justicedao/ipfs_state_laws huggingface dataset:
836-020-0770 Authority, Purpose and Effective Date of OAR 836-020-0770 to 836-020-0806 (1) OAR 836-020-0770 to 836-020-0806 are adopted by the Director of the Department of Consumer and Business Services pursuant to the authority of ORS 731.244 and 743.552, for the purpose of implementing 743.552. (2) The purpose of OAR 836-020-0770 to 836-020-0806 is to: (a) Establish a uniform order of benefit determination under which plans pay claims; (b) Reduce duplication of benefits by permitting a reduction of the benefits to be paid by plans that, as provided in OAR 836-020-0770 to 836-020-0806, do not have to pay their benefits first; and (c) Provide greater efficiency in the processing of claims when a person is covered under more than one plan. Statutory/Other Authority: ORS 731.244 & 743.552 Statutes/Other Implemented: ORS 743.552 History: ID 12-2013, f. 12-31-13, cert. ef. 1-1-14 ID 3-2007, f. & cert. ef. 2-12-07 ID 14-2006, f. & cert. ef. 7-20-06
836-020-0780 Use of Model COB Contract Provision (1) Appendix A (Exhibit 1 to this rule) contains a model COB provision for use in contracts. The use of this model COB provision is subject to OAR 836-020-0785(1), (2) and (3). (2) Appendix B (Exhibit 2 to this rule) is a plain language description of the COB process that explains to the covered person how health plans will implement coordination of benefits. It is not intended to replace or change the provisions that are set forth in the contract. Its purpose is to explain the process by which the two or more plans will pay for or provide benefits. (3) The COB provision contained in Appendix A and the plain language explanation in Appendix B do not have to use the specific words and format shown in Appendix A or Appendix B. Changes may be made to fit the language and style of the rest of the contract or to reflect differences among plans that provide services, that pay benefits for expenses incurred and that indemnify. No substantive changes are permitted. (4) A COB provision may not be used that permits a plan to reduce its benefits on the basis that: (a) Another plan exists and the covered person did not enroll in that plan; (b) A person is eligible or could have been covered under another plan, including Part B of Medicare; or (c) A person has elected an option under another plan providing a lower level of benefits than another option that could have been elected. (5) A plan may not contain a provision that its benefits are "always excess" or "always secondary" except in accordance with the rules permitted by OAR 836-020-0770 to 836-020-0806. (6) Under the terms of a closed panel plan, benefits are not payable if the covered person does not use the services of a closed panel provider. In most instances, COB does not occur if a covered person is enrolled in two or more closed panel plans and obtains services from a provider in one of the closed panel plans because the other closed panel plan (the one whose providers were not used) has no liability. However, COB may occur during the plan year when the covered person receives emergency services that would have been covered by both plans. Then the secondary plan shall use OAR 836-020-0790 to determine the amount it should pay for the benefit. (7) A plan may not use a COB provision, or any other provision that allows it to reduce its benefits with respect to any other coverage its insured may have, that does not meet the definition of plan in OAR 836-020-0775. [ED. NOTE: Appendices referenced are available from the agency.] Statutory/Other Authority: ORS 731.244 & ORS 743B.475 Statutes/Other Implemented: ORS 743B.475 History: ID 13-2023, amend filed 06/22/2023, effective 07/01/2023 ID 12-2013, f. 12-31-13, cert. ef. 1-1-14 ID 14-2006, f. & cert. ef. 7-20-06
836-020-0791 Procedure to be Followed by Secondary Plan to Calculate Benefits and Pay a Claim (1) In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount to any allowable expense under its plan that is unpaid by the primary plan. (2) The secondary plan may reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed 100 percent of the total allowable expense for that claim. (3) In addition, the secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage. Statutory/Other Authority: ORS 731.244 & 743.552 Statutes/Other Implemented: 743.549 & 743.552 History: ID 14-2006, f. & cert. ef. 7-20-06
836-020-0796 Notice to Covered Persons A plan shall, in its explanation of benefits provided to covered persons, include the following language: “If you are covered by more than one health benefit plan, you should file all your claims with each plan.” Statutory/Other Authority: ORS 731.244 & 743.552 Statutes/Other Implemented: 743.549 & 743.552 History: ID 14-2006, f. & cert. ef. 7-20-06
836-020-0806 Effective Date for Existing Contracts (1) The amendments to OAR 836-020-0770, 836-020-0775 and 836-020-0785 apply to a contract that provides health care benefits and that was issued before January 1, 2015 must comply with the amendments to OAR 836-020-0770, 836-020-0775 and 836-020-0806 that are effective on January 1, 2014 by: (a) The next anniversary date or renewal date of the contract; or (b) The expiration of any applicable collectively bargained contract pursuant to which it was written. (2) A question of the order of benefits between a contract operating under OAR 836-020-0770, 836-020-0775 and 836-020-0785 as amended effective January 1, 2014 for contracts issued or renewed on or after January 1, 2015 and a contract operating under the provisions of OAR 836-020-0770, 836-020-0775 and 836-020-0785 for contracts issued or renewed prior to January 1, 2015 is governed by the version of the rules in effect prior to amendment of the rules effective on January 1, 2014. Statutory/Other Authority: ORS 731.244 & 743.552 Statutes/Other Implemented: ORS 743.552 History: ID 12-2013, f. 12-31-13, cert. ef. 1-1-14 ID 14-2006, f. & cert. ef. 7-20-06
836-024-0003 Statutory Authority; Purpose OAR 836-024-0003 to 836-024-0055 are authorized by ORS 732.415(4). These rules are adopted to carry out the purposes of 732.415, to prevent fraud or deception in connection with the solicitation of proxies, consents, and other authorizations, and to protect the insurance-buying public in accordance with the purpose of the Insurance Code. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06 IC 68, f. & ef. 6-22-76
836-024-0004 Application of OAR 836-024-0003 to 836-024-0055 (1) A domestic stock insurer that has a class of equity securities held of record by 300 or more persons, or any director, officer or employee of that insurer, or any other person, may not solicit or permit the use of the name of a holder of any of the equity securities to solicit, by mail or otherwise, any proxy, consent or authorization in respect to any class of equity securities contrary to any provision of OAR 836-024-0003 to 836-024-0055 or Schedules A and B. OAR 836-024-0003 to 836-024-0055 do not apply, however, to: (a) A domestic stock insurer if 95 percent or more of its equity securities is owned or controlled by a parent or an affiliated insurer and the remaining securities are held of record by fewer than 500 persons; or (b) A domestic stock insurer, with respect to a class of securities, if the insurer files with the federal Securities and Exchange Commission forms of proxies, consents and authorizations complying with the requirements of the Securities and Exchange Act of 1934, as amended, and its applicable regulations, with respect to that class of securities. (2) If proxies, consents or authorizations relating to a class of equity securities of a domestic stock insurer subject to section (1) of this rule are not solicited by or on behalf of the management of the insurer from the holders of record of the securities according to OAR 836-024-0003 to 836-024-0055 and its schedules, the insurer shall: (a) File with the Director a written information statement containing the information specified in Schedule C; and (b) Transmit the written information statement referred to in subsection (a) of this section to every security holder who is entitled to vote on a matter to be acted upon at any meeting of the security holders, and from whom a proxy is not solicited. (3) Exhibits A, B and C are incorporated into this rule as Exhibits 1, 2 and 3. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 731.244 & 732.415 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06
836-024-0008 Solicitations to which OAR 836-024-0003 to 836-024-0055 Apply OAR 836-024-0041 applies to every solicitation that is subject to 836-024-0004. 836-024-0006 to 836-024-0039 and 836-024-0046 apply to every solicitation that is subject to 836-024-0004 except the following: (1) A solicitation not made on behalf of the issuer, when the total number of persons solicited is not more than ten. (2) A solicitation by a person regarding securities carried in the name of the person or in the name of the person’s nominee other than as voting trustee, or held in the person’s custody, if the person does all of the following: (a) Receives no commission or remuneration for the solicitation, directly or indirectly, other than reimbursement of reasonable expenses. (b) Furnishes promptly to the solicited person a copy of all soliciting material relating to the same subject matter or meeting that is received from all persons. The persons who furnish the soliciting material shall furnish copies of that soliciting material for distribution to the solicited persons and shall, upon request, pay the reasonable expenses incurred in forwarding the material. (c) Does no more than: (A) Impartially instruct the solicited person to forward a proxy to the person, if any, to whom the solicited person desires to give a proxy; or (B) Impartially request instructions from the solicited person regarding the authority to be conferred by the proxy and state that a proxy will be given if no instructions are received by a certain date. (3) A solicitation by a person relating to securities of which the person is the beneficial owner. (4) A solicitation through a newspaper advertisement that informs security holders of a source from which they may obtain copies of a proxy statement, form of proxy and any other soliciting material, and does no more than: (a) Name the issuer; (b) State the reason for the advertisement; and (c) Identify the proposal or proposals to be acted upon by security holders. (5) Any solicitation that the Director finds for good cause should be exempted from all or part of OAR 836-024-0003 to 836-024-0055. Statutory/Other Authority: ORS 731.244 & 732.415 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06
836-024-0033 Presentation of Information in Proxy Statement (1) The information included in the proxy statement shall be clearly presented. The statements made must be divided into groups according to subject matter. The various groups of statements must be preceded by appropriate headings. (2) All proxy statements shall disclose, under an appropriate caption, the date by which proposals of security holders intended to be presented at the next annual meeting must be received by the issuer for inclusion in the issuer’s proxy statement and form of proxy relating to that meeting. The date must be calculated according to OAR 836-024-0039(2). If the date of the next annual meeting is subsequently advanced by more than 30 calendar days or delayed by more than 90 calendar days from the date of the annual meeting to which the proxy statement relates, the issuer in a timely manner shall inform security holders of the change and the date by which proposals of security holders must be received, by any means reasonably calculated to inform the security holders. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06
836-024-0036 Material Required to Be Filed (1) Two preliminary copies of the proxy statement and form of proxy, and any other soliciting material to be furnished to security holders with the proxy, or the information pursuant to Schedule C, shall be filed with the Director at least ten days prior to the date final copies of the material are first sent or given to security holders, or a shorter period prior to that date that the Director authorizes upon a showing of good cause. (2) Two preliminary copies of any additional soliciting material relating to the same meeting or subject matter to be furnished to security holders after the proxy statements shall be filed with the Director at least two days (exclusive of Saturdays, Sundays, or holidays) prior to the date copies of the material are first sent or given to security holders, or a shorter period prior to that date that the Director authorizes upon a showing of good cause. (3) Two definitive copies of the proxy statement, form of proxy and all other soliciting material, or the information statement, in the form in which the material is furnished to security holders, shall be filed with, or mailed for filing to, the Director not later than the date the material is first sent or given to a security holder. (4) Copies of replies to inquiries from security holders requesting further information and copies of communications that do no more than request that the proxy form previously solicited be signed and returned need not be filed pursuant to this rule. (5) Notwithstanding the provisions of sections (1) and (2) of this rule and of OAR 836-024-0055(1), copies of soliciting material in the form of speeches, press releases and radio or television scripts may, but need not, be filed with the Director prior to use or publication. Definitive copies, however, shall be filed with or mailed for filing to the Director as required by section (3) of this rule not later than the date the material is used or published. Sections (1) and (2) of this rule and 836-024-0055(1) apply, however, to any reprints or reproductions of all or any part of such material. (6) If a proxy statement, form of proxy or other material filed pursuant to this rule is amended or revised, one of the copies of the amendment or revision shall be marked to clearly show the changes. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06 IC 68, f. & ef. 6-22-76
836-024-0038 Mailing Communications for Security Holders (1) If the management of the issuer has made or intends to make any solicitation subject to OAR 836-024-0003 to 836-024-0055, the issuer shall perform any act described in this rule that is requested in writing with respect to the same subject matter or meeting by any security holder who is, or by security holders who are, entitled to vote at least one percent of the votes entitled to be voted on the matter. The requesting security holder or security holders shall pay the reasonable expenses incurred by the issuer in performing the act or acts requested. (2) The issuer shall mail or otherwise furnish to a security holder, as promptly as practicable after the receipt of the request: (a) A statement of the approximate number of record owners and, to the extent known to the issuer, the approximate number of beneficial owners of any class of securities, any of whom have been or are to be solicited on behalf of the management, or any group of whom that is designated by the security holder; and (b) An estimate of the cost of mailing a specified proxy statement, form of proxy or other communication to the owners. (3) The issuer shall mail copies of any proxy statement, form of proxy or other communication furnished by the security holder to the security owners specified in section (2) of this rule and designated by the security holder. The issuer shall mail the material furnished by the security holder with reasonable promptness after receiving the material to be mailed, envelopes or other containers therefor, and postage or payment for postage. The issuer need not, however, mail any material before the first day that solicitation is made on behalf of the issuer. The issuer is not responsible for the proxy statement, form of proxy or other communication. (4) Instead of performing the acts specified in section (3) of this rule, the issuer may furnish promptly to a security holder a reasonably current list of the names and addresses of the record owners and, to the extent known to the issuer, the beneficial owners designated by the security holder and a schedule of the handling and mailing costs if the schedule has been supplied to the issuer. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06
836-024-0039 Proposals of Security Holders (1) As used in this rule, “proponent” means a holder or holders of an issuer’s securities. (2) An issuer shall set forth a proposal for action in its proxy statement if the proponent notifies the issuer as provided in this section and if the proponent is entitled at the time of the notice to vote at least one percent of the votes entitled to be voted on the proposal. The proponent must notify the issuer in writing not less than 90 days before the issuer’s annual meeting of the proponent’s intention to present a proposal for action at an upcoming meeting of the issuer’s security holders. The issuer shall identify the proposal in the issuer’s form of proxy and provide for specifying approval or disapproval of the proposal. The proxy statement shall also include the name and address of the proponent. (3) If the issuer opposes a proposal received from a proponent, the issuer shall also include in its proxy statement, at the request of the proponent, a statement of the proponent not exceeding 200 words in support of the proposal. (4) The issuer may omit a proposal and any supporting statement from its proxy statement and form of proxy under any of the following circumstances: (a) The proponent has submitted more than one proposal in connection with a particular meeting. (b) The proposal is more than 300 words in length. (c) The proposal or the supporting statement is contrary to any provision of OAR 836-024-0003 to 836-024-0055. (d) The proposal relates to the enforcement of a personal claim or the redress of a personal grievance against the issuer, its management or any other person. (e) The proposal deals with a matter not significantly related to the issuer’s business, a matter beyond the issuer’s power to effectuate, a matter relating to the conduct of the ordinary business operations of the issuer or an election to office. (f) The proposal is counter to a proposal to be submitted by the issuer at the meeting, the proposal has been rendered moot or the proposal relates to specific amounts of cash or stock dividends. (g) The proposal is substantially duplicative of a proposal that was previously submitted to the issuer by another proponent and will be included in the management’s proxy material for the meeting. (h) Substantially the same proposal has previously been submitted to security holders in the issuer’s proxy statement and form of proxy relating to any annual or special meeting of security holders held within the preceding five years and received less than five percent of the total number of votes cast at the time of the proposal’s most recent submission. (5) If the issuer intends to omit a proposal from its proxy statement or forms of proxy or both, the issuer shall notify the proponent in writing of its intention at least ten days before the issuer’s preliminary proxy material is filed pursuant to OAR 836-024-0036. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06
836-024-0041 False or Misleading Statements A proxy statement, form of proxy, notice of meeting, information statement, and any other communication, written or oral, that is subject to OAR 836-024-0003 to 836-024-0055 may not contain any statement that: (1) At the time and in the light of the circumstances under which it is made, is false or misleading with respect to any material fact; or (2) Omits any material fact that is necessary in order to make the statements in the communication not false or misleading, or that is necessary to correct any statement in an earlier communication with respect to the same meeting or subject matter that has become false or misleading. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06 IC 68, f. & ef. 6-22-76
836-024-0046 Prohibition of Certain Solicitations A person making a solicitation may not solicit any undated or postdated proxy, or any proxy that provides it will be considered to be dated as of any date subsequent to the date on which it is signed by the security holder. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06 IC 68, f. & ef. 6-22-76
836-024-0051 Special Provisions Applicable to Election Contests; Definition OAR 836-024-0051 to 836-024-0055 apply to a solicitation by any person or group for the purpose of opposing a solicitation by another person or group regarding the election or removal of directors at an annual or special meeting of security holders. As used in 836-024-0051 to 836-024-0055, unless the context requires otherwise: (1) "Participant" and "participant in a solicitation" include: (a) The issuer; (b) A director of the issuer, and a nominee for whose election as a director proxies are solicited; and (c) Any other person, acting alone or with one or more other persons, committees or groups, in organizing, directing, or financing the solicitation. (2) "Participant" and "participant in a solicitation" do not include: (a) A bank, broker, or dealer who, in the ordinary course of business, lends money or executes orders for the purchase or sale of securities and who is not otherwise a participant; (b) A person or organization retained or employed by a participant to solicit security holders, or a person who merely transmits proxy-soliciting material or performs ministerial or clerical duties; (c) A person employed in the capacity of attorney or accountant, or advertising, public relations or financial adviser, and whose activities are limited to the performance of duties in the course of such employment; (d) A person regularly employed as an officer or employee of the issuer or any of its subsidiaries or affiliates, who is not otherwise a participant; or (e) An officer or director of, or a person regularly employed by, any other participant, if the officer, director, or employee is not otherwise a participant. Statutory/Other Authority: ORS 731 & 732 Statutes/Other Implemented: ORS 732.415(4) History: ID 16-2006, f. & cert. ef. 8-7-06 IC 68, f. & ef. 6-22-76