justicedao/ipfs_state_laws huggingface dataset:
836-011-0600 Report on Services Provided by Expanded Practice Dental Hygienists (1) As used in this rule: (a) “Expanded practice dental hygienist” has the meaning given in ORS 679.010. (b) “Health insurer” includes: (A) An insurer authorized to transact health insurance in Oregon; (B) A health care service contractor as defined in ORS 750.005; (C) A multiple employer welfare arrangement as defined in ORS 750.301; (D) A coordinated care organization as defined in ORS 414.025, or a dental care organization or governed by the Oregon Health Authority; (E) A third party administrator licensed under ORS 744.702; and (F) Federally qualified health centers governed by the United States Department of Health and Human Services. (2) A health insurer authorized to transact health insurance that provides coverage for dental services in Oregon shall, by August 1 of every even-numbered year, report to the Department of Consumer and Business Services information pertaining to reimbursement for those dental services provided by Expanded Practice Dental Hygienists (EPDH) to Oregon residents for the 24-month period ending June 30 of the reporting year. For each dental service provided during the period under review the information shall include: (a) The Current Dental Terminology code denoting the type of service provided; (b) The provider’s National Provider Identifier number; and (c) The following information, which the department will aggregate prior to providing the information to the Board of Dentistry: (A) The amount billed by the EPDH to the insurer for the service provided; (B) The amount allowed for the service under the insurance plan; (C) The amount of benefit paid by the insurer for the dental service (i.e. the amount of the benefit subtracting any deductible, copay, coinsurance or other cost-sharing); (D) The amount owed by the insured for the service (i.e. deductible, copay, coinsurance or other cost-sharing); (E) The amount of excluded charges owed by the insured; and (F) The amount of excluded charges, if any, that the provider is not allowed to collect from the insured due to their provider agreement with the insurer. (3) A health insurer subject to this rule shall provide the report required in section (2) of this rule electronically, as requested by the Director. Statutory/Other Authority: ORS 731.244 & 680.210 Statutes/Other Implemented: ORS 680.210 (Sec. 11 & 12, Ch.716 & OL 2011) History: ID 5-2012, f. & cert. ef. 2-16-12
836-012-0000 Director's Authority (1) OAR 836-012-0000 to 836-012-0110 are adopted pursuant to ORS 731.508 to 731.514, and general rulemaking authority under ORS 731.244. (2) OAR 836-012-0000 to 836-012-0110 are adopted for the purpose of establishing standards and procedural requirements that the director determines to be necessary and appropriate in the public interest for carrying out ORS 731.508 to 731.514, relating to credit for reinsurance, for the protection of the insurance-buying public and the ceding insurers in this state. (3) Form AR-1, Certificate of Assuming Insurer, Exhibit 1 to this rule, is adopted for purposes of OAR 836-012-0000 to 836-012-0110, when the use of the form is required by such rules. (4) Form ACR-1, Certificate of Assuming Certified Reinsurer, Exhibit 2 to this rule, is adopted for purposes of OAR 836-012-0000 to 836-012-0110, when the use of the form is required by such rules. (5) Form CR-F, Certificate For Property/Casualty Reinsurers, Exhibit 3 to this rule, is adopted for purposes of OAR 836-012-0000 to 836-012-0110, when the use of the form is required by such rules. (6) Form CR-S, Certificate For Life/Health Reinsurers, Exhibit 4 to this rule, is adopted for purposes of OAR 836-012-0000 to 836-012-0110, when the use of the form is required by such rules. (7) Form RJ-1, Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction, Exhibit 5 to this rule, is adopted for purposes of OAR 836-012-0000 to 836-012-0110, when the use of the form is required by such rules. (8) If any provision of this regulation, or the application of the provision to any person or circumstance, is held invalid, the remainder of the regulation, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected. [ED. NOTE: To view attachments referenced in rule text, click here to view rule.] Statutory/Other Authority: Or Laws 2021, ch 204, sec 2, ORS 731.508 - 731.514 & ORS 731.244 Statutes/Other Implemented: Or Laws 2021, ch 204, sec 2 & ORS 731.508 - 731.514 History: ID 11-2021, amend filed 12/15/2021, effective 01/01/2022 ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0006 Definitions As used in OAR 836-012-0000 to 836-012-0110, “statutory financial statement” means quarterly, annual or other financial statements required by state law. Statutory/Other Authority: 731.244 & ORS 731.508 - 731.511 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, adopt filed 12/19/2019, effective 01/01/2020
836-012-0011 Credit for Reinsurance — Reinsurer Authorized in this State Pursuant to ORS 731.509(4), the director shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that was authorized in this state as of any date on which statutory financial statement credit for reinsurance is claimed. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0021 Credit for Reinsurance — Accredited Reinsurers (1) Pursuant to ORS 731.509(4) and ORS 731.511, the director shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is accredited as a reinsurer in this state as of the date on which statutory financial statement credit for reinsurance is claimed. An accredited reinsurer must: (a) File a properly executed Form AR-1 (Exhibit 1, OAR 836-012-0000) as evidence of its submission to this state’s jurisdiction and to this state’s authority to examine its books and records; (b) File with the director a certified copy of a certificate of authority or other acceptable evidence that it is licensed to transact insurance or reinsurance in at least one state, or, in the case of a U.S. branch of an alien assuming insurer, is entered through and licensed to transact insurance or reinsurance in at least one state; (c) File annually with the director a copy of its annual statement filed with the insurance department of its state of domicile or, in the case of an alien assuming insurer, with the state through which it is entered and in which it is licensed to transact insurance or reinsurance, and a copy of its most recent audited financial statement; and (d) Maintain a surplus as regards policyholders in an amount not less than $20,000,000 or obtain the director’s affirmative approval upon a finding by the director that it has adequate financial capacity to meet its reinsurance obligations and is otherwise qualified to assume reinsurance from domestic insurers. (2) If the director determines that the assuming insurer has failed to meet or maintain any of these qualifications, the director may upon written notice and opportunity for hearing pursuant to ORS chapter 183, suspend or revoke the accreditation. Credit shall not be allowed a domestic ceding insurer under this section if the assuming insurer’s accreditation has been revoked by the director, or if the reinsurance was ceded while the assuming insurer’s accreditation was under suspension by the director. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0031 Credit for Reinsurance — Reinsurer Domiciled and Licensed in Another State (1) Pursuant to ORS 731.509(6), the director shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that as of any date on which statutory financial statement credit for reinsurance is claimed: (a) Is domiciled in a state employing standards regarding credit for reinsurance that equal or exceed those applicable under ORS 731.509 to 731.511 and OAR 836-012-0000 to 836-012-0110 or, in the case of a U.S. branch of an alien assuming insurer, is entered through a state employing such standards; (b) Maintains capital and surplus in an amount not less than $20,000,000; and (c) Files a properly executed Form AR-1 (Exhibit 1, OAR 836-012-0000) with the director as evidence of its submission to this state's authority to examine its books and records. (2) The provisions of this section relating to surplus as regards policyholders do not apply to reinsurance ceded and assumed pursuant to pooling arrangements among insurers in the same holding company system. As used in this section, “substantially similar” standards means credit for reinsurance standards that the director determines equal or exceed the standards of the Act and this regulation. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0051 Credit for Reinsurance Required by Law Pursuant to ORS 731.511, the director shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of ORS 731.509(4), (5), (6) or (7), or other appropriate provisions contained in ORS 731.510 to 731.511, but only as to the insurance of risks located in jurisdictions where the reinsurance is required by the applicable law or regulation of that jurisdiction. As used in this rule, "jurisdiction" means any state, district or territory of the United States and any lawful national government. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0060 Asset or Reduction from Liability for Reinsurance Ceded to an Unauthorized Assuming Insurer Not Meeting the Requirements of OAR 836-012-0011 to 836-012-0051 (1) Pursuant to ORS 731.510, the director shall allow a reduction from liability for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of ORS 731.509 in an amount not exceeding the liabilities carried by the ceding insurer. The reduction shall be in the amount of funds held by or on behalf of the ceding insurer, including funds held in trust for the exclusive benefit of the ceding insurer, under a reinsurance contract with such assuming insurer as security for the payment of obligations under the reinsurance contract. The security must be held in the United States subject to withdrawal solely by and under the exclusive control of the ceding insurer or, in the case of a trust, held in a qualified U.S. financial institution as defined in ORS 731.510(1). The security may be in the form of any of the following: (a) Cash; (b) Securities listed by the Securities Valuation Office of the National Association of Insurance Commissioners, including those deemed exempt from filing as defined by the Purposes and Procedures Manual of the Securities Valuation Office, and qualifying as allowed assets; (c) Clean, irrevocable, unconditional and "evergreen" letters of credit issued or confirmed by a qualified U.S. institution, as defined in ORS 731.510(2), effective no later than December 31 of the year for which filing is being made, and in the possession of, or in trust for, the ceding insurer on or before the filing date of its annual statement. Letters of credit meeting applicable standards of issuer acceptability as of the dates of their issuance or confirmation shall, notwithstanding the issuing or confirming institution's subsequent failure to meet applicable standards of issuer acceptability, continue to be acceptable as security until their expiration, extension, renewal, modification or amendment, whichever first occurs; or (d) Any other form of security acceptable to the director. (2) An allowed asset or a reduction from liability for reinsurance ceded to an unauthorized assuming insurer pursuant to section (1) of this rule shall be allowed only when the requirements of OAR 836-012-0100 and the applicable provisions of OAR 836-012-0070, 836-012-0080 and 836-012-0090 are met. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0090 Other Security A ceding insurer may take credit for unencumbered funds withheld by the ceding insurer in the United States subject to withdrawal solely by the ceding insurer and under its exclusive control. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0100 Reinsurance Contract Credit shall not be granted, nor an asset or reduction from liability allowed, to a ceding insurer for reinsurance effected with assuming insurers meeting the requirements of OAR 836-012-0011, 836-012-0021, 836-012-0031, 836-012-0041 or 836-012-0060 or otherwise in compliance with ORS 731.509 after the adoption of OAR 836-012-0000 to 836-012-0110, unless the reinsurance agreement: (1) Includes a proper insolvency clause, which stipulates that reinsurance is payable directly to the liquidator or successor without diminution regardless of the status of the ceding company pursuant to ORS 731.508; (2) Includes a provision pursuant to ORS 731.509(10), whereby the assuming insurer, if an unauthorized assuming insurer, has submitted to the jurisdiction of an alternative dispute resolution panel or court of competent jurisdiction within the United States, has agreed to comply with all requirements necessary to give such court or panel jurisdiction, has designated an agent upon whom service of process may be effected and has agreed to abide by the final decision of the court or panel; and (3) Includes a proper reinsurance intermediary clause, if applicable, which stipulates that the credit risk for the intermediary is carried by the assuming insurer. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 22-2002, f. & cert. ef. 11-27-02 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0110 Contracts Affected All new and renewal reinsurance transactions entered into on and after January 1, 2019, shall conform to the requirements of ORS 731.509 to 731.511 and OAR 836-012-0000 to 836-012-0110 if credit is to be given to the ceding insurer for such reinsurance. Statutory/Other Authority: ORS 731.508 - 731.511 & 731.244 Statutes/Other Implemented: ORS 731.508 - 731.511 & Or Laws 2019, ch 151 History: ID 13-2019, amend filed 12/19/2019, effective 01/01/2020 ID 15-1996, f. & cert. ef. 11-12-96 ID 8-1993, f. & cert. ef. 9-23-93
836-012-0200 Authority This regulation is adopted and promulgated by the director of the Department of Consumer and Business Services pursuant to ORS 731.244. Statutory/Other Authority: ORS 731.244, ORS 731.508 - 731.511 & 731.514 Statutes/Other Implemented: ORS 731.508 - 731.511 & 731.514 History: ID 10-2022, adopt filed 12/27/2022, effective 01/01/2023
836-012-0210 Definitions As used in OAR 836-012-0200 to 836-012-0270: (1) “Actuarial Method” means the methodology used to determine the Required Level of Primary Security, as described in OAR 836-012-0250. (2) “Covered Policies” means the following policies (unless such policies were issued prior to January 1, 2015, and ceded as of December 31, 2014, as part of a reinsurance treaty that would not have met one of the exemptions set forth in OAR 836-012-0240 had that section then been in effect): (a) Life insurance policies with guaranteed nonlevel gross premiums and/or guaranteed nonlevel benefits (other than flexible premium universal life insurance policies); and (b) Flexible premium universal life insurance policies with provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period. (3) “Non-Covered Policies” means any policy that is not a Covered Policy. (4) “Required Level of Primary Security” means the dollar amount determined by applying the Actuarial Method to the risks ceded with respect to Covered Policies, but not more than the total reserve ceded. (5) “Primary Security” means the following forms of security: (a) Cash; (b) Securities meeting the requirements of OAR 836-012-0060 (1)(b), but excluding any synthetic letter of credit, contingent note, credit-linked note or other similar security that operates in a manner similar to a letter of credit, and excluding any securities issued by the ceding insurer or any of its affiliates; and (c) For security held in connection with funds-withheld and modified coinsurance reinsurance treaties: (A) Commercial loans in good standing of CM3 quality and higher; (B) Policy Loans; and (C) Derivatives acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty. (6) “Other Security” means any security acceptable to the director other than security meeting the definition of Primary Security. (7) “Valuation Manual” means the valuation manual described in OAR 836-031-0605. (8) “Director” means the director of the Department of Consumer and Business Services. (9) “NAIC” means the National Association of Insurance Commissioners. (10) “This rule” means OAR 836-012-0200 to 836-012-0270. Statutory/Other Authority: ORS 731.244, ORS 731.508 - 731.511 & 731.514 Statutes/Other Implemented: ORS 731.508 - 731.511 & 731.514 History: ID 10-2022, adopt filed 12/27/2022, effective 01/01/2023
836-012-0220 Purpose and Intent The purpose and intent of this rule is to establish uniform, national standards governing reserve financing arrangements pertaining to life insurance policies containing guaranteed nonlevel gross premiums, guaranteed nonlevel benefits and universal life insurance policies with secondary guarantees; and to ensure that, with respect to each such financing arrangement, funds consisting of Primary Security and Other Security, are held by or on behalf of ceding insurers in the forms and amounts required herein. In general, reinsurance ceded for reserve financing purposes has one or more of the following characteristics: some or all of the assets used to secure the reinsurance treaty or to capitalize the reinsurer (1) are issued by the ceding insurer or its affiliates; or (2) are not unconditionally available to satisfy the general account obligations of the ceding insurer; or (3) create a reimbursement, indemnification or other similar obligation on the part of the ceding insurer or any if its affiliates (other than a payment obligation under a derivative contract acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty). Statutory/Other Authority: ORS 731.244, ORS 731.508 - 731.511 & 731.514 Statutes/Other Implemented: ORS 731.508 - 731.511 & 731.514 History: ID 10-2022, adopt filed 12/27/2022, effective 01/01/2023
836-012-0230 Applicability This rule applies to reinsurance treaties that cede liabilities pertaining to Covered Policies issued by any life insurance company domiciled in this state. This rule and OAR 836-012-0046 shall both apply to such reinsurance treaties; provided, that in the event of a direct conflict between the provisions of this rule and OAR 836-012-0046, the provisions of this rule shall apply, but only to the extent of the conflict. Statutory/Other Authority: ORS 731.244, ORS 731.508 - 731.511 & 731.514 Statutes/Other Implemented: ORS 731.508 - 731.511 & 731.514 History: ID 10-2022, adopt filed 12/27/2022, effective 01/01/2023
836-012-0270 Prohibition against Avoidance No insurer that has Covered Policies as to which this rule applies shall take any action or series of actions, or enter into any transaction or arrangement or series of transactions or arrangements if the purpose of such action, transaction or arrangement or series thereof is to avoid the requirements of this rule, or to circumvent its purpose and intent, as set forth in OAR 836-012-0220. Statutory/Other Authority: ORS 731.244, ORS 731.508 - 731.511 & 731.514 Statutes/Other Implemented: ORS 731.508 - 731.511 & 731.514 History: ID 10-2022, adopt filed 12/27/2022, effective 01/01/2023
836-012-0300 Authority; Statement of Purpose; Director’s Authority (1) OAR 836-012-0300 to 836-012-0332 are adopted pursuant to the authority of ORS 731.244 and 731.508 for the purpose of implementing ORS 731.508(6). (2) OAR 836-012-0300 to 836-012-0332 apply to each domestic insurer transacting life insurance, health insurance or both, to each domestic health care service contractor, and to each other authorized insurer or health care service contractor transacting life insurance, health insurance or both who is not subject to substantially similar rules or regulations in its domiciliary state. 836-012-0300 to 836-012-0332 do not apply with respect to assumption reinsurance, yearly renewable term reinsurance or certain nonproportional reinsurance such as stop loss or catastrophic reinsurance. (3) The Director recognizes that authorized insurers routinely enter into reinsurance agreements that yield legitimate relief to the ceding insurer from strain to surplus. It is improper for an authorized insurer, however, in the capacity of ceding insurer, to enter into reinsurance agreements for the principal purpose of producing significant surplus aid for the ceding insurer, typically on a temporary basis, while not transferring all of the significant risks inherent in the business being reinsured. In substance and effect, the expected potential liability to the ceding insurer in agreements that do not transfer all of the significant risks remains basically unchanged by the reinsurance transaction, notwithstanding certain risk elements in the reinsurance agreement, such as catastrophic mortality or extraordinary survival. Statutory/Other Authority: ORS 731.244 & 731.508 Statutes/Other Implemented: ORS 731.508(6) History: ID 4-2010, f. & cert. ef. 2-5-10 ID 7-1995, f. & cert. ef. 11-15-95 ID 8-1993, f. & cert. ef. 9-23-93