justicedao/ipfs_state_laws huggingface dataset:
836-043-0300 Qualifications for Workers’ Compensation Rating Oganizations (1) Prior to operating in Oregon, a worker’s compensation rating organization shall apply to the Director for a license. The Director shall act on the application within 60 days of the application. Prior to approving any applicant’s license, the Director shall determine that the organization meets the qualifications and requirements of ORS 737.355(1). (2) The rating organization shall include with its application the following documents: (a) Copies of its articles of incorporation; (b) Bylaws; (c) Biographies of its corporate officers; (d) A description of its operation; (e) Copies of its last three quarterly financial statements; (f) A copy of its two most recent annual report; (g) Copies of its Securities and Exchange Commission filings, if any. (3) The rating organization’s application shall demonstrate to the Director’s satisfaction: (a) The level of professional staffing that the rating organization will dedicate to serving insurers within Oregon, including the number of actuaries, statisticians and economists, the number of years of experience of each professional staff member and the professional designations of its staff; (b) The capacity and quality of the rating organization’s electronic data processing system dedicated to the workers’ compensation rating system in Oregon; (c) The rating organization’s knowledge of insurance ratemaking both generally and within Oregon; and (d) The rating organization’s availability to its clients in Oregon. Statutory/Other Authority: ORS 731.244 & 737.355 Statutes/Other Implemented: ORS 737.355 History: ID 3-2000, f. & cert. ef. 3-29-00
836-043-0310 Exchange of Data Among Workers’ Compensation Rating Organizations (1) Not later than the 25th day of each month, each licensed workers’ compensation rating organization shall report to the statistical agent all edited data reported by its member insurers under OAR 836-042-0045 during the prior month that the rating organization finds useable for experience rating. (2) The data to be reported by each rating organization under section (1) of this rule includes all financial data by policy year, accident year and calendar year. Statutory/Other Authority: ORS 731.244 & 737.355 Statutes/Other Implemented: ORS 737.355 History: ID 3-2000, f. & cert. ef. 3-29-00
836-050-0000 Purpose, Statutory Authority and Implementation OAR 836-050-0000 to 836-050-0020 are adopted under the authority of ORS 731.244, 742.156 and 742.158, for the purpose of implementing 742.156 and 742.158, relating to assumption reinsurance. Statutory/Other Authority: ORS 731.244, 742.156 & 742.158 Statutes/Other Implemented: ORS 742.156 & 742.158 History: ID 15-2006, f. & cert. ef. 7-27-06 ID 4-1996, f. & cert. ef. 2-28-96
836-050-0020 Notice of Rejection A policyholder or certificate holder who elects to reject the transfer and novation of the policy under an assumption reinsurance agreement to which ORS 742.150 applied must give notice indicating rejection to the transferring insurer on a pre-addressed, postage-paid response card provided by the transferring insurer in the notice of transfer as required in OAR 836-050-0010 and Exhibit 1 to that rule, or in another written notice by the policyholder or certificate holder. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 731.244, 742.156 & 742.158 Statutes/Other Implemented: ORS 742.156 & 742.158 History: ID 15-2006, f. & cert. ef. 7-27-06 ID 4-1996, f. & cert. ef. 2-28-96
836-050-0105 Statutory Authority; Purpose; Applicability (1) OAR 836-050-0105 to 836-050-0120 are adopted by the Director pursuant to ORS 743.028. (2) The purpose of OAR 836-050-0105 to 836-050-0120 is to prescribe, as required by ORS 743.028, uniform health insurance claims forms that must be accepted by all insurers transacting health insurance in this state and by all state agencies that require health insurance claim forms for their records. (3) OAR 836-050-0105 to 836-050-0120 do not apply to claims for vision care or drugs, or to benefits paid on other than an expense-incurred basis. (4) “Insurer” as used in OAR 836-050-0105 to 836-050-0120 includes health care service contractors and state agencies that require health insurance claim forms for their records. Statutory/Other Authority: ORS 731.244 & 743.028 Statutes/Other Implemented: ORS 743.028 History: ID 1-1995, f. 4-26-95, cert. ef. 8-1-95 IC 75, f. & ef. 5-27-77 IC 73, f. 2-25-77, ef. 3-1-77
836-050-0110 Uniform Claim Forms (1) An insurer shall accept a properly completed claim submitted on the applicable uniform form prescribed by the exhibits to this rule, or on the substantially identical respective form approved by the American Medical Association’s Council on Medical Services or the American Dental Association’s Council on Dental Care Programs, as follows: (a) Exhibit 1 — For claims other than dental care claims; (b) Exhibit 2 — For dental care claims. (2) If the information entered on the form is incomplete, the insurer may return the form to the provider for completion to the extent necessary. (3) If additional information is essential to the insurer’s proper handling of the claim, it may seek such information by letter, investigative inquiry, or other reasonable means of communication. These inquiries shall be kept to a minimum and shall not seek information duplicating what already is known to the insurer. (4) An insurer may, at its option, accept a claim form different from the uniform form prescribed by this rule. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 731.244 & 743.028 Statutes/Other Implemented: ORS 743.028 History: ID 1-1995, f. 4-26-95, cert. ef. 8-1-95 IC 75, f. & ef. 5-27-77 IC 73, f. 2-25-77, ef. 3-1-77
836-050-0115 Permitted Modifications to Uniform Forms (1) An insurer may add to the face of the form its own identification and similar information, including insurer name and logo and policy identification by color coding or otherwise. The captions may be supplemented by instructions that merely facilitate the completion of the form. (2) An insurer may add to the back of the form or, for Exhibit 2, to any blank area on the face of the form, an item whose purpose is the certification of the status of the patient as a person in the insured group or as a member of the family or dependent of a person in the insured group. In the case of a claim form required by a state agency, the back of the form may also contain such provider certification and acknowledgment language as is required or permitted by law. (3) No alteration may be made to the format of the face of the form. No addition to the form may impose any additional requirement on any person, except for the certification item permitted by section (2) of this rule. (4) An insurer may screen the portions of the uniform claim form that it does not require to be completed, if the screening is done in such a way as to leave these portions usable by others. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 731.244 & 743.028 Statutes/Other Implemented: ORS 743.028 History: IC 75, f. & ef. 5-27-77 IC 73, f. 2-25-77, ef. 3-1-77
836-050-0120 Effective Date; Temporary Provisions (1) Except as provided in sections (2) and (3) of this rule, OAR 836-050-0105 and 836-050-0110 as amended are effective August 1, 1995, for claims other than dental care claims and for dental care claims. (2) For claims other than dental care claims, an insurer shall accept until January 1, 1996, a properly completed claim submitted on either the Exhibit 1 form of OAR 836-050-0110 in effect on July 31, 1995, or the Exhibit 1 form of OAR 836-050-0110 effective as of August 1, 1995. (3) For dental care claims, insurers shall accept until January 1, 1996, a properly completed claim submitted on either the Exhibit 2 form of OAR 836-050-0110 in effect on July 31, 1995, or the Exhibit 2 form of 836-050-0110 effective as of August 1, 1995. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 731.244 & 743.028 Statutes/Other Implemented: ORS 743.028 History: ID 1-1995, f. 4-26-95, cert. ef. 8-1-95 IC 75, f. & ef. 5-27-77 IC 73, f. 2-25-77, ef. 3-1-77
836-050-0150 Advance Payments (1) The notice required by ORS 12.155 shall contain the following: (a) The time and location of the occurrence in regard to which the advance payment is made. (b) A statement to the effect that the amount of any advance payment will be credited against any judgment entered in favor of the payee. (c) The following words: "The period of limitation for commencement of an action for damages as set by Chapter 12 of Oregon Revised Statutes will expire on _____", or such other similar words as the Director of the Department of Consumer and Business Services approves. (d) The signature of a person authorized to act for the insurer. (e) The date on which notice is transmitted to the party entitled to the advance payment. (2) The type size used in the portion of the notice described in section (1)(c) of this rule shall not be smaller than the type used for other typed or printed material required by this rule and shall not be arranged or displayed in such a way as to obscure the content of the notice. Statutory/Other Authority: ORS 12.155 & 731.244 Statutes/Other Implemented: ORS 12.155 History: ID 22-2002, f.& cert. ef. 11-27-02, Renumbered from 836-020-0900 ID 15-1996, f. & cert. ef. 11-12-96, Renumbered from 836-020-0060 IC 48, f. 8-18-71, cert. ef. 9-1-71
836-050-0200 Purpose, Scope and Definitions (1) OAR 836-050-0200 to 836-050-0215 provide for equitable coverage under life and health insurance policies for conditions relating to HIV-infection, including AIDS and ARC. OAR 836-050-0200 to 836-050-0215 apply to all health insurance policies, including those of fraternal benefit societies and health care service contractors, issued or delivered for issue in Oregon. OAR 836-050-0200, 836-050-0205, 836-050-0207, and 836-050-0210 apply to all life insurance policies, including those of fraternal benefit societies, issued or delivered for issue in Oregon. (2) For purposes of OAR 836-050-0200 to 836-050-0215: (a) “AIDS” means Acquired Immunodeficiency Syndrome; (b) “ARC” means AIDS Related Complex; (c) “HIV” means Human Immunodeficiency Virus. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 742.003, 742.005 & 746.240 History: ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert ef. 11-9-88
836-050-0205 Authority OAR 836-050-0200 to 836-050-0215 are adopted by the Director pursuant to the general rulemaking authority of the Director under ORS 731.244, for the purpose of carrying out the responsibilities of the Director under 731.008 and 731.016, regarding the protection of the insurance-buying public, under 742.003 and 742.005, regarding approval of forms, and under 746.240, regarding definition of unfair practices in the transaction of insurance. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 742.005 & 746.240 History: ID 2-1999, f. & cert. ef. 3-25-99 ID 12-1997, f. & cert. ef. 10-13-97 Reverted to ID 10-1988, f. & cert. ef. 6-10-88 ID 1-1997(Temp), f. & cert. ef. 2-24-97 ID 6-1987(Temp), f. & cert. ef. 11-9-88 ID 10-1988, f. & cert. ef. 6-10-88
836-050-0207 Unfair Trade Practices Failure of an insurer to comply with OAR 836-050-0210 and 836-050-0215 is an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 742.005 & 746.240 History: ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert. ef. 11-9-88
836-050-0210 General Exclusions (1) All health insurance policies, other than those providing coverage only for specified diseases, shall cover HIV infection, including AIDS and ARC, as they would any other serious medical condition. (2) All life insurance policies, other than those providing coverage for specific causes of death only, shall cover death from AIDS or ARC as they would death from any other cause. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 742.005 & 746.240 History: ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert. ef. 11-9-88
836-050-0215 Pre-existing Condition Exclusions; Health Insurance With respect to health insurance policies: (1) Asymptomatic HIV infection shall not be considered a preexisting condition with respect to subsequent claims related to AIDS or ARC. “Asymptomatic HIV infection” is that which is identified solely through use of a test for a virus or antibodies to the virus. (2) The period of exclusion for HIV infection claims, when physical symptoms were present before the coverage date, shall be no longer than that for other pre-existing diseases. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 742.005 & 746.240 History: ID 12-1997, f. & cert. ef. 10-13-97 Reverted to ID 10-1988, f. & cert. ef. 6-10-88 ID 1-1997(Temp), f. & cert. ef. 2-24-97 ID 6-1987(Temp), f. & cert. ef. 11-9-88 ID 10-1988, f. & cert. ef. 6-10-88
836-050-0230 Purpose, Scope and Definitions (1) OAR 836-050-0230 to 836-050-0255 provide for fair standards of underwriting for risks relating to HIV infection and apply to all transactions of life and health insurance subject to the Oregon Insurance Code. Such transactions include the underwriting of applicants for coverage under individual and group life and health insurance, as well as the setting of group underwriting standards. OAR 836-050-0230 to 836-050-0255 apply to all insurers, including health care service contractors and fraternal benefit societies, and all insurance producers and insurance support organizations, that are engaged in the transaction of life and health insurance under the Oregon Insurance Code. (2) For purposes of OAR 836-050-0230 to 836-050-0255: (a) "AIDS" means Acquired Immunodeficiency Syndrome; (b) "ARC" means AIDS Related Complex; (c) "HIV" means Human Immunodeficiency Virus. [Publications: Publications referenced are available from the agency.] Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 433.045(7), 742.005 & 746.240 History: ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert. ef. 11-9-88
836-050-0235 Rulemaking Authority OAR 836-050-0230 to 836-050-0255 are adopted by the Director pursuant to the general rulemaking authority of the Director under ORS 731.244, for the purpose of carrying out the responsibilities of the Director under 731.008 and 731.016, regarding the protection of the insurance-buying public, under 742.003 and 742.005, regarding approval of forms, and under 746.240, regarding definition of unfair practices in the transaction of insurance; and for the purpose of assuring compliance by insurers with the requirements of 433.045. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 433.045(7), 742.005 & 746.240 History: ID 12-1997, f. & cert. ef. 10-13-97 Reverted to ID 18-1988, f. & cert. ef. 10-31-88 ID 1-1997(Temp), f. & cert. ef. 2-24-97 ID 6-1987(Temp), f. & cert. ef. 11-9-88 ID 18-1988, f. & cert. ef. 10-31-88 ID 10-1988, f. & cert. ef. 6-10-88 ID 5-1988(Temp), f. & cert. ef. 2-26-88
836-050-0237 Unfair Trade Practices Failure of an insurer to comply with any provision of OAR 836-050-0240 or 836-050-0245, or the requirement in 836-050-0250(2)(a) that testing for HIV infection be done only with the informed consent of the applicant for insurance, is an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 433.045(7), 742.005 & 746.240 History: ID 18-1988, f. & cert. ef. 10-31-88 ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert. ef. 11-9-88
836-050-0240 General Principles (1) No inquiry in an application for health or life insurance coverage, in an investigation conducted by an insurer, insurance producer or insurance support organization in connection with an application for such coverage, shall be directed toward determining the applicant's sexual orientation. (2) Sexual orientation shall not be used in the underwriting process or in the determination of insurability. (3) Insurance support organization shall be directed by insurers not to investigate, directly or indirectly, the sexual orientation of an applicant or a beneficiary. (4) Testing for or asking medical questions about HIV infection, including ARC and AIDS, is prohibited when not done in conjunction with testing for or asking medical questions about other health conditions. However, testing for HIV infection alone is permissible if the applicant has answered affirmatively that the applicant has tested positive in any HIV antibody test or has been diagnosed as having HIV infection, including AIDS or ARC. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 433.045(7), 742.005 & 746.240 History: ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert. ef. 11-9-88
836-050-0245 Medical and Lifestyle Application Questions and Underwriting Standards (1) No question shall be used that is designed to establish the sexual orientation of the applicant. (2) The following provisions govern medical questions relating to HIV infection: (a) Questions relating to the applicant’s having or having been diagnosed as having HIV infection, including AIDS or ARC, are permissible if the questions are factual and designed to establish the existence of the condition. For example, insurer shall not ask such questions as “do you believe you may have…?”, or “have you had any indications of…?”, but insurers may ask “have you been diagnosed or treated for…?”; (b) Questions relating to HIV infection, including AIDS and ARC, may be asked, but only if questions related to other high risk medical conditions are also asked. The questions must be presented and asked, and the answers used, in the same manner as other questions and their answers relating to other high risk medical conditions. Additional questions may be asked in a supplement but the supplement must be used in conjunction with medical questions on the application form. (3) Questions relating to medical and other factual matters that are intended to reveal the possible existence of a medical condition are permissible if they are not used to establish the sexual orientation of the applicant and if the applicant is given opportunity to provide a detailed explanation for any affirmative answers given in the application. For example, insurers may ask such questions as, “Have you had chronic cough, significant weight loss, chronic fatigue, diarrhea, enlarged glands…?” Such questions must pertain to a finite period of time preceding completion of the application, not to exceed ten years. The finite period does not apply to questions concerning prior diagnosis, treatment or testing. (4) Questions relating to the applicant’s having, or having been diagnosed as having, or having been advised to seek treatment for, a sexually transmitted disease are permissible. (5) Neither the marital status, the “living arrangements,” the occupation, the gender, the medical history, the beneficiary designation nor the zip code or other territorial classification of an applicant may be used to establish, or aid in establishing, the applicant’s sexual orientation. (6) For purposes of rating an applicant for health and life insurance, an insurer may impose territorial rates, but only if the rates are based on sound actuarial principles and are related to actual or reasonably anticipated experience. (7) No adverse underwriting decision shall be based on information that the applicant has demonstrated AIDS, ARC or other HIV infection-related concerns by seeking counseling from health care professionals. This section does not apply to an applicant seeking treatment or diagnosis. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 433.045(7), 742.005 & 746.240 History: ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert. ef. 11-9-88
836-050-0255 Inquiries Regarding Past Test Results Insurers may ask whether an applicant has tested positive in any HIV antibody test, subject to the following restrictions: (1) General questions asking only whether the applicant has taken such a test, regardless of outcome, are prohibited. (2) Except as provided in this section, an insurer may not rate or deny coverage based merely on an affirmative response on the application to a questions about past test results. Before rating or denying coverage, the insurer must confirm a positive result to the full test protocol described in OAR 836-050-0250 through medical records or current retesting unless: (a) The applicant fails to respond to a request by the insurer for the medical records or for retesting; or (b) The insurer is informed that the applicant declines such further testing. Statutory/Other Authority: ORS 433, 731, 743 & 746 Statutes/Other Implemented: ORS 433.045(7), 742.00 & 746.240 History: ID 10-1988, f. & cert. ef. 6-10-88 ID 6-1987(Temp), f. & cert. ef. 11-9-88
836-050-0275 Credit Unions as Associations; Group Life Insurance A credit union organized under ORS Chapter 723, a credit union authorized to conduct business as a credit union in this state under 723.042 or a federal credit union the principal office of which is located in Oregon is considered to be maintained primarily for purposes other than the procurement of insurance. Such a credit union may qualify as an association for the purposes of being the policyholder of a group life insurance policy if: (1) The credit union is authorized to provide insurance to its members under the laws under which the credit union is organized; and (2) The Director determines that the credit union otherwise satisfies the requirements of ORS 743.351(1). Statutory/Other Authority: ORS 731 & 743 Statutes/Other Implemented: ORS 743.303 & 743.351 History: ID 7-1994, f. & cert. ef. 6-3-94 ID 17-1990, f. & cert. ef. 7-25-90
836-050-0280 Credit Unions as Association; Group Health Insurance A credit union organized under ORS Chapter 723, a credit union authorized to conduct business as a credit union in this state under 723.042 or a federal credit union the principal office of which is located in Oregon is considered to have a constitution and bylaws and to be maintained primarily for purposes other than the procurement of insurance. Such a credit union may qualify as an association for the purposes of being the policyholder of a group health insurance policy if: (1) The credit union is authorized to be such a policyholder under the laws under which the credit union is organized; and (2) The Director determines that the credit union otherwise satisfies the requirements of ORS 743.522(2). Statutory/Other Authority: ORS 731 & 743 Statutes/Other Implemented: ORS 743.522 & 743.524 History: ID 7-1994, f. & cert. ef. 6-3-94 ID 17-1990, f. & cert. ef. 7-25-90
836-050-0300 Purpose, Authority, Application (1) OAR 836-050-0300 and 836-050-0305 are adopted to implement section 2, chapter 22, Oregon Laws 2008 (Enrolled HB 3605), which requires the Director to adopt rules establishing general criteria for orders that the Director is authorized to issue when the Governor declares a state of emergency under ORS 401.055. (2) OAR 836-050-0300 and 836-050-0305 apply to a state of emergency declared by the Governor when the conditions leading to the declaration substantially interfere with the public’s ability to carry on its normal business affairs. Statutory/Other Authority: ORS 731.244 & 2008 OL Ch. 22 & Sec. 2 Statutes/Other Implemented: 2008 OL Ch. 22 & Sec. 2 History: ID 12-2008, f. & cert. ef. 7-29-08 ID 10-2008, f. & cert. ef. 6-30-08