justicedao/ipfs_state_laws huggingface dataset:
836-051-0320 Payment Options; Filing of Claims; Remaining Benefits (1) An insurer shall include among payment options for the accelerated benefit an option that allows the policy owner or certificate holder to take the benefit as a lump sum. The insurer shall not make the benefit available as an annuity contingent upon the life of the insured. (2) An insurer shall not impose any restriction on the use of the proceeds. (3) If any death benefit remains after payment of an accelerated benefit, any accidental death benefit that is part of the policy shall not be affected by the payment of the accelerated benefit. Any other benefits in force at the time of acceleration shall not be affected by the payment of the accelerated benefit if premiums continue to be paid for those benefits. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 743.154 History: ID 15-1996, f. & cert. ef. 11-12-96 ID 12-1993, f. & cert. ef. 11-19-93 ID 8-1992, f. 5-26-92, cert. ef. 6-1-92
836-051-0330 Disclosure (1) An accelerated benefit provision shall include “accelerated benefit” or “accelerated death benefit” as part of the descriptive title. The policy, certificate or rider schedule must: (a) Include one of the following: (A) Any premium or cost of insurance charge designated for the accelerated benefit; (B) The interest rate if fixed; or (C) The method used by the insurer to establish the interest rate in OAR 836-051-0370(3); and (b) Disclose any administrative expense charge associated with the exercise of the accelerated benefit. (2) When a life insurance policy or certificate containing an accelerated benefit provision is applied for or delivered, or when an accelerated benefit rider to a life insurance policy is applied for, delivered or added, the insurer shall give or cause to be given a summary of coverage described in this section to the applicant for the policy, certificate or rider. The description must include all of the following: (a) A brief summary of the accelerated benefit and definitions of the conditions or occurrences triggering payment of the benefit; (b) An explanation of any effect of the payment of an accelerated benefit on the cash value, accumulation account, death benefit, premium payments, any loans or liens. (c) Disclosure of the basis for payment, whether a premium, cost of insurance charge, lien assessment or present value calculation; (d) A statement that receipt of the accelerated benefit may be taxable and that assistance should be sought from a personal tax advisor. (3) When an accelerated benefit option is exercised, the insurer shall provide the following to the policy holder or certificate holder and any irrevocable beneficiary: (a) An illustration that: (A) Numerically demonstrates any effect the payment of the benefit will have on the cash value, accumulation account, death benefit, premium payments, any loans or liens; (B) Separately illustrates the loaned amount from the accelerated risk amount if the acceleration is based on a lien and the interest accrued on the two portions are not at the same rate; and (C) Includes a statement that receipt of accelerated benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements, that benefits may be taxable and that assistance should be sought from a personal tax advisor. (b) An amended schedule page showing any new, reduced in-force face amount and the continuing premium requirements to keep the remaining coverage in force. Statutory/Other Authority: ORS 731.244 & 743.154 Statutes/Other Implemented: ORS 743.154 History: ID 12-1993, f. & cert. ef. 11-19-93 ID 8-1992, f. 5-26-92, cert. ef. 6-1-92
836-051-0340 Exercise of the Accelerated Benefit (1) For conditions of eligibility resulting from accident, an accelerated benefit provision must be exercisable on or after the issue date of the accelerated benefit provision. (2) For conditions of eligibility resulting from illness, an accelerated benefit provision must be exercisable not later than the 30th day after the issued date of the accelerated benefit provision. (3) For the purpose of defining the qualifying event described in ORS 743.154(2)(c), an insurer shall not require a period of continuous confinement that is greater than 180 days. Statutory/Other Authority: ORS 731.244 & 743.154 Statutes/Other Implemented: ORS 743.154 History: ID 8-1992, f. 5-26-92, cert. ef. 6-1-92
836-051-0350 Waiver of Premium (1) An insurer may offer a waiver of premium as part of the accelerated benefit provision in the absence of a regular waiver of premium provision. (2) When an accelerated benefit is included in an individual term policy or an individually-paid group certificate, the accelerated benefit provision must include a waiver of premium provision for any remaining face amount. (3) A term rider shall not be affected by the payment of the accelerated benefit if premiums continue to be paid for the rider. Statutory/Other Authority: ORS 731.244 & 743.154 Statutes/Other Implemented: ORS 743.154 History: ID 1-1996, f. & cert. ef. 1-12-96 ID 8-1992, f. 5-26-92, cert. ef. 6-1-92
836-051-0360 Discrimination In the payment of accelerated benefits, an insurer shall not unfairly discriminate among insureds with differing qualifying events covered under the policy or among insureds with similar qualifying events covered under the policy. An insurer shall not apply further conditions on the payment of the accelerated benefits other than those conditions specified in the policy or rider. An insurer who provides that its accelerated benefit provision is exercisable in the event of a medical condition to which ORS 743.154(2)(d) applies shall not limit exercise of the benefit to specific medical conditions. Statutory/Other Authority: ORS 731.244 & 743.154 Statutes/Other Implemented: ORS 743.154 History: ID 8-1992, f. 5-26-92, cert. ef. 6-1-92
836-051-0380 Actuarial Disclosure and Reserves (1) An insurer shall submit an actuarial memorandum with each filing that describes the accelerated benefit, the risks, the expected costs, the development of premiums, the bases used to calculate benefits payable and the calculation of statutory reserves. (2) When an accelerated benefit is included as part of a policy, certificate or rider, an insurer shall determine reserves in accordance with the Standard Valuation Law. The actuary must follow both actuarial standards and certification for good and sufficient reserves. Reserves in the aggregate must be sufficient to cover: (a) Policies upon which no claim has yet arisen; and (b) Policies upon which an accelerated claim has arisen. (3) Policy liens and policy loans, including accrued interest, represent assets of the insurer for statutory reporting purposes. For any policy on which the policy lien exceeds the policy’s statutory reserve liability, the excess must be held as a non-admitted asset. Statutory/Other Authority: ORS 731.244 & 743.154 Statutes/Other Implemented: ORS 743.154 History: ID 8-1992, f. 5-26-92, cert. ef. 6-1-92
836-051-0500 Purpose; Authority (1) The purpose of OAR 836-051-0500 to 836-051-0600 is to provide rules for life insurance policy illustrations that will protect consumers and foster consumer education. OAR 836-051-0500 to 836-051-0600 provide illustration formats, prescribe standards to be followed when illustrations are used and specify the disclosures that are required in connection with illustrations. The goals of 836-051-0500 to 836-051-0600 are to ensure that illustrations do not mislead purchasers of life insurance and to make illustrations more understandable. (2) Insurers shall, as far as possible, eliminate the use of footnotes and caveats and define terms used in the illustration in language that would be understood by a typical person within the segment of the public to which the illustration is directed. (3) OAR 836-051-0500 to 836-051-0600 are adopted pursuant to ORS 731.244 and 746.240 for the purpose of implementing 746.075, 746.085, 746.100, 746.110, and 746.240. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 746.085, 746.100, 746.110 & 746.240 History: ID 5-1997, f. 5-27-97, cert. ef. 7-1-97
836-051-0510 Applicability and Scope (1) OAR 836-051-0500 to 836-051-0600 apply to all group life insurance policies and certificates and all individual life insurance policies except: (a) Variable life insurance; (b) Individual and group annuity contracts; (c) Credit life insurance; (d) Life insurance policies with an illustrated death benefit that does not exceed $10,000 on any individual; and (e) Group term life insurance policies. (2) OAR 836-051-0500 to 836-051-0600 apply to life insurance policies described in section (1) of this section that are sold on or after July 1, 1997. An insurer may conform its policies to the provisions of OAR 836-051-0500 to 836-051-0600 prior to that date. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 746.085, 746.100, 746.110 & 746.240 History: ID 5-1997, f. 5-27-97, cert. ef. 7-1-97
836-051-0530 Policies to Be Illustrated (1) An insurer shall identify each life insurance policy form filed with the Director on or after July 1, 1997, that will be marketed with an illustration. For informational purposes, the insurer shall file with the policy form filing a sample illustration in John Doe format to match a John Doe policy. Approval of a policy form filing will not be given until the Director has received the informational sample illustration. The insurer shall also identify in writing each policy form being actively marketed on July 1, 1997, with which an illustration is being or will be used. Any decision to market with an illustration or not may be changed by notice to the Director. (2) If an insurer does not identify a policy form as one to be marketed with an illustration, any use of an illustration for any policy using that form prior to the first policy anniversary is prohibited. (3) If a policy form is identified by the insurer as one to be marketed with an illustration, a basic illustration prepared and delivered in accordance with OAR 836-051-0500 to 836-051-0600 is required, except that a basic illustration need not be provided to individual members of a group or to individuals insured under multiple lives coverage issued to a single applicant unless the coverage is marketed to these individuals. The illustration furnished an applicant for a group life insurance policy or policies issued to a single applicant on multiple lives may be either an individual or composite illustration representative of the coverage on the lives of members of the group or the multiple lives covered. (4) Potential enrollees of non-term group life insurance subject to OAR 836-051-0500 to 836-051-0600 shall be furnished a quotation as described in this section with the enrollment materials. The quotation shall show potential policy values for sample ages and policy years on a guaranteed and non-guaranteed basis appropriate to the group and the coverage. This quotation shall not be considered an illustration for purposes of 836-051-0500 to 836-051-0600, but all information provided shall be consistent with the illustrated scale. A basic illustration shall be provided at delivery of the certificate to enrollees for non-term group life who enroll for more than the minimum premium necessary to provide pure death benefit protection. In addition, the insurer shall make a basic illustration available to any non-term group life enrollee who requests it. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 746.085, 746.100, 746.110 & 746.240 History: ID 5-1997, f. 5-27-97, cert. ef. 7-1-97
836-051-0540 General Rules and Prohibitions (1) An illustration used in the sale of a life insurance policy shall satisfy the applicable requirements of OAR 836-051-0500 to 836-051-0600, be clearly labeled "life insurance illustration" and contain the following basic information: (a) Name of insurer; (b) Name and business address of the insurance producer, if any; (c) Name, age and sex of proposed insured, except when a composite illustration is permitted under OAR 836-051-0500 to 836-051-0600; (d) Underwriting or rating classification upon which the illustration is based; (e) Generic name of policy, the insurer product name, if different, and form number; (f) Initial death benefit; and (g) Dividend option election or application of non-guaranteed elements, if applicable. (2) When using an illustration in the sale of a life insurance policy, neither an insurer nor its insurance producer shall: (a) Represent the policy as anything other than a life insurance policy; (b) Use or describe non-guaranteed elements in a manner that is misleading or has the capacity or tendency to mislead; (c) State or imply that the payment or amount of non-guaranteed elements is guaranteed; (d) Use an illustration that does not comply with the requirements of OAR 836-051-0500 to 836-051-0600; (e) Use an illustration that at any policy duration depicts policy performance more favorable to the policy owner than that produced by the illustrated scale of the insurer whose policy is being illustrated; (f) Provide an applicant with an incomplete illustration; (g) Represent in any way that premium payments will not be required for each year of the policy in order to maintain the illustrated death benefits, unless that is the fact; (h) Use the term "vanish" or "vanishing premium," or a similar term that implies the policy becomes paid up, to describe a plan for using non-guaranteed elements to pay a portion of future premiums; (i) Except for policies that can never develop nonforfeiture values, use an illustration that is "lapse-supported"; or (j) Use an illustration that is not "self-supporting." (3) If an interest rate used to determine the illustrated non-guaranteed elements is shown, it shall not be greater than the earned interest rate underlying the disciplined current scale. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 746.085, 746.100, 746.110 & 746.240 History: ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 5-1997, f. 5-27-97, cert. ef. 7-1-97
836-051-0560 Standards for Supplemental Illustrations (1) A supplemental illustration may be provided so long as: (a) It is appended to, accompanied by or preceded by a basic illustration that complies with OAR 836-051-0500 to 836-051-0600; (b) The non-guaranteed elements shown are not more favorable to the policy owner than the corresponding elements based on the scale used in the basic illustration; (c) It contains the same statement required of a basic illustration that non-guaranteed elements are not guaranteed; and (d) For a policy that has a contract premium, the contract premium underlying the supplemental illustration is equal to the contract premium shown in the basic illustration. For policies that do not require a contract premium, the premium outlay underlying the supplemental illustration shall be equal to the premium outlay shown in the basic illustration. (2) The supplemental illustration shall include a notice referring to the basic illustration for guaranteed elements and other important information. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 746.085, 746.100, 746.110 & 746.240 History: ID 5-1997, f. 5-27-97, cert. ef. 7-1-97
836-051-0570 Delivery of Illustration and Record Retention (1) If a basic illustration is used by an insurance producer in the sale of a life insurance policy and the policy is applied for as illustrated, a copy of that illustration, signed in accordance with OAR 836-051-0500 to 836-051-0600, shall be submitted to the insurer at the time of policy application. A copy also shall be provided to the applicant. If the policy is issued other than as applied for, a revised basic illustration conforming to the policy as issued shall be sent with the policy. The revised illustration shall conform to the requirements of 836-051-0500 to 836-051-0600, shall be labeled "Revised Illustration" and shall be signed and dated by the applicant or policy owner and insurance producer no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner. (2) If no illustration is used by an insurance producer in the sale of a life insurance policy or if the policy is applied for other than as illustrated, the insurance producer shall certify to that effect in writing on a form provided by the insurer. On the same form the applicant shall acknowledge that no illustration conforming to the policy applied for was provided and shall further acknowledge an understanding that an illustration conforming to the policy as issued will be provided no later than at the time of policy delivery. This form shall be submitted to the insurer at the time of policy application. If the policy is issued, a basic illustration conforming to the policy as issued shall be sent with the policy and signed no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner. (3) If the basic illustration or revised illustration is sent to the applicant or policy owner by mail from the insurer, it shall include instructions for the applicant or policy owner to sign the duplicate copy of the numeric summary page of the illustration for the policy issued and return the signed copy to the insurer. The insurer's obligation under this section shall be satisfied if the insurer can demonstrate that it has made a diligent effort to secure a signed copy of the numeric summary page. The requirement to make a diligent effort shall be satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed numeric summary page. (4) A copy of the basic illustration and a revised basic illustration, if any, signed as applicable, along with any certification that either no illustration was used or that the policy was applied for other than as illustrated, shall be retained by the insurer until three years after the policy is no longer in force. A copy need not be retained if no policy is issued. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 746.085, 746.100, 746.110 & 746.240 History: ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 5-1997, f. 5-27-97, cert. ef. 7-1-97
836-051-0600 Trade Practice Regulation Violation of any provision of OAR 836-051-0500 to 836-051-0600 is an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.075, 746.085, 746.100, 746.110 & 746.240 History: ID 5-1997, f. 5-27-97, cert. ef. 7-1-97
836-051-0700 Authorization, Genetic Testing (1) A person who asks an applicant for insurance to take a genetic test in connection with an application for insurance shall obtain the specific authorization of the applicant by use of the form in Exhibit 1 to this rule, or a form that is substantively similar. (2) This rule implements ORS 746.135. Statutory/Other Authority: ORS 746.135 Statutes/Other Implemented: ORS 746.135 History: ID 5-2004, f. & cert. ef. 6-14-04
836-051-0750 Purpose; Authority; Applicability; and Effective Date (1) OAR 836-051-0750 to 836-051-0775 are adopted pursuant to the general rulemaking authority of the Director in ORS 731.244, and specific authority of ORS 733.306 and 743.215 for approving mortality tables adopted by the National Association of Insurance Commissioners for use in determining minimum valuation and nonforfeiture standards. (2) OAR 836-051-0750 to 836-051-0775 apply to preneed insurance and to similar policies and certificates used to fund funeral services and expenses as determined by the Director, issued on or after January 1, 2009. (3) The purpose of OAR 836-051-0750 to 836-051-0775 is to establish for preneed insurance products minimum mortality standards for reserves and nonforfeiture values, and to require the use of the 1980 Commissioners Standard Ordinary (CSO) Life Valuation Mortality Table for use in determining the minimum standard of valuation of reserves and the minimum standard nonforfeiture values for preneed insurance products. Statutory/Other Authority: ORS 731.244, 733.306 & 743.205 Statutes/Other Implemented: ORS 733.306, 733.310, 743.215, 743.216 & 743.221 History: ID 17-2008, f. & cert. ef. 12-9-08
836-051-0755 Definitions As used in OAR 836-051-0750 to 836-051-0775: (1) “Preneed insurance” is any life insurance policy that is issued in combination with, in support of, with an assignment to, or as a guarantee for a prearrangement agreement for goods and services to be provided at the time of and immediately following the death of the insured. Goods and services may include, but are not limited to embalming, cremation, body preparation, viewing or visitation, coffin or urn, memorial stone, and transportation of the deceased. The status of the policy as preneed insurance is determined at the time of issue in accordance with the policy form filing. (2) “Ultimate 1980 CSO” means the 1980 Commissioners’ Standard Ordinary Life Valuation Mortality Tables (1980 CSO) without ten-year (10-year) selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law approved in December 1983. Statutory/Other Authority: ORS 731.244, 733.306 & 743.205 Statutes/Other Implemented: ORS 733.306, 733.310, 743.215, 743.216 & 743.221 History: ID 17-2008, f. & cert. ef. 12-9-08
836-051-0760 Minimum Valuation Mortality Standards For preneed insurance and to similar policies and certificates used to fund funeral services and expenses, the minimum mortality standard for determining reserve liabilities and nonforfeiture values for both male and female insureds shall be the Ultimate 1980 CSO. Statutory/Other Authority: ORS 731.244, 733.306 & 743.205 Statutes/Other Implemented: ORS 733.306, 733.310, 743.215, 743.216 & 743.221 History: ID 17-2008, f. & cert. ef. 12-9-08
836-051-0765 Minimum Valuation Interest Rate Standards (1) The interest rates used in determining the minimum standard for valuation of preneed insurance shall be the calendar year statutory valuation interest rates as defined in ORS 733.306 and 733.310. (2) The interest rates used in determining the minimum standard for nonforfeiture values for preneed insurance shall be the calendar year statutory nonforfeiture interest rates as defined in ORS 743.215, 743.216 and 743.221. Statutory/Other Authority: ORS 731.244, 733.306 & 743.205 Statutes/Other Implemented: ORS 733.306, 733.310, 743.215, 743.216 & 743.221 History: ID 17-2008, f. & cert. ef. 12-9-08
836-051-0770 Minimum Valuation Method Standards (1) The method used in determining the standard for the minimum valuation of reserves of preneed insurance shall be the method defined in ORS 733.306 and 733.310. (2) The method used in determining the standard for the minimum nonforfeiture values for preneed insurance shall be the method defined in ORS 743.215, 743.216 and 743.221. Statutory/Other Authority: ORS 731.244, 733.306 & 743.205 Statutes/Other Implemented: ORS 733.306, 733.310, 743.215, 743.216 & 743.221 History: ID 17-2008, f. & cert. ef. 12-9-08