justicedao/ipfs_state_laws huggingface dataset:
836-085-0025 Renewal with Altered Terms (1) If an insurer offers or purports to renew a policy of insurance on terms less favorable to the insured or at higher rates, the new terms or rates may take effect on the renewal date if the insurer provides 30 days' written notice to the insured and to the insurance producer, if any. If the insurer does not provide such notice, the insured may cancel the renewal policy within 30 days after receipt of such notice. Earned premium for period of coverage, if any, shall be calculated pro rata at the lower of the current or previous year's rate. If the insured accepts the renewal, any premium increase or changes in terms shall be effective immediately following the prior policy's expiration date. (2) Nonrenewal of a policy shall not be effective until at least 30 days after the insured receives a written notice of nonrenewal. If, after an insurer provides a notice of nonrenewal as described in this section, the insurer extends the policy 90 days or less, additional notice of nonrenewal is not required with respect to the extension. For purposes of this section, "nonrenewal" means the refusal of an insurer to renew a policy at its expiration date. (3) Section (1) of this rule does not apply: (a) If the change is a form, rate or plan filed with the Director of the Department of Consumer and Business Services and applicable to the entire line of insurance or class of business to which the policy belongs; or (b) To a premium increase based on the altered nature or extent of the risk insured against. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.045, 746.055, 746.160(3) & 746.240 History: ID 12-2013, f. 12-31-13, cert. ef. 1-1-14 ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 21-1988, f. & cert. ef. 12-16-88 ID 8-1988, f. & cert. ef. 12-14-87 IC 6-1985, f. 11-29-85, ef. 12-1-85 IC 4-1985, f. & ef. 9-19-85 IC 2-1985(Temp), f. 5-31-85, ef. 6-15-85
836-085-0035 Cancellation or Nonrenewal Notice (1) If a risk sharing plan exists under ORS Chapter 735 for the kind of coverage cancelled or nonrenewed, notice of cancellation or nonrenewal required under OAR 836-085-0010(2) is not effective unless the notice contains adequate instructions to the policyholder and the insurance producer, if any, for applying for insurance through a risk sharing plan under ORS Chapter 735. (2) Adequate instructions under section (1) of this rule must direct the policyholder to the agent of the notifying insurer for assistance or, if no agent exists, must provide that the insurer will directly assist in submission of the application. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.045, 746.055, 746.160(3) & 746.240 History: ID 12-2013, f. 12-31-13, cert. ef. 1-1-14 ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 8-1987, f. & ef. 12-14-87 IC 4-1985, f. & ef. 9-19-85 IC 2-1985(Temp), f. 5-31-85, ef. 6-15-85
836-085-0040 Cancellation for Nonpayment of Premium OAR 836-085-0035 does not apply if the ground for cancellation or nonrenewal is nonpayment of the premium and if the notice so states. Statutory/Other Authority: ORS 731 Statutes/Other Implemented: ORS 746.045, 746.055, 746.160(3) & 746.240 History: ID 8-1987, f. & ef. 12-14-87 IC 4-1985, f. & ef. 9-19-85 IC 2-1985(Temp), f. 5-31-85, ef. 6-15-85
836-085-0045 Unfair Trade Practices (1) Failure of an insurer to comply with OAR 836-085-0010 to 836-085-0050 constitutes an unfair trade practice under ORS 746.240. (2) A midterm premium increase or a policy coverage reduction attempted or executed in nonconformance with ORS 737.330 or 742.003 constitutes an unfair trade practice under 746.240. (3) Block Cancellations or Nonrenewals of entire lines of insurance or withdrawal of classes of business are presumed to be unfairly discriminatory and constitute an unfair trade practice under ORS 746.240, unless prior authorization is received. (4) Termination of an appointed insurance producer, or an attempt to terminate an appointed insurance producer solely to achieve block cancellation or nonrenewal of entire lines of insurance or other such instant reunderwriting of an insurance producer book of business is presumed to constitute an unfair trade practice under ORS 746.240 and an unfair trade practice detrimental to free competition under 746.160. (5) Any nonrenewal must be for justifiable cause. (6) Inability to substantiate justifiable cause for nonrenewal will be subject to Division of Financial Regulation review. (7) Unjustified nonrenewals of such frequency as to indicate a general business practice are presumed to constitute an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 731.244 & ORS 746.240 Statutes/Other Implemented: ORS 746.240, ORS 746.045, 746.055 & 746.160(3) History: ID 31-2024, minor correction filed 08/20/2024, effective 08/20/2024 ID 12-2013, f. 12-31-13, cert. ef. 1-1-14 ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 8-1987, f. & ef. 12-14-87 IC 4-1985, f. & ef. 9-19-85 IC 2-1985(Temp), f. 5-31-85, ef. 6-15-85
836-085-0050 Proof of Notice A post office certificate of mailing to the named insured at the named insured's last-known address constitutes conclusive proof that the named insured received the notice of cancellation or nonrenewal on the third calendar day after the date of the certificate of mailing. Statutory/Other Authority: ORS 731.244 & 746.240 Statutes/Other Implemented: ORS 746.045, 746.055, 746.160(3) & 746.240 History: ID 12-2013, f. 12-31-13, cert. ef. 1-1-14 ID 8-1987, f. & ef. 12-14-87
836-085-0055 Cancellation and Renewal of Commercial Package Policies (1) A commercial package policy that includes commercial liability insurance coverage is subject to ORS 742.702 (Grounds for cancellation) and ORS 742.706 (Renewal), governing the cancellation and renewal of commercial liability insurance policies. For purposes of this rule, “commercial liability insurance” has the meaning given that term in ORS 731.074 (“Commercial liability insurance”). (2) An insurer may cancel a commercial package policy that includes commercial liability insurance if: (a) At least 10 working days prior written or electronic notice is given for non-payment of premium; or (b) At least 30 days prior written or electronic notice is given for any other statutorily permitted reason. (3) An insurer may nonrenew a commercial package policy that includes commercial liability insurance if at least 45 days prior written notice or electronic notice is given. (4) Sections (2) and (3) do not apply to a commercial package policy subject to the exemptions set forth in ORS 742.710. (5) OAR 836-058-0055 does not apply to a commercial package policy cancelled at the request of the insured. Statutory/Other Authority: ORS 731.244, 742.702, 742.706 & 742.710 Statutes/Other Implemented: 742.702 History: ID 7-2022, amend filed 09/23/2022, effective 10/01/2022 ID 8-1990, f. & cert. ef. 5-4-90
836-085-0201 Statutory Authority; Purpose; Applicability (1) OAR 836-085-0201 to 836-085-0230 are adopted pursuant to the specific authority of 737.322, and the general rulemaking authority of the Director in ORS 731.244, to carry out 746.240 and the orderly administration of ORS Chapter 737 with respect to the workers' compensation experience rating system and its supporting statistical plan. (2) The purpose of OAR 836-085-0201 to 836-085-0230 is to amend the authorized workers' compensation experience rating system for timely apprising insured employers of their premium modification factors so the employers can make necessary adjustments in the cost of goods or services sold. (3) OAR 836-085-0201 to 836-085-0230 apply to all workers' compensation policies delivered or issued for delivery to employers in this state. Statutory/Other Authority: ORS 731 & 737 Statutes/Other Implemented: ORS 737.322(2) & 746.240 History: ID 6-2005, f. & cert. ef. 4-7-05 ID 3-1988, f. & cert. ef. 1-20-88
836-085-0205 Definitions As used in OAR 836-085-0201 to 836-085-0230, unless the context requires otherwise: (1) “Experience Rating” means the prospective modification of a workers’ compensation insurance premium according to the Experience Rating Plan Manual of the National Council on Compensation Insurance filed with the Director, or an alternative plan otherwise authorized pursuant to OAR 836-042-0015(6)(b). (2) “Insurer” means any person authorized to write workers’ compensation insurance in this state and includes the State Accident Insurance Fund Corporation. (3) “Modification Factor” means the numerical result of an experience rating calculation. (4) “Normal Anniversary Rating Date” means the date the rates and experience rating modification for an individual employer changes, as established by the rating organization. (5) “Premium” means the contractual amount charged to an insured for insurance for a specified period of time, regardless of the timing of actual charges. (6) “Rating Plan” means any set of rules and values filed with the Director of the Department of Insurance and Finance and used by an insurer to calculate premiums. (7) “Statistical Plan” means the uniform statistical plan for workers’ compensation insurance statistics as prescribed by OAR 836-042-0045. (8) “Tentative Experience Modification Endorsement” is the form of prior notice to the employer of the tentative modification factor calculation by the insurer for use in policy issuance. (9) “Workers’ Compensation Insurance” means insurance providing coverage for the obligation of an employer arising from illness or injury to workers whether such obligation is imposed by ORS Chapter 656 of this state, similar laws of the United States or agreements between states. [Publications: Publications referenced are available from the agency.] Statutory/Other Authority: ORS 731 & 737 Statutes/Other Implemented: ORS 737.322(2) History: ID 3-1988, f. & cert. ef. 1-20-88
836-085-0210 Adjustment for Experience of Employer; Calculation of Tentative Modification Factors For purposes of OAR 836-085-0201 to 836-085-0230: (1) An insurer shall adjust for experience of an employer by multiplying the insurance premium by the modification factor. (2) An insurer shall calculate tentative modification factors in accordance with experience data known or discoverable by the insurer and in accordance with the provisions and formulas of the experience rating plan authorized by OAR 836-042-0015(6). Statutory/Other Authority: ORS 731 & 737 Statutes/Other Implemented: ORS 737.322(2) History: ID 3-1988, f. & cert. ef. 1-20-88
836-085-0217 Employer Failure to Cooperate; Appeal (1) As provided in this rule, sections (2) and (3) of OAR 836-085-0215 do not apply if the rating organization is unable to calculate the modification factor for an insured employer because the employer has failed to cooperate in audits or because of other material fault attributable to the employer or an agent of the employer. (2) An employer may appeal application of experience modification factors under section (1) of this rule by applying to the administrator of the Division of Financial Regulation for a hearing not later than the 30th day after the insurer notifies the employer that the insure intends to apply the factors because of the employer’s noncooperation or other material fault. The administrator shall hold a hearing on the appeal as provided in ORS 737.505, and may affirm or deny the appeal. (3) An appeal under section (2) of this rule shall stay the application of the experience modification factors under section (1) of this rule. Statutory/Other Authority: ORS 731 & 737 Statutes/Other Implemented: ORS 737.322(2) & 746.240 History: ID 30-2024, minor correction filed 08/20/2024, effective 08/20/2024 ID 3-1988, f. & cert. ef. 1-20-88
836-085-0225 Unfair Trade Practices (1) Retroactive application of experience rating modification factors in any manner other than provided for in OAR 836-085-0215 constitutes an unfair trade practice under ORS 746.240. (2) Failure of an insurer or rating organization to comply with the statistical reporting requirements of OAR 836-042-0045 constitutes an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 731 & 737 Statutes/Other Implemented: ORS 737.322(2) & 746.240 History: ID 6-2005, f. & cert. ef. 4-7-05 ID 3-1988, f. & cert. ef. 1-20-88
836-085-0230 Penalties for Late Submission of Rating Data (1) When the Director imposes a civil penalty for violation of OAR 836-042-0045, the civil penalty shall be not less than $100 for each failure by the insurer to submit the data on the date that the submission of data is due. The Director may increase the civil penalty by $100 with respect to each such failure for each 30-day period following the due date in which the insurer continues the failure to submit the data. (2) With respect to each calendar month in which an insurer has failed to submit data, for all failures by the insurer to submit data during that month, including continuing failures, the Director shall not impose civil penalties under section (1) of this rule that exceed $10,000 in the aggregate. (3) Failure by an insurer to submit data for an individual employer after imposition of civil penalty under section (1) of this rule may result in suspension of the insurer’s certificate of authority. Statutory/Other Authority: ORS 731 & 737 Statutes/Other Implemented: ORS 737.322(2) History: ID 7-1989, f. & cert. ef. 7-28-89 ID 3-1988, f. & cert. ef. 1-20-88
836-100-0100 Authority; Purpose; Scope (1) OAR 836-100-0100 to 836-100-0120 are adopted by the Director of the Department of Consumer and Business Services pursuant to ORS 743.061. The purpose of OAR 836-100-0100 to 836-100-0120 is to establish the uniform administrative standards that health insurers and health care entities are required to comply with under ORS 743.061. The uniform standards have been developed by the Office for Oregon Health Policy and Research in consultation with stakeholders pursuant to ORS 743.062. (2) The uniform standards adopted under OAR 836-100-0100 to 836-100-0120 apply to all health insurers and health care entities in Oregon as specified in each companion guide. Statutory/Other Authority: ORS 731.244 & 743.061 Statutes/Other Implemented: ORS 743.061 History: ID 11-2013, f. 12-31-13, cert. ef. 1-1-14 ID 12-2011, f. & cert. ef. 7-15-11
836-100-0110 Adoption of Standards (1) On or after October 1, 2012, to the extent possible, all health insurers and health care entities must conduct eligibility benefit inquiry and response transactions with health care providers as electronic transactions that conform to the uniform standards developed by the Office for Oregon Health Policy and Research pursuant to ORS 743.062 as set forth in the Oregon Companion Guide for Health Care Eligibility Benefit Inquiry and Response in accordance with the following schedule: (2) On and after October 1, 2012, to the extent possible, all health insurers and health care entities must conduct claims or encounter transactions with health care providers in conformance with the uniform standards developed by the Office for Oregon Health Policy and Research pursuant to ORS 743.062 as set forth in the Oregon Companion Guide for Health Care Claim: Professional, Oregon Companion Guide for Health Care Claim: Institutional and Oregon Companion Guide for Health Care Claim: Dental in accordance with the following schedule: (3) On and after January 1, 2014, to the extent possible, all health insurers and health care entities must conduct claims payment or advice transactions with health care providers as electronic transactions that conform to the uniform standards developed by the Office for Oregon Health Policy and Research pursuant to ORS 743.062 as set forth in the Oregon Companion Guide for Health Care Claim Payment or Advice. (4) On and after January 1, 2014, to the extent possible, all health insurers and health care entities must conduct claims status request and response transactions with health care providers as electronic transactions that conform to the uniform standards developed by the Office for Oregon Health Policy and Research pursuant to ORS 743.062 as set forth in the Oregon Companion Guide for Claim Status Request and Response. Statutory/Other Authority: ORS 731.244 & 743.061 Statutes/Other Implemented: ORS 743.061 History: ID 11-2013, f. 12-31-13, cert. ef. 1-1-14 ID 16-2011, f. & cert. ef. 10-31-11 ID 12-2011, f. & cert. ef. 7-15-11
836-100-0115 Waiver If the director has granted a waiver before January 1, 2014, upon expiration of the waiver, the health insurer or health care entity shall comply with the requirements of OAR 836-100-0100. Statutory/Other Authority: ORS 731.244 & 743.061 Statutes/Other Implemented: ORS 743.061 History: ID 11-2013, f. 12-31-13, cert. ef. 1-1-14 ID 16-2011, f. & cert. ef. 10-31-11 ID 12-2011, f. & cert. ef. 7-15-11
836-100-0120 Review and Update of Standards (1) The Department of Consumer and Business Services and the Oregon Health Authority shall jointly appoint an Oregon Companion Guide Oversight Committee. The members appointed to the committee must demonstrate knowledge of the transactions subject to the Oregon Companion Guides, financial knowledge, operational industry or business expertise, or knowledge of the technology necessary to implement the requirements of the companion guides. (2) The Oregon Companion Guide Oversight Committee shall meet as needed to review the implementation of the administrative standards encompassed by the Oregon Companion Guides. The committee shall address issues identified by the Department of Consumer and Business Services and the Oregon Health Authority, including but not limited to: (a) Consider and make recommendations to Oregon Health Authority and Department of Consumer and Business Services about needed changes to the guides in order to keep the guide up to date with industry and federal government driven changes. (b) Provide reports to Department of Consumer and Business Services and Oregon Health Authority regarding health insurer and provider participation, successes and areas for improvement. (c) Review any proposed changes developed by Oregon Health Authority to the standards or companion guides. (d) Review any proposed changes developed by Department of Consumer and Business Services to the rules requiring compliance with the companion guides. Statutory/Other Authority: ORS 731.244 & 2011 OL Ch. 130 Sec. 2 (Enrolled SB 94) Statutes/Other Implemented: 2011 OL Ch. 130 Sec. 2 (Enrolled SB 94) History: ID 12-2011, f. & cert. ef. 7-15-11
836-150-0010 Purpose and Statutory Authority The purpose of OAR 836-150-0010 to 836-150-0060 is to administer the Oregon Reinsurance Program 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. Statutory/Other Authority: ORS 731.244 & 2017 Or Laws ch 538 sec 19 Statutes/Other Implemented: 2017 Or Laws ch 538 sec 18-21 History: ID 38-2018, adopt filed 12/19/2018, effective 01/01/2019
836-150-0020 Definitions The terms used in OAR 836-150-0010 to 836-150-0060 have the meaning prescribed in section 19, chapter 538, Oregon Laws 2017 (Enrolled House Bill 2391) and: (1) “Benefit year” means a calendar year beginning on or after January 1, 2018 for which a reinsurance eligible health benefit plan provides health insurance coverage. (2) “Department” means the Oregon Department of Consumer and Business Services. (3) “Reinsurance eligible claim” means a claim for services covered under a reinsurance eligible health benefit plan that is incurred by a reinsurance eligible issuer during a benefit year and paid by the reinsurance eligible issuer before July 1 of the following year. (4) “Reinsurance eligible issuer” means an insurer or health care service contractor who offers a reinsurance eligible health benefit plan to reinsurance eligible individuals. (5) “Reinsurance payment” means payments issued to a reinsurance eligible issuer in accordance with section 2(3), chapter 538 Oregon Laws 2017 (Enrolled House Bill 2391) and OAR 836-150-0050. Statutory/Other Authority: ORS 731.244 & 2017 Or Laws ch 538 sec 19 Statutes/Other Implemented: 2017 Or Laws ch 538 sec 18-21 History: ID 38-2018, adopt filed 12/19/2018, effective 01/01/2019
836-150-0030 Information Reporting (1) As a condition of receiving reinsurance payments from the Oregon Reinsurance Program, a reinsurance eligible issuer must provide, for each benefit year, the following information to the department in the form and manner prescribed by the department: (a) The name and company code assigned to the reinsurance eligible issuer by the National Association of Insurance Commissioners; (b) The identification number assigned to the reinsurance eligible issuer by the Health Insurance Oversight System (HIOS); (c) The total amount of the reinsurance eligible issuer’s reinsurance eligible claims for the benefit year; (d) The portion of the reinsurance eligible issuer’s total reinsurance eligible claims for the benefit year that fall between the attachment point and reinsurance cap; (e) A summary data file containing the following information for each reinsurance eligible individual with claims for which reinsurance payments are being requested: (A) The member identification number assigned by the reinsurance eligible issuer to the reinsurance eligible individual; (B) The start and end dates of coverage for the reinsurance eligible individual; (C) The HIOS plan identification number for the reinsurance eligible health benefit plan in which the reinsurance eligible individual was enrolled; (D) The total amount of reinsurance eligible claims for the reinsurance eligible individual for the benefit year; and (E) The total amount of reinsurance eligible claims for the reinsurance eligible individual for the benefit year that fall between the attachment point and reinsurance cap; (f) A detailed claims file extracted from the reinsurance eligible issuer’s claims processing system that includes the issuer’s complete record of all reinsurance eligible claims for the benefit year; (g) An attestation signed by an executive officer of the reinsurance eligible issuer stating that the information is accurate as of the date of submission; and (h) Any other information requested by the department. (2) As a condition of receiving reinsurance payments from the Oregon Reinsurance Program, a reinsurance eligible issuer must submit the information required under this rule to the department: (a) Using a secure method of transmission approved by the department; and (b) On or before July 15 of the year following the benefit year for which the reinsurance payment is requested. Statutory/Other Authority: ORS 731.244 & 2017 Or Laws ch 538 sec 19 Statutes/Other Implemented: 2017 Or Laws ch 538 sec 18-21 History: ID 38-2018, adopt filed 12/19/2018, effective 01/01/2019