justicedao/ipfs_state_laws huggingface dataset:
836-051-0775 Transition Rules (1) For preneed insurance policies issued on or after the effective date of this rule and before January 1, 2012, the 2001 CSO may be used as the minimum standard for reserves and minimum standard for nonforfeiture benefits for both male and female insureds. (2) If an insurer elects to use the 2001 CSO as a minimum standard for any preneed insurance policy issued on or after the effective date of this rule and before January 1, 2012, the insurer shall provide, as a part of the actuarial opinion memorandum submitted in support of the company’s asset adequacy testing, an annual written notification to the Director. The notification shall include: (a) A complete list of all preneed insurance policy forms that use the 2001 CSO as a minimum standard; (b) A certification signed by the appointed actuary stating that the reserve methodology employed by the company in determining reserves for the preneed insurance policies issued after the effective date and using the 2001 CSO as a minimum standard, develops adequate reserves (For the purposes of this certification, the preneed insurance policies using the 2001 CSO as a minimum standard cannot be aggregated with any other policies.); and (3) Supporting information regarding the adequacy of reserves for preneed insurance policies issued after the January 1, 2009, and using the 2001 CSO as a minimum standard for reserves. (4) Preneed insurance policies issued on or after January 1, 2012, must use the Ultimate 1980 CSO in the calculation of minimum nonforfeiture values and minimum reserves. Statutory/Other Authority: ORS 731.244, 733.306 & 743.205 Statutes/Other Implemented: ORS 733.306, 733.310, 743.215, 743.216 & 743.221 History: ID 17-2008, f. & cert. ef. 12-9-08
836-051-0900 Purpose; Authority (1) OAR 836-051-0900 to 836-051-0925 establish standards for disclosure of minimum information relating to annuity contracts, to protect consumers and foster consumer education. OAR 836-051-0900 to 836-051-0925 prescribe the minimum information that must be disclosed and the method for disclosing it in connection with the sale of annuity contracts. The goal of 836-051-0900 to 836-051-0925 is to ensure that purchasers of annuity contracts understand certain basic features of annuity contracts. (2) OAR 836-051-0900 to 836-051-0925 are adopted pursuant to ORS 731.244 for the purpose of implementing 746.075, 746.085, 746.110 & 746.240. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.009, 746.075, 746.085, 746.110 & 746.240 History: ID 14-2008, f. & cert. ef. 8-15-08
836-051-0905 Applicability and Scope (1) OAR 836-051-0900 to 836-051-0925 apply to all group and individual annuity contracts and certificates except: (a) Immediate and deferred annuities that contain no nonguaranteed elements except as provided in OAR 836-051-0920(2); (b) Annuities used to fund: (A) An employee pension plan that is covered by the Employee Retirement Income Security Act (ERISA); (B) A plan described by Sections 401(a), 401(k), 403(b), or 408(k) or (p) of the Internal Revenue Code, when the plan, for purposes of ERISA, is established or maintained by an employer; (C) A governmental or church plan defined in Section 414 or a deferred compensation plan of a state or local government or a tax exempt organization under Section 457 of the Internal Revenue Code; or (D) A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor. (c) Structured settlement annuities; and (d) Funding agreements. (2) OAR 836-051-0900 to 836-051-0925 also apply to annuities used to fund a plan or arrangement that is funded solely by contributions an employee elects to make, whether on a pre-tax or after-tax basis, and when the insurer has been notified that plan participants may choose from among two or more fixed annuity providers and there is a direct solicitation of an individual employee by a producer for the purchase of an annuity contract. A direct solicitation under this section does not include any meeting held by a producer solely for the purpose of educating or enrolling employees in the plan or arrangement. (3) OAR 836-051-0900 to 836-051-0925 apply to annuity contracts that are sold on or after October 1, 2008. An insurer may conform its contracts to the provisions of 836-051-0900 to 836-051-0925 prior to that date. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.009, 746.075, 746.085, 746.110, 746.240 & 743.262 History: ID 19-2024, amend filed 08/12/2024, effective 08/12/2024 ID 54-2023, temporary amend filed 12/20/2023, effective 01/01/2024 through 06/28/2024 ID 14-2008, f. & cert. ef. 8-15-08
836-051-0910 Definitions As used in OAR 836-051-0900 to 836-051-0925: (1) “Contract owner” means the owner named in the annuity contract or a certificate holder in the case of a group annuity contract. (2) “Determinable elements” means elements that are derived from processes or methods that are guaranteed at issue and not subject to insurer discretion, but in which the values or amounts cannot be determined until some point after issue. These elements include the premiums, credited interest rates (including any bonus), benefits, values, non-interest based credits, charges or elements of formulas used to determine any of these. These elements may be described as guaranteed but not determined at issue. An element is considered determinable if it was calculated from underlying determinable elements only, or from both determinable and guaranteed elements. (3) “Free look” means the number of days immediately after delivery of the contract in which the contract owner has to examine the contract and decide to return it to get the purchase payment returned penalty free. May also be referred to as “Right to Examine.” (4) “Funding agreement” means an agreement for an insurer to accept and accumulate funds and to make one or more payments at future dates in amounts that are not based on mortality or morbidity contingencies. (5) “Generic name” means a short title descriptive of the annuity contract being applied for or illustrated, such as “single premium deferred annuity.” (6) “Guaranteed elements” means the premiums, credited interest rates (including any bonus), benefits, values, non-interest based credits, charges or elements of formulas used to determine any of these, that are guaranteed and determined at issue. An element is considered guaranteed if all of the underlying elements that go into its calculation are guaranteed. (7) “Non-guaranteed elements” means the premiums, credited interest rates (including any bonus), benefits, values, non-interest based credits, charges or elements of formulas used to determine any of these, that are subject to company discretion and are not guaranteed at issue. An element is considered non-guaranteed if any of the underlying non-guaranteed elements are used in its calculation. (8) “Structured settlement annuity” means a “qualified funding asset” as defined in section 130(d) of the Internal Revenue Code or an annuity that, by its issue, would be a qualified funding asset under section 130(d) but for the fact that it is not owned by an assignee under a qualified assignment. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.009, 746.075, 746.085, 746.110 & 746.240 History: ID 14-2008, f. & cert. ef. 8-15-08
836-051-0920 Report to Contract Owners (1) For an annuity in the payout period with changes in non-guaranteed elements and for the accumulation period of a deferred annuity, the insurer shall provide each contract owner with a report, at least annually, on the status of the contract that contains at least the following information: (a) The beginning and end date of the current report period. (b) The accumulation and cash surrender value, if any, at the end of the previous report period and at the end of the current report period. (c) The total amounts, if any, that have been credited, charged to the contract value or paid during the current report period; and (d) The amount of outstanding loans, if any, as of the end of the current report period. (2) For a deferred annuity with only guaranteed elements and no cash surrender value during the accumulation period, the insurer shall provide each contract owner with a report, at least annually, on the status of the contract that contains at least the following information: (a) The beginning and end date of the current report period. (b) The selected annuitization date, including any time restraints for changing the annuitization date. (c) The selected annuitization option, including any time restraints for changing to another option. (d) Any additional benefit values, such as the death benefit and any optional access to cash values. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.009, 746.075, 746.085, 746.110 & 746.240 History: ID 14-2008, f. & cert. ef. 8-15-08
836-051-0925 Trade Practice Regulation Violation of any provision of OAR 836-051-0900 to 836-051-0925 is an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.009, 746.075, 746.085, 746.110 & 746.240 History: ID 14-2008, f. & cert. ef. 8-15-08
836-052-0103 Purpose (1) OAR 836-052-0103 to 836-052-0194 are adopted in order to: (a) Provide for the standardization of coverage and simplification of terms and benefits of Medicare supplement policies; (b) Facilitate public understanding and comparison of such policies; (c) Eliminate provisions contained in such policies that may be misleading or confusing in connection with the purchase of such policies or with the settlement of claims; and (d) Provide for full disclosures in the sale of accident and sickness insurance coverage to persons eligible for Medicare. (2) OAR 836-052-0138, 836-052-0145, and 836-052-0151 are amended pursuant to the authority of ORS 743.683, in order to carry out the legislative intent of: (a) Extending the opportunity for open enrollment for Medicare supplement insurance under OAR 836-052-0138 to all persons who enroll in Medicare Part B, regardless of age; and (b) Providing that for rating purposes the pool of persons qualifying for Medicare by reason of disability is combined with the pool of persons qualifying by reason of age, so that premiums will be affordable for persons qualifying by reason of disability. Statutory/Other Authority: ORS 731.244 & 743.680 Statutes/Other Implemented: ORS 743.010 & 743.683 History: ID 5-1996, f. & cert. ef. 4-26-96 ID 9-1993, f. 9-28-93, cert. ef. 10-1-93 ID 5-1993(Temp), f. 8-11-93, cert. ef. 9-1-93 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90 ID 5-1989, f. 6-30-89, cert. ef. 7-3-89 ID 1-1989(Temp), f. & cert. ef. 1-3-89
836-052-0107 Authority OAR 836-052-0103 to 836-052-0194 are adopted pursuant to the general rulemaking authority of the Director under ORS 731.244 and the specific authority in 742.009, 743.013, 743.680 to 743.689, and 746.240. Statutory/Other Authority: ORS 731.244, 743.010, 743.013, 743.680 - 743.689 & 746.240 Statutes/Other Implemented: ORS 743.010(2) & 743.683 History: ID 9-1997, f. & cert. ef. 7-10-97 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90 ID 5-1989, f. 6-30-89, cert. ef. 7-3-89 ID 1-1989(Temp), f. & cert. ef. 1-3-89
836-052-0129 Policy Provisions (1) Except for permitted preexisting condition clauses as described in OAR 836-052-0133(2)(a), 836-052-0134(2)(a) and 836-052-0132(1)(a), no policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare. (2) No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions. (3) No Medicare supplement policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare. (4)(a) Subject to OAR 836-052-0133(2)(d) and (e), 836-052-0134(2)(d), (e) and (g) and 836-052-0133(1)(d) and (e), a Medicare supplement policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006 may be renewed for current policyholders who do not enroll in Part D at the option of the policyholder. (b) A Medicare supplement policy with benefits for outpatient prescription drugs may not be issued after December 31, 2005. (c) After December 31, 2005, a Medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless: (A) The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Part D plan; and (B) Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable. Statutory/Other Authority: ORS 743.683 Statutes/Other Implemented: ORS 743.010 & 743.683 History: ID 3-2009, f. 6-30-09, cert. ef. 7-1-09 ID 10-2005, f. & cert. ef. 7-26-05 ID 5-1996, f. & cert. ef. 4-26-96 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90 ID 5-1989, f. 6-30-89, cert. ef. 7-3-89 ID 1-1989(Temp), f. & cert. ef. 1-3-89
836-052-0143 Annual Opportunity to Select Another Medicare Supplement Policy or Certificate (1) For the purposes of this rule, for 1990, 2010, and 2020 Medicare Supplement Plans, “same or lesser benefits” means a policy or certificate of the same or lower benefit level as indicated on a chart available on the website of the Division of Financial Regulation of the Department of Consumer and Business Services. (2) Beginning 30 days prior to a person’s birthday and for 30 days after the person’s birthday, a person enrolled in a Medicare supplement policy may cancel the person’s existing Medicare supplement policy or certificate and purchase or select another Medicare supplement policy or certificate with the same or lesser benefits to replace the existing Medicare supplement policy or certificate. An issuer may not deny or condition the issuance or effectiveness, nor discriminate in the pricing of the replacement policy or certificate on the basis of health status, claims experience, receipt of health care or medical condition of the applicant. (3) This rule does not apply to Medicare supplement policies or certificates issued or delivered before January 1, 1990. Statutory/Other Authority: ORS 743.010, ORS 743.680 - 743.689 & 731.244 Statutes/Other Implemented: ORS 743.010 & ORS 743.683 - 743.684 History: ID 9-2022, amend filed 12/22/2022, effective 01/01/2023 ID 30-2018, amend filed 08/28/2018, effective 09/01/2018 ID 4-2012, f. 2-16-12, cert. ef. 1-1-13
836-052-0156 Permitted Compensation Arrangements (1) An issuer or other entity may provide commission or other compensation to an insurance producer or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation, including overrides and other sales-connected remuneration to field supervisory personnel, does not exceed 200 percent of the commission or the compensation paid for selling or servicing the policy or certificate in the second year or period. (2) The commission or other compensation to an insurance producer or other representative for the sale or renewal of a guaranteed issue Medicare supplement policy or certificate must be made on the same basis as for any other Medicare supplement policy or certificate. (3) The commission or other compensation provided in subsequent renewal years must be the same as that provided in the second year or period and must be provided for a reasonable number of renewal years. The total number of renewal years shall not be fewer than five renewal years. (4) An issuer or entity shall not provide compensation to its insurance producers and an insurance producer shall not receive compensation greater than the renewal compensation payable by the replacing issuer if an existing policy or certificate is replaced. (5) For purposes of this rule, "compensation" includes pecuniary or non-pecuniary remuneration of any kind relating to the sale or renewal of the policy or certificate, including but not limited to bonuses, gifts, prizes, awards and finder's fees. (6) Violation of this rule is an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 743.010, 743.013, 743.680 - 743.689, 746.240 & 731.244 Statutes/Other Implemented: ORS 743.684(3) History: ID 9-2022, amend filed 12/22/2022, effective 01/01/2023 ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90
836-052-0170 Filing Requirements for Advertising An issuer shall provide to the Director a copy of any Medicare supplement advertisement intended for use in this state, whether through the written, radio or television medium, for review or approval by the Director to the extent it may be required under ORS 742.009 and other state law. Each advertisement shall comply with all applicable laws and rules of this state. Statutory/Other Authority: ORS 731.244, 743.010, 743.013, 743.680 - 743.689 & 746.240 Statutes/Other Implemented: ORS 743.687 History: ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90 ID 5-1989, f. 6-30-89, cert. ef. 7-3-89 ID 1-1989(Temp), f. & cert. ef. 1-3-89
836-052-0175 Standards for Marketing (1) An issuer, directly or through its producers, shall: (a) Establish marketing procedures to assure that any comparison of policies by its insurance producers will be fair and accurate; (b) Establish marketing procedures to assure excessive insurance is not sold or issued; (c) Display prominently by type, stamp or other appropriate means, on the first page of the policy, the following: "Notice to Buyer: This policy may not cover all of your medical expenses"; (d) Inquire and otherwise make every reasonable effort to identify whether a prospective applicant or enrollee for Medicare supplement insurance already has health insurance and the types and amounts of any such insurance; (e) Establish auditable procedures for verifying compliance with this section. (2) In addition to the practices prohibited under ORS Chapter 746, the following acts and practices are prohibited: (a) Twisting, which includes knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing or tending to induce any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on or convert any insurance policy or to take out a policy of insurance with another insurer; (b) High pressure tactics, which include the employing of any method of marketing having the effect of inducing or tending to induce the purchase of insurance through force, fright or threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance; (c) Cold lead advertising, which is making use, directly or indirectly, of any method of marketing that fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance producer or insurance company. (3) Violation of any provision of section (2) of this rule is an unfair trade practice under ORS 746.240. (4) The terms "Medicare Supplement," "Medigap," "Medicare Wrap-Around" and words of similar import shall not be used unless the policy is issued in compliance with OAR 836-052-0103 to 836-052-0194. Statutory/Other Authority: ORS 731.244, 743.010, 743.013, 743.680 - 743.689 & 746.240 Statutes/Other Implemented: ORS 743.010(1)(c), 743.010(2), 743.685(8) & 746.240 History: ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 9-1997, f. & cert. ef. 7-10-97 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90
836-052-0180 Appropriateness of Recommended Purchase and Excessive Insurance (1) In recommending the purchase or replacement of any Medicare supplement policy or certificate, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. (2) Any sale of Medicare supplement coverage that will provide an individual more than one Medicare supplement policy or certificate is prohibited. (3) An issuer shall not issue a Medicare supplement policy or certificate to an individual enrolled in Medicare Part C unless the effective date of the coverage is after the termination date of the individual’s Part C coverage. Statutory/Other Authority: ORS 731.244, 743.010, 743.013, 743.680 - 743.689 & 746.240 Statutes/Other Implemented: ORS 743.010(1)(c), 743.010(2), 743.683(2) & 743.685(8) History: ID 10-2005, f. & cert. ef. 7-26-05 ID 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90 ID 1-1990, f. 1-10-90, cert. ef. 4-1-90
836-052-0185 Reporting of Multiple Policies (1) On or before March 1 of each year, each issuer shall report to the Director the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement insurance policy or certificate: (a) Policy and certificate number; and (b) Date of issuance. (2) The information required under section (1) of this rule must be grouped by individual policyholder. (3) Each issuer shall report the information required under this rule on the reporting form prescribed in Exhibit 1 to this rule. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 731.244, 743.010, 743.013, 743.680 - 743.689 & 746.240 Statutes/Other Implemented: ORS 743.010(1)(c) & 743.010(2) History: ID 11-2001, f. & cert. ef. 9-24-01 ID 8-2001(Temp), f. 6-15-01, cert. ef. 6-18-01 thru 12-10-01 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90
836-052-0190 Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies and Certificates (1) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new Medicare supplement policy to the extent such a time period was spent under the original policy. (2) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate that has been in effect for at least six months, the replacing policy shall not provide any time period applicable to preexisting conditions, waiting periods, elimination periods and probationary periods. Statutory/Other Authority: ORS 731.244, 743.010, 743.013, 743.680 - 743.689 & 746.240 Statutes/Other Implemented: ORS 743.010(1)(c), 743.010(2), 743.683(2) & 743.685(8) History: ID 9-1993, f. 9-28-93, cert. ef. 10-1-93 ID 5-1993(Temp), f. 8-11-93, cert. ef. 9-1-93 ID 7-1992, f. & cert. ef. 5-8-92 ID 11-1990, f. 5-11-90, cert. ef. 9-1-90
836-052-0194 Separability If any provision of OAR 836-052-0103 to 836-052-0194 or the application thereof to any person or circumstance is held to be invalid for any reason, the remainder of 836-052-0103 to 836-052-0194 shall not be affected thereby. Statutory/Other Authority: ORS 731.244, 743.010, 743.013, 743.680 - 743.689 & 746.240 Statutes/Other Implemented: ORS 174.040 & 731.244 History: ID 7-1992, f. & cert. ef. 5-8-92
836-052-0225 Durational Limits for Health Maintenance Organizations Text in ORMS History: Reverted to ID 9-1988, f. 6-9-88, cert. ef. 7-1-88 ID 4-1998(Temp), f. & cert. ef. 2-13-98 thru 8-10-98 ID 9-1988, f. 6-9-88, cert. ef. 7-1-88
836-052-0230 Provider Services Limits for Insurers and Health Care Contractors Text in ORMS History: Reverted to ID 9-1988, f. 6-9-88, cert. ef. 7-1-88 ID 4-1998(Temp), f. & cert. ef. 2-13-98 thru 8-10-98 ID 9-1988, f. 6-9-88, cert. ef. 7-1-88