholder or certificate holder, or a personal or authorized representative of either, the insurer must:

(a) Provide a written explanation of the reasons for the denial; and

(b) Make available all information directly related to the denial.

(13) Long term care insurance policies shall include a clear description of the process for appealing and resolving disputes regarding whether the conditions of a benefit trigger have been met.

(14) A policy may not be advertised, marketed or offered as long term care or nursing home insurance unless it complies with the provisions of ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements) .

(15) Rules adopted pursuant to ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements) shall be in accordance with the provisions of ORS chapter 183.

(16) This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) . [1989 c.1022 §§6,7; 1991 c.67 §200; 2003 c.364 §110; 2007 c.486 §4; 2011 c.69 §5]

Source: Section 743.655 — Rules; disclosure; contents of policy , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 744.605 — OR Code / Title 56 / Chapter 744 / Section 744.605
744.605 Insurance consultant’s license required
Status: in_force

(1) A person may not engage in business as an insurance consultant unless the person holds a valid license the Director of the Department of Consumer and Business Services issues under ORS 744.614 (Powers of director to issue, renew, amend, suspend and reinstate licenses) that authorizes the person to engage in business as an insurance consultant. For purposes of this section, a person engages in business as an insurance consultant if:

(a) The person purports or offers to engage in any of the activities described in paragraph (b) of this subsection by using, in conjunction with the person’s name, the title or designation of insurance planner, consultant, adviser or counselor, or financial and insurance planner, consultant, adviser or counselor, or any similar title or designation; or

(b) The person, for compensation other than commission from the sale of insurance, engages, attempts to engage or offers to engage in any of the following activities:

(A) Acting as a consultant regarding insurance.

(B) Giving advice, counsel, opinion or service with respect to the benefits, advantages or disadvantages of insurance that may be issued in this state.

(C) In any other manner providing information about insurance.

(2) For the purposes of subsection (1)(b) of this section, compensation includes consideration paid for financial and other related services the person provides in connection with services referred to in subsection (1)(b) of this section. [1985 c.697 §2; 1989 c.701 §53; 1991 c.810 §15; 1997 c.419 §1; 2019 c.151 §31]

Source: Section 744.605 — Insurance consultant’s license required , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 750.675 — OR Code / Title 56 / Chapter 750 / Section 750.675
750.675 Filing of provider and membership agreement with director
Status: in_force

An organization shall file with the Director of the Department of Consumer and Business Services a copy of the current membership agreement forms and the current provider agreement forms used by the organization, and a schedule of the rates charged its members. An organization shall file any material change in the provider agreement or membership agreement with the director prior to use. [1989 c.331 §12]

Source: Section 750.675 — Filing of provider and membership agreement with director , https://www.­oregonlegislature.­gov/bills_laws/ors/ors750.­html (accessed May 26, 2025).
ORS § 744.311 — OR Code / Title 56 / Chapter 744 / Section 744.311
744.311 Books, bank accounts and records
Status: in_force

A managing general agent shall maintain all of its books, bank accounts and records in a form usable by the Director of the Department of Consumer and Business Services. The managing general agent shall allow the director access to all of its books, bank accounts and records. [1991 c.495 §7]

Source: Section 744.311 — Books, bank accounts and records , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 743a.063 — OR Code / Title 56 / Chapter 743a / Section 743a.063
743A.063 Ninety-day supply of prescription drug refills
Status: in_force

(1) A prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan as defined in ORS 743B.005 (Definitions) , must provide for reimbursement for up to a 90-day supply of a prescription drug dispensed by a pharmacy, as defined in ORS 689.005 (Definitions) , if:

(a) The prescription drug is covered by the program or plan;

(b) An initial 30-day supply of the prescription drug has been previously dispensed to the program or plan member; and

(c) The quantity of the prescription drug dispensed does not exceed the total remaining quantity of the prescription drug that the prescribing practitioner authorized to be dispensed through refills.

(2) The coverage required by subsection (1) of this section may be limited by the terms and conditions of a pharmacy network contract, or a prescription drug benefit program or health benefit plan, that are related to the reimbursement rate of the prescription drug.

(3) The coverage required by subsection (1) of this section may be limited by formulary restrictions that are related to the prescription drug.

(4) This section does not apply to the reimbursement of prescription drugs classified as a controlled substance in Schedule II.

(5) This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) . [2015 c.661 §2]

Note: 743A.063 (Ninety-day supply 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 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743A.063 — Ninety-day supply of prescription drug refills , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html (accessed May 26, 2025).
ORS § 731.859 — OR Code / Title 56 / Chapter 731 / Section 731.859
731.859 Applicability of retaliatory provisions
Status: in_force

(1) On or before April 1 of each year, each foreign or alien insurer shall:

(a) Determine and report to the Director of the Department of Consumer and Business Services whether the provisions of the laws of any state or country require the imposition of the burdens specified by ORS 731.854 (Retaliatory tax) ;

(b) Compute the amount owing under ORS 731.854 (Retaliatory tax) ; and

(c) Pay to the director that amount.

(2) If the director, during the period in which the director under ORS 731.836 (Limitation on enforcement of insurer’s tax obligations) may collect taxes owing under this section, finds the amount of such taxes paid by an insurer to have been incorrect, the director shall charge or credit the insurer with the difference between the correct amount of tax and the amount actually paid.

(3) Notwithstanding ORS 314.835 (Divulging particulars of returns and reports prohibited) or 314.840 (Disclosure of information) or any other law concerning the confidentiality of tax returns, the Department of Consumer and Business Services may disclose to the Department of Revenue, and the Department of Revenue may disclose to the Department of Consumer and Business Services, tax returns and all other information necessary to carry out the provisions of this section and ORS 731.854 (Retaliatory tax) . [1969 c.158 §3 (enacted in lieu of 731.858); 1989 c.700 §9; 2021 c.204 §4]

Source: Section 731.859 — Applicability of retaliatory provisions; disclosure of tax returns , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 731.836 — OR Code / Title 56 / Chapter 731 / Section 731.836
731.836 Limitation on enforcement of insurer’s tax obligations
Status: in_force

The Director of the Department of Consumer and Business Services shall commence an action for the recovery of taxes payable under ORS 731.820 (Gross premium tax on fire insurance premiums) , 731.824 (Tax on underwriting profits of wet marine and transportation insurers) , 731.828 (Computation of wet marine and transportation insurance tax) and 731.859 (Applicability of retaliatory provisions) not later than the later of the following:

(1) Five years after the date such taxes were payable to the director under such sections; or

(2) Three years after the date on which the report of examination by the domiciliary state of the insurer, disclosing that such taxes were owing by the insurer under such sections, was filed with the director. [1967 c.359 §139; 1969 c.158 §4; 1989 c.700 §8]

Source: Section 731.836 — Limitation on enforcement of insurer’s tax obligations , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 743a.034 — OR Code / Title 56 / Chapter 743a / Section 743a.034
743A.034 Services provided by expanded practice dental hygienist
Status: in_force

(1) If a policy of insurance covering dental health provides for coverage for services performed by a dentist licensed under ORS chapter 679, the policy must also cover the services when they are performed by an expanded practice dental hygienist, as defined in ORS 679.010 (Definitions) , who has entered into a provider contract with the insurer.

(2) The provisions of ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) do not apply to this section. [2011 c.716 §11]

Note: 743A.034 (Services provided by expanded practice dental hygienist) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743A.034 — Services provided by expanded practice dental hygienist , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html (accessed May 26, 2025).
ORS § 731.752 — OR Code / Title 56 / Chapter 731 / Section 731.752
731.752 Confidentiality of report used for determination of required amount of capital or surplus
Status: in_force

(1) A report filed with the Director of the Department of Consumer and Business Services according to requirements established by rule for the purpose of determining the amount of capital or surplus, or any combination thereof, that should be possessed and maintained by an insurer under ORS 731.554 (Capital and surplus requirements) or by a health care service contractor under ORS 750.045 (Required capitalization) , or under the laws of another state establishing similar requirements, shall be confidential and shall not be disclosed except as provided in ORS 705.137 (Information that is confidential or not subject to disclosure) .

(2) A financial plan of action stating corrective actions to be taken by an insurer or health care service contractor in response to a determination of inadequate capital or surplus, or any combination thereof, that is filed by the insurer or health care service contractor with the director according to requirements established by rule shall be confidential and shall not be disclosed except as provided in ORS 705.137 (Information that is confidential or not subject to disclosure) .

(3) The results or report of any examination or analysis of an insurer or health care service contractor performed by the director in connection with a financial plan described in subsection (2) of this section and any corrective order issued by the director pursuant to such an examination or analysis shall be confidential and shall not be disclosed except as provided in ORS 705.137 (Information that is confidential or not subject to disclosure) .

(4) Information contained in documents described in subsections (1) to (3) of this section that is also contained in financial statements of insurers or health care service contractors filed under ORS 731.574 (Annual financial statement) or in final examination reports filed under ORS 731.312 (Report of examination) is not confidential under this section. [1995 c.638 §4; 2001 c.318 §19; 2001 c.377 §8]

Source: Section 731.752 — Confidentiality of report used for determination of required amount of capital or surplus; confidentiality of financial plan of action and report of examination connected with plan , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 742.366 — OR Code / Title 56 / Chapter 742 / Section 742.366
742.366 Cancellation of bond by surety
Status: in_force

(1) As used in this section:

(a) “Bond” means any undertaking, recognizance or other obligation required by statute, ordinance or regulation to be executed by a surety and given to a public body by any person as a condition to the granting of a permit, license or franchise by a public body.

(b) “Public body” means the state and any department, agency, board or commission of the state, any city, county, school district or other political subdivision or municipal or public corporation, any instrumentality thereof and any court.

(2) The surety may cancel a bond by sending notice of cancellation by registered or certified mail to the public body with which the bond is filed and to the principal at the principal’s address of record with the surety. Such cancellation takes effect on the date specified in the notice but not earlier than the 30th day after the date of mailing. The surety shall have no liability under the bond for an act or default occurring after the effective date of such cancellation.

(3) Notwithstanding subsection (2) of this section, a statute, ordinance, regulation or the provisions of a bond may provide procedures for release of surety on a bond. [Formerly 743.755]

Source: Section 742.366 — Cancellation of bond by surety , https://www.­oregonlegislature.­gov/bills_laws/ors/ors742.­html (accessed May 26, 2025).
ORS § 732.537 — OR Code / Title 56 / Chapter 732 / Section 732.537
732.537 Application of ORS 732.527, 732.539, 732.542 and 732.544 to change of control of insurer
Status: in_force

(1) As used in subsection (3)(d) of this section, “market” means the direct written insurance premium for a line of business in this state that an insurer authorized to transact insurance in this state claims in the annual financial statement the insurer files under ORS 731.574 (Annual financial statement) .

(2) Except as provided in subsection (3) of this section, ORS 732.527 (Approval of acquisition by chief insurance regulatory officials of two or more jurisdictions) , 732.539 (Notification of acquisition) , 732.542 (Monopoly or substantial diminishment of competition) and 732.544 (Director’s order) apply to an acquisition in which a change of control occurs in an insurer that is authorized to transact insurance in this state.

(3) ORS 732.527 (Approval of acquisition by chief insurance regulatory officials of two or more jurisdictions) , 732.539 (Notification of acquisition) , 732.542 (Monopoly or substantial diminishment of competition) and 732.544 (Director’s order) do not apply to:

(a) A person’s purchase of an insurer’s securities solely for investment purposes, provided that the person does not use the person’s ownership of the securities to cause or attempt to cause an action, or to vote to take an action, that would cause a substantial decrease in competition in an insurance market in this state. If a presumption arises that a person controls the insurer by reason of the person’s purchase of securities, the person’s purchase of the securities is not solely for investment purposes unless the chief insurance regulatory official in the state in which the person is domiciled accepts a disclaimer of control from the person or the regulatory official affirmatively finds that the person does not control the insurer. The person or the regulatory official must communicate the disclaimer or the finding to the Director of the Department of Consumer and Business Services.

(b) A person’s acquisition of another person, if both the person that is acquiring the other person and the person that is subject to the acquisition are not engaged primarily in transacting insurance, either directly or through an affiliate. An exemption under this subsection from the application of ORS 732.527 (Approval of acquisition by chief insurance regulatory officials of two or more jurisdictions) , 732.539 (Notification of acquisition) , 732.542 (Monopoly or substantial diminishment of competition) and 732.544 (Director’s order) is effective only if the person that is acquiring the other person notifies the director in accordance with ORS 732.539 (Notification of acquisition) not less than 30 days before the date on which the acquisition would be completed. The requirement to notify the director does not apply if an exclusion set forth in paragraph (a), (c), (d), (e) or (f) of this subsection applies to the acquisition.

(c) An acquisition in which a person acquires another person with which the person is already affiliated.

(d) An acquisition that, immediately after completion, would meet any of these conditions:

(A) The combined market share held by an insurer that is acquiring another insurer and the insurer that is subject to the acquisition does not exceed five percent of the total market share in any market;

(B) The market share in any market does not increase for either an insurer that is acquiring another insurer or the insurer that is subject to the acquisition; or

(C) The combined market share held by an insurer that is acquiring another insurer and the insurer that is subject to the acquisition does not:

(i) Exceed 12 percent of the total market share in any market; or

(ii) Increase by more than two percent of the total market share in any market.

(e) An acquisition for which an insurer that is acquiring another insurer must notify the director in accordance with ORS 732.539 (Notification of acquisition) solely because of the effect the acquisition would have on the ocean marine line of business.

(f) Intentionally left blank —Ed.

(A) An acquisition of an insurer for which the chief insurance regulatory officer of the state in which the insurer is domiciled finds that:

(i) The insurer is in failing condition;

(ii) No feasible alternative exists for improving the insurer’s condition; and

(iii) The public benefit that would arise from improving the insurer’s condition by means of the acquisition outweigh the detriment that may result from diminishing competition among insurers; and

(B) For an exemption under this paragraph to apply, the chief insurance regulatory officer of the state in which the insurer is domiciled must communicate the regulatory officer’s findings to the director. [2013 c.370 §5]

Source: Section 732.537 — Application of ORS 732.527, 732.539, 732.542 and 732.544 to change of control of insurer; exemptions , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 743.247 — OR Code / Title 56 / Chapter 743 / Section 743.247
743.247 Notice to variable life insurance policyholders
Status: in_force

An insurer issuing individual variable life insurance policies shall mail to each policyholder at least once in each policy year after the first, at the last address of the policyholder known to the insurer:

(1) A statement reporting the investments held in the applicable separate account.

(2) A statement reporting as of a date not more than four months preceding the date of mailing:

(a) In the case of an annuity policy under which payments have not yet commenced, the number of accumulation units credited to such policy and the dollar value of a unit, or the value of the policyholder’s account; and

(b) In the case of a life insurance policy, the dollar amount of the death benefit. [1973 c.435 §15]

Source: Section 743.247 — Notice to variable life insurance policyholders , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 743.207 — OR Code / Title 56 / Chapter 743 / Section 743.207
743.207 Required provisions relating to nonforfeiture
Status: in_force

(1) A life insurance policy shall contain in substance the following provisions, or corresponding provisions which in the opinion of the Director of the Department of Consumer and Business Services are at least as favorable to the defaulting or surrendering policyholder as are the minimum requirements specified in this section, and which are essentially in compliance with ORS 743.221 (Cash surrender values upon default in premium payment) :

(a) That in the event of default in any premium payment the insurer will grant, upon proper request not later than 60 days after the due date of the premium in default, a paid-up nonforfeiture benefit on a plan stipulated in the policy, effective as of such due date, of the amount required by ORS 743.213 (Determination of paid-up nonforfeiture benefits) . In lieu of this stipulated benefit the insurer may substitute, upon proper request made not later than 60 days after the due date of the premium in default, another paid-up nonforfeiture benefit which is actuarially equivalent and provides a greater amount or longer period of death benefit or, if applicable, a greater amount or earlier payment of endowment benefit.

(b) That upon surrender of the policy within 60 days after the due date of any premium payment in default after premiums have been paid for at least three full years in the case of ordinary life insurance or five full years in the case of industrial life insurance, the insurer will pay, in lieu of any paid-up nonforfeiture benefit, a cash surrender value of the amount required by ORS 743.210 (Determination of cash surrender values) .

(c) That a specified paid-up nonforfeiture benefit will become effective as specified in the policy unless the person entitled to make such election elects another available option not later than 60 days after the due date of the premium in default.

(d) That, if the policy has become paid up by completion of all premium payments or if it is continued under any paid-up nonforfeiture benefit which became effective on or after the third policy anniversary in the case of ordinary life insurance or the fifth policy anniversary in the case of industrial life insurance, the insurer will pay, upon surrender of the policy within 30 days after any policy anniversary, a cash surrender value of the amount required by ORS 743.210 (Determination of cash surrender values) .

(e) Intentionally left blank —Ed.

(A) In the case of all policies other than those provided for in subparagraph (B) of this paragraph, a statement of the mortality table and interest rate used in calculating the cash surrender values and the paid-up nonforfeiture benefits available under the policy, together with a table showing the cash surrender value, if any, and paid-up nonforfeiture benefit, if any, available under the policy on each policy anniversary either during the first 20 policy years or during the term of the policy, whichever is shorter. Such values and benefits shall be calculated on the assumption that there are no dividends or paid-up additions credited to the policy and that there is no indebtedness to the insurer on the policy. At the option of the insurer such table may also show such values and benefits for any year or years beyond the 20th policy year.

(B) In the case of policies which provide, on a basis guaranteed in the policy, for unscheduled changes in benefits or premiums, or which provide an option for changes in benefits or premiums other than by change to a new policy, a statement of the mortality table, interest rate and method used in calculating cash surrender values and paid-up nonforfeiture benefits available under the policy.

(f) Intentionally left blank —Ed.

(A) A statement that the cash surrender values and the paid-up nonforfeiture benefits available under the policy are not less than the minimum values and benefits required by or pursuant to the insurance law of the state in which the policy is delivered.

(B) An explanation of the manner in which the cash surrender values and the paid-up nonforfeiture benefits are altered by the existence of any paid-up additions credited to the policy or any indebtedness to the insurer on the policy.

(C) If a detailed statement of the method of computation of the cash surrender values and paid-up nonforfeiture benefits shown in the policy is not stated in the policy, a statement that the method of computation has been filed with the insurance supervisory official of the state in which the policy is delivered.

(D) A statement of the method to be used in calculating the cash surrender value and paid-up nonforfeiture benefit available under the policy on any policy anniversary beyond the last anniversary for which such values and benefits are shown for consecutive years in the policy.

(2) Any of the provisions set forth in subsection (1) of this section, or portions of the provisions, not applicable by reason of the particular plan of insurance may, to the extent inapplicable, be omitted from the policy.

(3) The insurer shall reserve the right to defer the payment of any cash surrender value for a period of six months after demand therefor with surrender of the policy. [Formerly 739.345; 1981 c.609 §13]

Source: Section 743.207 — Required provisions relating to nonforfeiture , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 743b.281 — OR Code / Title 56 / Chapter 743b / Section 743b.281
743B.281 Estimate of costs for in-network procedure or service
Status: in_force

(1) An insurer offering a health benefit plan as defined in ORS 743B.005 (Definitions) must establish a procedure for providing to an enrollee in the plan a reasonable estimate of an enrollee’s costs for an in-network procedure or service covered by the enrollee’s health benefit plan, in advance of the procedure or service, when an enrollee or an enrollee’s authorized representative provides the following information to the insurer:

(a) The type of procedure or service;

(b) The name of the provider;

(c) The enrollee’s member number or policy number; and

(d) If requested by the insurer, the site where the procedure or service will be performed.

(2) The estimate of costs described in subsection (1) of this section must include an itemization of:

(a) The enrollee’s deductible;

(b) The amount of the deductible that has been met by processed claims;

(c) Coinsurance, copayment or other cost share to be paid by the enrollee for the procedure or service; and

(d) Any applicable benefit maximum.

(3) Subsections (1) and (2) of this section apply to the insurer’s five most common procedures or services within each of the following categories:

(a) Office visits;

(b) Diagnostic radiology and imaging;

(c) Diagnostic pathology and laboratory procedures;

(d) Normal vaginal delivery;

(e) Immunizations;

(f) Orthopedic-musculoskeletal surgery; and

(g) Digestive system endoscopy.

(4) In addition to the information specified in subsections (1) and (2) of this section, the insurer’s estimate must include the following disclosures:

(a) That other services may be provided to the enrollee that are medically necessary and appropriate as part of the common procedures, of which the insurer or enrollee may not be aware at the time of the inquiry and for which the enrollee may have additional financial responsibility;

(b) That the enrollee may be responsible for costs of procedures or services not covered by the plan;

(c) How an enrollee may contact the insurer for an explanation, if the estimate differs from the actual cost or if the enrollee has other questions; and

(d) The toll-free telephone number of the consumer advocacy unit of the Department of Consumer and Business Services and the address for the department’s consumer information and complaints website.

(5) An insurer must make the information required by this section available to enrollees and in-network providers through an interactive website and by toll-free telephone.

(6) This section does not prohibit an insurer from providing information in addition to or in more detail than the information required by this section. [Formerly 743.874]

Note: See note under 743B.280 (Definitions for ORS 743B.280 to 743B.285) .

Source: Section 743B.281 — Estimate of costs for in-network procedure or service , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 743a.064 — OR Code / Title 56 / Chapter 743a / Section 743a.064
743A.064 Prescription drugs dispensed at rural health clinics
Status: in_force

(1) All health insurance policies that provide a prescription drug benefit, except those policies in which coverage is limited to expenses from accidents or specific diseases that are unrelated to the coverage required by this subsection, must include coverage for prescription drugs dispensed by a licensed practitioner at a rural health clinic for an urgent medical condition if there is not a pharmacy within 15 miles of the clinic or if the prescription is dispensed for a patient outside of the normal business hours of any pharmacy within 15 miles of the clinic.

(2) The coverage required by subsection (1) of this section is subject to the terms and conditions of the prescription drug benefit provided under the policy.

(3) As used in this section, “urgent medical condition” means a medical condition that arises suddenly, is not life-threatening and requires prompt treatment to avoid the development of more serious medical problems. [Formerly 743.793]

Note: See 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) .

Source: Section 743A.064 — Prescription drugs dispensed at rural health clinics , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html (accessed May 26, 2025).
ORS § 743b.003 — OR Code / Title 56 / Chapter 743b / Section 743b.003
743B.003 Purposes
Status: in_force

The purposes of ORS 743.004 (Submission of information by carriers offering health benefit plans) , 743.022 (Premium rates for individual health benefit plans) , 743.535 (Health benefit coverage for guaranteed association) , 743B.003 (Purposes) to 743B.127 (Rules for ORS 743.022, 743B.125 and 743B.126) and 743B.800 (Risk adjustment procedures) are:

(1) To promote the availability of health insurance coverage to groups regardless of their enrollees’ health status or claims experience;

(2) To prevent abusive rating practices;

(3) To require disclosure of rating practices to purchasers of small employer and individual health benefit plans;

(4) To prohibit the use of preexisting condition exclusions;

(5) To encourage the availability of individual health benefit plans for individuals who are not enrolled in group health benefit plans;

(6) To improve renewability and continuity of coverage for employers and covered individuals;

(7) To improve the efficiency and fairness of the health insurance marketplace; and

(8) To ensure that health insurance coverage in Oregon satisfies the requirements of the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191) and 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), and that enforcement authority for those requirements is retained by the Director of the Department of Consumer and Business Services. [Formerly 743.731; 2021 c.281 §1]

Source: Section 743B.003 — Purposes , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 735.172 — OR Code / Title 56 / Chapter 735 / Section 735.172
735.172 Reporting
Status: in_force

(1) A captive insurer is not required to make a report except as specified in this section.

(2) Intentionally left blank —Ed.

(a) Before March 1 of each year, or in accordance with rules adopted under subsection (6) of this section, a captive insurer shall submit to the Director of the Department of Consumer and Business Services a report of the financial condition of the captive insurer, verified by oath of two of the executive officers of the captive insurer.

(b) A captive insurer shall report:

(A) Using generally accepted accounting principles, except to the extent that the director requires, approves or accepts the use of statutory accounting principles;

(B) Using a useful or necessary modification or adaptation to an accounting principle that is required, approved or accepted by the director for the type of insurance and kind of insurer to be reported upon; and

(C) Supplemental or additional information required by the director.

(c) Except as otherwise provided in ORS 735.150 (Definitions for ORS 735.150 to 735.190) to 735.190 (Incorporation of captive reinsurer) , an association captive insurer shall file the financial statement required by ORS 731.574 (Annual financial statement) .

(d) For the purposes of this subsection, “statutory accounting” means a method of accounting using rules that insurance companies must follow in filing an annual financial statement with the Department of Consumer and Business Services.

(3) Intentionally left blank —Ed.

(a) A pure captive insurer may make a written request to file the required report on a fiscal year end that is consistent with the fiscal year of the parent company of the pure captive insurer.

(b) If the director grants an alternative reporting date for a pure captive insurer as described under paragraph (a) of this subsection, the annual report is due 60 days after the fiscal year end.

(4) Intentionally left blank —Ed.

(a) Not later than 60 days after the fiscal year end, an alien captive insurer operating as a branch captive insurer in this state shall file with the director a copy of all reports and statements required to be filed under the laws of the jurisdiction in which the alien captive insurer is formed, verified by oath by two of the alien captive insurer’s executive officers.

(b) If the director is satisfied that the annual report filed by the alien captive insurer in the jurisdiction in which the alien captive insurer is formed provides adequate information concerning the financial condition of the alien captive insurer, the director may waive the requirement for completion of the annual statement required for a captive insurer under this section with respect to business written in the alien jurisdiction.

(c) A waiver granted by the director under paragraph (b) of this subsection shall be in writing and is subject to public inspection.

(5) All captive insurers transacting insurance in this state shall engage a qualified actuary with knowledge of this state for purposes of determining and setting premiums to be charged by the captive insurer.

(6) The director may establish by rule criteria to waive or modify the requirements of this section relating to the frequency of reporting and the contents of the report. [2012 c.84 §13]

Note: See note under 735.150 (Definitions for ORS 735.150 to 735.190) .

Source: Section 735.172 — Reporting; contents; filing date; waiver of annual statement for alien captive insurer; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 744.736 — OR Code / Title 56 / Chapter 744 / Section 744.736
744.736 Delivery from insurer to insured
Status: in_force

When the third party administrator receives policies, certificates, booklets, termination notices or other written communications from the insurer for delivery to insured parties or covered individuals, the third party administrator shall promptly make the delivery after receiving instructions from the insurer. [1991 c.812 §20]

Source: Section 744.736 — Delivery from insurer to insured , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 744.614 — OR Code / Title 56 / Chapter 744 / Section 744.614
744.614 Powers of director to issue, renew, amend, suspend and reinstate licenses
Status: in_force

(1) The Director of the Department of Consumer and Business Services may issue a license for a person to engage in business as an insurance consultant in this state if the director finds that the person:

(a) Submitted a complete and accurate application in accordance with ORS 744.611 (License application) ;

(b) Paid all required fees to the director and to any other provider or entity the director specifies by rule;

(c) Met the qualifications set forth in ORS 744.619 (Qualifications for resident insurance consultant’s license) or 744.621 (Qualifications for nonresident insurance consultant’s license) , as appropriate;

(d) Met the qualifications for each category of insurance business and class of insurance that the license will authorize the applicant to transact; and

(e) Has not engaged in conduct that would subject the person to discipline under ORS 744.644 (Prohibited conduct) .

(2) Intentionally left blank —Ed.

(a) The director may renew a license the director issues under this section if the licensee:

(A) Pays all fees the director by rule requires for the renewal;

(B) Demonstrates, if the licensee is an individual, that the licensee has satisfactorily completed the number of continuing education hours in subjects that the director specifies by rule;

(C) Proves to the director that the licensee continues to hold a valid license or other evidence of an authorization to engage in each category of insurance business and class of insurance authorized in the license that the licensee intends to renew, if the licensee is not a resident;

(D) Provides satisfactory evidence that the licensee has in effect the insurance required under ORS 744.635 (Errors and omissions insurance) ;

(E) Has not engaged in any conduct that would subject the licensee to discipline under ORS 744.644 (Prohibited conduct) ; and

(F) Satisfies any other requirement the director by rule establishes for renewing a license under this subsection.

(b) The director may renew a license that has expired within one year after the expiration date if:

(A) The director did not revoke the former licensee’s license or did not refuse to renew the license for failing the condition stated in paragraph (a)(E) of this subsection;

(B) The director determines, by examination or otherwise, that the former licensee knows the portions of the Insurance Code that apply to a licensee;

(C) The former licensee pays double the amount of the fee the director has specified in accordance with paragraph (a)(A) of this subsection; and

(D) The former licensee otherwise satisfies all applicable requirements for renewal.

(c) A former licensee may renew a license that has expired during a period of suspension as provided in paragraph (b) of this subsection.

(d) A person that does not renew a license as provided in paragraph (a) or (b) of this subsection may obtain a license only as provided in subsection (1) of this section.

(3) The director may amend a license to add a category of insurance business or a class or classes of insurance if the licensee applies for the amendment in accordance with procedures the director specifies by rule. The director may require a licensee that applies for an amendment to the license to follow the application procedures set forth in ORS 744.611 (License application) .

(4) A license that the director issues or renews under this section shall specify whether the licensee is a resident or a nonresident and the class or classes of insurance, as described in ORS 744.626 (Classes of insurance for consultants) , under which the licensee may engage in business as an insurance consultant.

(5) Intentionally left blank —Ed.

(a) A license that the director issues under subsection (1) of this section expires on the last day of the month in which the anniversary of the date on which the director issued the license occurs, unless the director specifies a different date by rule or order.

(b) A license that the director renews as provided in subsection (2) of this section expires two years after the renewal date, unless the director specifies a different date by rule or order.

(c) Adding a category of insurance business to a license under subsection (3) of this section does not change the expiration date for the license.

(6) The director may reinstate a licensee’s license under the following circumstances:

(a) If the director revoked the license, removed a category of insurance business or removed a class of insurance, the director may reinstate the license, category or class if the licensee satisfies all of the conditions that the director prescribes for reinstatement; and

(b) If a licensee has voluntarily surrendered a license, the director may reinstate the license without requiring the former licensee to take an examination otherwise required for the license if the former licensee applies for the license as provided in ORS 744.611 (License application) within two years after surrendering the previous license and demonstrates that the former licensee has satisfied any continuing education requirements that would have applied had the former licensee renewed the previous license.

(7) If the director has suspended a license, the director may modify or lift the suspension at a time certain or upon the licensee’s satisfying the conditions the director prescribes for modifying or lifting the suspension. [2019 c.151 §13]

Source: Section 744.614 — Powers of director to issue, renew, amend, suspend and reinstate licenses; license expiration; fees , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 731.385 — OR Code / Title 56 / Chapter 731 / Section 731.385
731.385 Standards for determining whether continued operation of insurer is hazardous
Status: in_force

(1) The Director of the Department of Consumer and Business Services shall establish standards by rule for determining whether the continued operation of an authorized insurer may be hazardous to the policyholders or to the insurance-buying public generally, for the purpose of carrying out ORS chapter 734 and other provisions of the Insurance Code that authorize the director to take action against such an insurer. If the director makes such a determination, the director may order the insurer to take one or more of the following actions:

(a) Reduce the total amount of present and potential liability for policy benefits by reinsurance.

(b) Reduce, suspend or limit the volume of business being accepted or renewed.

(c) Reduce general insurance and commission expenses by methods specified by the director.

(d) Increase the capital and surplus of the insurer.

(e) Suspend or limit the declaration and payment of dividends by the insurer to its stockholders or to its policyholders.

(f) Limit or withdraw from certain investments or discontinue certain investment practices to the extent the director determines such action to be necessary.

(2) The director may exercise authority under subsection (1) of this section in addition to or instead of any other authority that the director may exercise under the Insurance Code.

(3) The director may issue an order under this section with or without a hearing. An insurer subject to an order issued without a hearing may file a written request for a hearing to review the order. Such a request shall not stay the effect of the order. The hearing shall be held within 30 days after the filing of the request. The director shall complete the review within 30 days after the record for the hearing is closed, and shall discontinue the action taken under subsection (1) of this section if the director determines that none of the conditions giving rise to the action exists. [1993 c.447 §14]

Source: Section 731.385 — Standards for determining whether continued operation of insurer is hazardous; rules; order; hearing , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 743b.470 — OR Code / Title 56 / Chapter 743b / Section 743b.470
743B.470 Medicaid not considered in coverage eligibility determination
Status: in_force

(1) For the purposes of this section:

(a) “Health insurer” or “insurer” means an employee benefit plan, self-insured plan, managed care organization or group health plan, a third party administrator, fiscal intermediary or pharmacy benefit manager of the plan or organization, or other party that is by statute, contract or agreement legally responsible for payment of a claim for a health care item or service.

(b) “Medicaid” means medical assistance provided under 42 U.S.C. 1396a (section 1902 of the Social Security Act).

(2) A health insurer is prohibited from considering the availability or eligibility for medical assistance in this or any other state under Medicaid when considering eligibility for coverage or making payments under its group or individual plan for eligible enrollees, subscribers, policyholders or certificate holders.

(3) To the extent that payment for covered expenses has been made under the state Medicaid program for health care items or services furnished to an individual, in any case when a third party has a legal liability to make payments, the state is considered to have acquired the rights of the individual to payment by any other party for those health care items or services.

(4) An insurer may not deny a claim submitted by the state Medicaid agency, a prepaid managed care health services organization, as defined in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414) , or a coordinated care organization, as defined in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414) , under subsection (3) of this section based on the date of submission of the claim, the type or format of the claim form or a failure to present proper documentation at the point of sale that is the basis of the claim if:

(a) The claim is submitted by the agency, the prepaid managed care health services organization or the coordinated care organization within the three-year period beginning on the date on which the health care item or service was furnished; and

(b) Any action by the agency, the prepaid managed care health services organization or the coordinated care organization to enforce its rights with respect to the claim is commenced within six years of the agency’s or organization’s submission of the claim.

(5) An insurer must provide to the state Medicaid agency, a prepaid managed care health services organization or a coordinated care organization, upon request, the following information:

(a) The period during which a Medicaid recipient, the spouse or dependents may be or may have been covered by the plan;

(b) The nature of coverage that is or was provided by the plan; and

(c) The name, address and identifying numbers of the plan.

(6) An insurer may not deny enrollment of a child under the group or individual health plan of the child’s parent on the ground that:

(a) The child was born out of wedlock;

(b) The child is not claimed as a dependent on the parent’s federal tax return; or

(c) The child does not reside with the child’s parent or in the insurer’s service area.

(7) When a child has group or individual health coverage through an insurer of a noncustodial parent, the insurer must:

(a) Provide such information to the custodial parent as may be necessary for the child to obtain benefits through that coverage;

(b) Permit the custodial parent or the provider, with the custodial parent’s approval, to submit claims for covered services without the approval of the noncustodial parent; and

(c) Make payments on claims submitted in accordance with paragraph (b) of this subsection directly to the custodial parent, the provider or, if a claim is filed by the state Medicaid agency, a prepaid managed care health services organization or a coordinated care organization, directly to the agency or the organization.

(8) When a parent is required by a court or administrative order to provide health coverage for a child, and the parent is eligible for family health coverage, the insurer must:

(a) Permit the parent to enroll, under the family coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season restrictions;

(b) If the parent is enrolled but fails to make application to obtain coverage for the child, enroll the child under family coverage upon application of the child’s other parent, the state agency administering the Medicaid program or the state agency administering 42 U.S.C. 651 to 669, the child support enforcement program; and

(c) Not disenroll or eliminate coverage of the child unless the insurer is provided satisfactory written evidence that:

(A) The court or administrative order is no longer in effect; or

(B) The child is or will be enrolled in comparable health coverage through another insurer which will take effect not later than the effective date of disenrollment.

(9) An insurer may not impose requirements on a state agency that has been assigned the rights of an individual eligible for medical assistance under Medicaid and covered for health benefits from the insurer if the requirements are different from requirements applicable to an agent or assignee of any other individual so covered.

(10) The provisions of ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) do not apply to this section. [Formerly 743.847]

Source: Section 743B.470 — Medicaid not considered in coverage eligibility determination; claims for services paid for by medical assistance; prohibited ground for denial of enrollment of child; insurer duties , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html (accessed May 26, 2025).
ORS § 743.007 — OR Code / Title 56 / Chapter 743 / Section 743.007
743.007 Data reporting
Status: in_force

(1) A carrier offering a health benefit plan, an insurer offering insurance against the risk of economic loss assumed under a less than fully insured employee health plan described in ORS 742.065 (Insurance against risk of loss assumed under less than fully insured employee health benefit plan) and a third party administrator licensed under ORS 744.702 (Third party administrator license) shall annually submit to the Department of Consumer and Business Services, in a form and manner prescribed by the department, data concerning the number of covered lives of the carrier, insurer or third party administrator, reported by line of business and by zip code.

(2) The department shall aggregate the data collected under subsection (1) of this section and may publish reports on the number of covered lives in Oregon, by line of business and by region. [Formerly 743.818]

Note: 743.007 (Data reporting) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743.007 — Data reporting , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 743a.310 — OR Code / Title 56 / Chapter 743a / Section 743a.310
743A.310 Primary care visits
Status: in_force

(1) As used in this section, “primary care” means outpatient behavioral health services, nonspecialty medical services or the coordination of health care for the purpose of:

(a) Promoting or maintaining behavioral and physical health and wellness; and

(b) Diagnosis, treatment or management of acute or chronic conditions caused by disease, injury or illness.

(2) An individual or group policy or certificate of health insurance that is not offered on the health insurance exchange and that reimburses the cost of hospital, medical or surgical expenses, other than coverage limited to expenses from accidents or specific diseases and limited benefit coverage, shall, in each plan year, reimburse the cost of at least three primary care visits for behavioral health or physical health treatment.

(3) The coverage under subsection (2) of this section:

(a) May not be subject to copayments, coinsurance or deductibles, except as provided in ORS 742.008 (Health savings account exemption from prohibition on deductible) and subsection (5) of this section; and

(b) Is in addition to one annual preventive primary care visit that must be covered without cost-sharing.

(4) An insurer that offers a qualified health plan on the health insurance exchange must offer at least one plan in each metal tier offered by the insurer that provides the coverage described in subsections (2) and (3) of this section.

(5) The Department of Consumer and Business Services may adopt rules to allow an individual or group policy or certificate of health insurance to impose a copayment of not more than $5 for a primary care visit if necessary to comply with the requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343).

(6) This section does not apply to health benefit plans offered to public employees by insurers that contract with the Public Employees’ Benefit Board or the Oregon Educators Benefit Board.

(7) This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance) . [2022 c.37 §6; 2023 c.425 §5]

Note: 743A.310 (Primary care visits) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743A.310 — Primary care visits; rules , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html (accessed May 26, 2025).
ORS § 743.321 — OR Code / Title 56 / Chapter 743 / Section 743.321
743.321 Evidence of insurability
Status: in_force

A group life insurance policy shall contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the coverage. [1967 c.359 §418]

Source: Section 743.321 — Evidence of insurability , https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html (accessed May 26, 2025).
ORS § 731.075 — OR Code / Title 56 / Chapter 731 / Section 731.075
731.075 “Covered life.”
Status: in_force

“Covered life” means a subscriber, policyholder, certificate holder, spouse, dependent child or any other individual insured under an insurance policy or whose benefits are administered by a third party administrator licensed under ORS 744.702 (Third party administrator license) . [2009 c.595 §1194]

Note: 731.075 (“Covered life.”) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 731 or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 731.075 — “Covered life.” , https://www.­oregonlegislature.­gov/bills_laws/ors/ors731.­html (accessed May 26, 2025).
ORS § 732.578 — OR Code / Title 56 / Chapter 732 / Section 732.578
732.578 Liability of officers and directors of insurer that is subject to registration
Status: in_force

(1) A person’s control of a domestic insurer that is subject to registration does not relieve the officers and directors of the insurer of any obligation or liability to which the officers and directors would otherwise be subject by law. The domestic insurer must be managed so as to assure the insurer’s separate operating identity in accordance with the Insurance Code.

(2) This section does not preclude a domestic insurer from having or sharing a common management, or from using personnel, property or services jointly or cooperatively, with another person under an arrangement that meets the standards set forth in ORS 732.574 (Standards for transactions within holding company) .

(3) Intentionally left blank —Ed.

(a) At least one-third of a domestic insurer’s directors and at least one-third of the members of each committee of the insurer’s board of directors must be persons who are not:

(A) Officers or employees of the insurer or of any entity that controls, is controlled by or is under common control with the insurer; or

(B) Beneficial owners of a controlling interest in the voting securities of the insurer or of an entity that controls, is controlled by or is under common control with the insurer.

(b) A quorum for transacting business at a meeting of the insurer’s board of directors or any committee of the board of directors must include at least one person with the qualifications described in paragraph (a) of this subsection.

(4) A domestic insurer’s board of directors shall establish at least one committee of which the entire membership consists of persons who have the qualifications described in subsection (3)(a) of this section. The board of directors shall give the committee the board establishes under this subsection responsibility for:

(a) Recommending independent certified public accountants for the board to select;

(b) Reviewing the insurer’s financial condition and the scope and results of any independent or internal audit;

(c) Nominating candidates for election to the board of directors;

(d) Recommending principal officers for selection and the compensation for the principal officers; and

(e) Evaluating the principal officers’ performance.

(5) Subsections (3) and (4) of this section do not apply to a domestic insurer if the person that controls the domestic insurer has a board of directors, and committees of the person’s board of directors, that meet the requirements set forth in subsections (3) and (4) of this section.

(6) Intentionally left blank —Ed.

(a) The Director of the Department of Consumer and Business Services may waive the requirements set forth in subsections (3) and (4) of this section if an insurer applies for a waiver and:

(A) The insurer has less than $300 million in annual direct written and assumed premium, excluding premium reinsured with the Federal Crop Insurance Corporation and the National Flood Insurance Program; or

(B) Unique circumstances justify the director’s waiver.

(b) In determining whether to grant the waiver, the director may consider what type of business entity the insurer is, the volume of insurance the insurer transacts, whether the insurer has qualified board members, the insurer’s ownership or organizational structure and any other factor the director deems relevant. [1993 c.447 §49; 2013 c.370 §28]

Source: Section 732.578 — Liability of officers and directors of insurer that is subject to registration; allowance for common management; qualifications of directors; exemptions; waiver , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 735.417 — OR Code / Title 56 / Chapter 735 / Section 735.417
735.417 Insured required to report and pay taxes on independently procured insurance covering Oregon home state risks
Status: in_force

(1) Each insured in this state who obtains independently procured insurance, or continues or renews independently procured insurance on Oregon home state risks, other than insurance procured through a surplus lines licensee, shall file, within 30 days after the date the insurance was procured, continued or renewed, a written report with the Director of the Department of Consumer and Business Services showing:

(a) The name and address of the insurer;

(b) The subject of the insurance;

(c) The amount of premium currently charged; and

(d) Additional pertinent information reasonably requested by the director.

(2) The insured filing a report under subsection (1) of this section shall pay, at the time of filing the report, the director an amount equal to the taxes imposed under ORS 735.470 (Premium tax) for the premium reported under subsection (1)(c) of this section. The filing of the report and payment of the taxes may be made by a person authorized by the insured to act on the insured’s behalf.

(3) Intentionally left blank —Ed.

(a) The director may require that reports filed under subsection (1) of this section be filed with the Surplus Line Association of Oregon. The director may require that such filings be made electronically, but may allow an exemption to this requirement for good cause shown.

(b) The director may require that amounts to be paid to the director under subsection (2) of this section be paid to the Surplus Line Association of Oregon. [2011 c.660 §5]

Source: Section 735.417 — Insured required to report and pay taxes on independently procured insurance covering Oregon home state risks , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).
ORS § 744.079 — OR Code / Title 56 / Chapter 744 / Section 744.079
744.079 Termination of relationship with insurance producer
Status: in_force

(1) An insurer or authorized representative of the insurer who terminates the appointment, employment, contract or other insurance business relationship with an insurance producer shall notify the Director of the Department of Consumer and Business Services not later than the 30th day after the effective date of the termination, in the manner prescribed by the director, if the reason for termination is one of the reasons set forth in ORS 744.074 (Authority of director to place licensee on probation or to suspend, revoke or refuse to issue or renew license) or if the insurer has knowledge that the insurance producer was found by a court, government body or self-regulatory organization authorized by law to have engaged in any of the activities set forth in ORS 744.074 (Authority of director to place licensee on probation or to suspend, revoke or refuse to issue or renew license) . Upon the written request of the director, the insurer shall provide additional information, documents, records or other data pertaining to the termination or activity of the insurance producer.

(2) An insurer or the authorized representative of the insurer shall promptly notify the director in a manner acceptable to the director if, upon further review or investigation, the insurer discovers additional information that would have been reportable to the director in accordance with subsection (1) of this section if the insurer had then known of its existence.

(3) Not later than the 15th day after making a notification required by subsection (1) or (2) of this section, the insurer shall mail a copy of the notification to the insurance producer at the insurance producer’s last known business address. If the insurance producer is terminated for cause for any of the reasons listed in ORS 744.074 (Authority of director to place licensee on probation or to suspend, revoke or refuse to issue or renew license) , the insurer shall provide a copy of the notification to the insurance producer at the insurance producer’s last known business address by certified mail, return receipt requested, postage prepaid or by overnight delivery using a nationally recognized carrier.

(4) Not later than the 30th day after the insurance producer has received a notification under subsection (3) of this section, the insurance producer may file with the director written comments concerning the substance of the notification. The insurance producer shall, by the same means, simultaneously send a copy of the comments to the reporting insurer. The comments shall become a part of the director’s file and shall accompany every copy of a report distributed or disclosed for any reason about the insurance producer as allowed under subsection (5) of this section.

(5) In the absence of actual malice, an insurer, the authorized representative of the insurer, an insurance producer, the director or an organization of which the director is a member and that compiles the information and makes it available to other insurance regulators or regulatory or law enforcement agencies shall not be subject to civil liability. In the absence of actual malice, a civil cause of action shall not arise against any such entity or its agents or employees as a result of any statement or information required by or provided pursuant to this section, or any information relating to any statement that may be requested in writing by the director from an insurer or insurance producer, or relating to a statement by a terminating insurer or insurance producer to an insurer or insurance producer, that is limited exclusively to whether a termination for cause under subsection (1) of this section was reported to the director. Immunity under this subsection is available only if the propriety of any termination for cause under subsection (1) of this section is certified in writing by an officer or authorized representative of the insurer terminating the relationship.

(6) In any action brought against a person who may have immunity under subsection (5) of this section for making any statement required by this section or providing any information relating to any statement that may be requested in writing by the director, the party bringing the action must plead specifically in any allegation that subsection (5) of this section does not apply because the person making the statement or providing the information did so with actual malice.

(7) Subsections (5) and (6) of this section do not abrogate or modify any existing statutory or common law privileges or immunities.

(8) The director may take any administrative action authorized by the Insurance Code, including suspension or revocation of a license or certificate of authority, against an insurer, the authorized representative of an insurer or an insurance producer who fails to file notice as required by this section or who is found by a court of competent jurisdiction to have filed notice with actual malice.

(9) Any information, documents, records or other data in the control or possession of the director that are furnished by an insurer or an insurance producer, or an employee or agent thereof acting on behalf of the insurer or insurance producer, or that are obtained by the director in an investigation pursuant to this section shall be confidential, shall not be subject to subpoena and shall not be subject to discovery nor admissible in evidence in any private civil action. The director, however, may use the confidential information, documents, records or other data in administering this section and in the furtherance of any other regulatory or legal action brought as a part of the director’s duties. The information, documents, records or other data referred to in this subsection are subject to the public officer privilege described in ORS 40.270 (Rule 509. Public officer privilege) . [2001 c.191 §17; 2003 c.364 §19]

Source: Section 744.079 — Termination of relationship with insurance producer , https://www.­oregonlegislature.­gov/bills_laws/ors/ors744.­html (accessed May 26, 2025).
ORS § 732.517 — OR Code / Title 56 / Chapter 732 / Section 732.517
732.517 Purpose of ORS 732.517 to 732.546
Status: in_force

The purpose of ORS 732.517 (Purpose of ORS 732.517 to 732.546) to 732.546 (Severability) is that of regulating the control or ownership of an insurer or of an insurance holding company system. A further purpose of ORS 732.517 (Purpose of ORS 732.517 to 732.546) to 732.546 (Severability) is that of promoting the public interest and the interests of policyholders and shareholders by facilitating, consistent with those interests, better use of management skills and services, diversification through acquisitions, free access to capital markets, sound tax planning and open competition. [1983 c.498 §5; 1993 c.447 §25]

Source: Section 732.517 — Purpose of ORS 732.517 to 732.546 , https://www.­oregonlegislature.­gov/bills_laws/ors/ors732.­html (accessed May 26, 2025).
ORS § 735.636 — OR Code / Title 56 / Chapter 735 / Section 735.636
735.636 Duties of licensee
Status: in_force

A licensee shall:

(1) Notify the Director of the Department of Consumer and Business Services immediately whenever the licensee’s license or other form of authority to operate as a discount medical plan organization in another jurisdiction is suspended, revoked or not renewed in that jurisdiction.

(2) Describe in a notice to the director any change in the name, address or contact information of the discount medical plan organization provided in the application under ORS 735.634 (License application) within 30 days after making the change. [Formerly 742.428]

Note: See note under 735.631 (Definitions for ORS 735.631 to 735.643) .

Source: Section 735.636 — Duties of licensee , https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).