justicedao/ipfs_state_laws huggingface dataset:
836-053-1630 Drug Price Transparency Insurer Reporting (1) For the purposes of this rule, “insurer” means a licensed insurance company, health care services contractor, or health maintenance organization that issues health benefit plans as defined in ORS 743B.005(16) in this state. (2) No later than May 1 of each year, an insurer must report to the department the information described in ORS 743.025(2) in the form and manner prescribed by the department. For drugs reimbursed by the insurer under both pharmacy and medical benefits in health benefit plans during the prior calendar year, the reporting must include all of the following: (a) The 25 most frequently prescribed drugs. (b) The 25 most costly drugs. In determining this list, the insurer must consider total annual spending, including the net impact of any rebates or other price concessions if applicable. (c) The 25 drugs that have caused the greatest increase in total plan spending from one year to the next. In determining this list, the insurer must consider the net impact on total plan spending of any rebates or other price concessions if applicable. (d) The impact of the costs of prescription drugs on premium rates, on a per member per month basis, including the net impact of any rebates or other price concessions if applicable. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 743.025 History: ID 6-2025, amend filed 07/29/2025, effective 08/01/2025 ID 3-2024, adopt filed 04/29/2024, effective 05/01/2024
836-054-0020 Timely Notice of Denial of Charges to Provider (1) This rule is adopted under the authority of ORS 731.244 for the purpose of implementing ORS 742.524. (2) When an insurer is required to provide notice of a denial of charges within 60 days of receipt, it shall be presumed that the provider has received the denial within three days after it is served by mail. (3) If an insurer serves the denial electronically or by fax, it shall be presumed that the provider has received it on the day it is transmitted. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.524 History: ID 15-2015, f. 12-29-15, cert. ef. 1-1-16
836-054-0201 Statutory Authority and Purpose OAR 836-054-0201 to 836-054-0210 are adopted pursuant to the general rulemaking authority of the Director of the Department of Consumer and Business Services to specify requirements for large deductible provisions of workers’ compensation insurance policies which may be approved according to ORS 742.001 to 742.007. Statutory/Other Authority: ORS 731.244 History: ID 4-1995, f. 7-21-95, cert. ef. 10-1-95
836-054-0205 Definitions As used in OAR 836-054-0201 to 836-054-0210: (1) “Insurer” means any insurer authorized to write workers’ compensation insurance and includes the State Accident Insurance Fund Corporation. (2) “Large Deductible” means a provision in a workers’ compensation policy, or added by endorsement thereto, which allows a policyholder to be financially responsible for claims incurred under the policy up to a percentage of premium, a stated amount per claim, or other limit specified in the provision in exchange for a prospective premium reduction. (3) “Workers’ Compensation Insurance” means insurance providing coverage for the obligations of an employer arising from illness or injury to workers whether such obligation is imposed by ORS Chapters 654 and 656, similar laws of the United States, or agreements between states. (4) “Workers’ Compensation Premium Assessment” means the assessment imposed on insurers, self-insured employers, and self-insured employer groups by the Director of the Department of Consumer and Business Services pursuant to ORS 656.612. Statutory/Other Authority: ORS 731.244 History: ID 4-1995, f. 7-21-95, cert. ef. 10-1-95
836-054-0300 Loan to Value (1) A mortgage insurer may provide insurance with respect to an obligation that does not exceed, solely or in combination with liens existing at the time the insured loan is made, 105 percent of the fair market value of the securing real property at the time the loan is made if permitted by the insurer's domicile and if the obligation insured is secured by a mortgage, deed of trust or other instrument constituting a first lien or charge. (2) A mortgage insurer may provide insurance with respect to an obligation that does not exceed, solely or in combination with liens existing at the time the insured loan is made, 110 percent of the fair market value of the securing real property at the time the loan is made if permitted by the insurer’s domicile and if the insured obligation is secured by a mortgage, deed of trust or other instrument constituting a junior lien or junior charge. In determining the 110 percent limitation, the full amount of a line of credit to be secured by a junior lien shall be considered the amount of the loan. (3) This rule is adopted under the authority of ORS 731.244 for the purpose of implementing ORS 742.282(1)(a). Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.282 History: ID 22-2002, f.& cert. ef. 11-27-02 ID 4-2001, f. & cert. ef. 4-3-01
836-054-0400 Purpose and Scope of OAR 836-054-0410 The purpose of OAR 836-054-0400 to 836-054-0410 is to wind down an emergency order by the director of the Department of Consumer and Business Services. Under ORS 731.870, the director may order the temporary postponement of insurance policy nonrenewals. This rule provides that expiration of an emergency order is a valid reason to cancel a commercial liability policy under ORS 742.702 if the emergency order was the sole reason the policy was renewed. Statutory/Other Authority: ORS 731.244 & ORS 742.702 Statutes/Other Implemented: ORS 742.702 & ORS 731.870 History: ID 1-2021, adopt filed 01/21/2021, effective 01/22/2021 ID 5-2020, temporary adopt filed 07/27/2020, effective 07/27/2020 through 01/22/2021
836-054-0410 Cancellations An insurer may cancel a commercial liability policy if: (1) The insurer was required to renew the policy by an emergency order issued by the director; (2) The cancellation is not due to claims resulting solely from the circumstances on which the emergency order was based, except in cases of fraud or material misrepresentation; (3) The insurer has provided 45 days written notice to the insured and insurance producer, if any; and (4) The cancellation does not violate any other law or order by the director. Statutory/Other Authority: ORS 731.244 & ORS 742.702 Statutes/Other Implemented: ORS 742.702 & ORS 731.870 History: ID 1-2021, adopt filed 01/21/2021, effective 01/22/2021 ID 5-2020, temporary adopt filed 07/27/2020, effective 07/27/2020 through 01/22/2021
836-058-0010 Permitted Reasons to Exclude Named Person An insurer may exclude by name a person other than the named insured from the coverage required by ORS 742.450(2)(a) to be provided in a motor vehicle liability insurance policy issued for delivery in this state, for any of the following reasons: (1) The excluded person is higher rated than the named insured and the difference between the annualized premium that the named insured would pay on the liability coverage under the policy including the higher rated person and the annualized premium that the named insured would pay on the policy excluding the higher rated person would cause financial hardship as described in this section to the named insured. For the purpose of this section: (a) A financial hardship is caused only if the difference exceeds $1,000; (b) Premium owing to rating for a high performance vehicle or a sports car shall be excluded for the purpose of determining whether financial hardship is caused. (2) The excluded person's Oregon driver's license is suspended pursuant to ORS 809.409(5). (3) The excluded person's Oregon driver's license is suspended pursuant to ORS 809.419(3). Statutory/Other Authority: ORS 731.244 & 742.450 Statutes/Other Implemented: ORS 742.450(6)(b) History: ID 19-2006, f. & cert. ef. 9-26-06 ID 6-1993, f. & cert. ef. 8-25-93
836-058-0020 Exclusion from Excess Coverage (1) An insurer who excludes one or more persons as provided by law from any coverage in excess of the coverage required by ORS 742.450(2)(a) to be provided in a motor vehicle liability insurance policy issued for delivery in this state must state in the policy or indorsement the policy limits applicable to the person. (2) The disclosure requirement of section (1) of this rule does not apply with respect to a person also excluded from coverage under a motor vehicle liability insurance policy under ORS 742.450(6)(a) or OAR 836-058-0010. Statutory/Other Authority: ORS 731.244 & 742.031 Statutes/Other Implemented: ORS 742.450(1) - 742.450(2) & 742.464 History: ID 6-1993, f. & cert. ef. 8-25-93
836-060-0000 Statutory Authority; Purpose; Effective Date (1) OAR 836-060-0000 through 836-060-0060 are adopted pursuant to the general rulemaking authority of the Director in ORS 731.244. (2) The purpose of OAR 836-060-0000 through 836-060-0060 is to protect the interests of debtors and the public by providing a system of rate, policy form and operating standards for the transaction of credit life and credit health insurance in Oregon. These rules interpret and implement ORS 733.306, 742.003, 742.005, 743.015, 743.371 to 743.380, 746.160, 746.220, and 746.240. (3) OAR 836-060-0000 through 836-060-0060 as amended become effective on January 1, 2001, and apply as follows: (a) Except as otherwise provided in this section, on January 1, 2001, all forms not in compliance with OAR 836-060-0000 through 836-060-0060 as amended become disapproved for use in Oregon. No such form may be issued or delivered after that date unless it has been changed and resubmitted to and approved by the Director, or unless an approved rider has been attached bringing the form into compliance with 836-060-0000 through 836-060-0060 as amended; (b) Certificates, notices of proposed insurance and premium rates for existing group policies shall conform to OAR 836-060-0000 through 836-060-0060 as amended not later than the anniversary date of the group policy on or next following January 1, 2001; (c) Any replacement or amendment of a group credit insurance policy in an attempt to delay or circumvent application of these rules shall nonetheless be subject to OAR 836-060-0000 through 836-060-0060 as amended. No group credit insurance policy in force may be rewritten or redated in order to delay or circumvent the effect of 836-060-0000 through 836-060-0060 as amended; (d) All forms received for filing on or after October 10, 2000 must comply with OAR 836-060-0000 through 836-060-0060 as amended. No such form may be issued or delivered on or after January 1, 2001 unless the form has been submitted to and approved by the Director. (4) These rules, except as provided in OAR 836-060-0041, do not apply to production credit associations, bank agricultural loans or educational loan commitments. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.003, 742.005, 743.015, 743.371 - 743.380, 746.160, 746.220 & 746.240 History: Reverted to ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 13-2000(Temp), f. & cert. ef. 12-21-00 thru 6-9-01 ID 24-1990, f. 12-28-90, cert. ef. 1-1-91 IC 1-1983, f. 1-28-83, ef. 2-1-83 Repealed by IC 13-1982, f. 11-30-82, ef. 12-1-82 IC 11-1982, f. & ef. 6-23-82 IC 7-1982, f. 2-12-82, ef. 6-1-82
836-060-0005 Definitions As used in OAR 836-060-0000 through 836-060-0060: (1) "Closed-End Credit" means credit other than open-end credit. (2) "Credit Health Insurance" means the kind of insurance defined in ORS 743.371 and limited by ORS 743.372. (3) "Credit Insurance" means credit life insurance or credit health insurance or both. (4) "Credit Life Insurance" means the kind of insurance defined in ORS 743.371 and limited by ORS 743.372. (5) "Credit Transaction" means any transaction by the terms of which the repayment of money loaned, or payment for goods, services or properties sold or leased, is to be made at a future date or dates. (6) "Indebtedness" means total amount repayable, including principal, interest and finance charges. (7) "Open-End Credit" means credit extended by a creditor under an agreement in which: (a) The creditor reasonably contemplates repeated transactions; (b) The creditor imposes a finance charge from time to time on an outstanding unpaid balance; and (c) The amount of credit that may be extended to the debtor during the term of the agreement, up to any limit set by the creditor, is generally made available to the extent that any outstanding balance is repaid. (8) "Underwritten" or "underwriting" refers to the use of medical questions to elicit the existence of high risk medical conditions as described in OAR 836-060-0026 and 836-060-0031 for the purpose of determining insurability, to the extent such conditions were assumed in developing the underwritten prime facie rates. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.005, 743.015, 743.371-.380, 746.220 & 746.240 History: ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 24-1990, f. 12-28-90, cert. ef. 1-1-91 IC 1-1983, f. 1-28-83, ef. 2-1-83 Repealed by IC 13-1982, f. 11-30-82, ef. 12-1-82 IC 7-1982, f. 2-12-82, ef. 6-1-82 IC 40, f. 2-15-68, ef. 4-1-68
836-060-0016 Policy Forms and Related Material (1) Permissible Forms. Credit insurance shall be issued only in the forms described in ORS 743.373. (2) Rates and Forms Filing Requirements. All credit insurance policy forms, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements and riders to be delivered or issued for delivery in this state and the schedules of premium rates pertaining thereto shall be filed with the Director as required by ORS 743.015. Statutory/Other Authority: ORS 731, 742, 743 & 746 Statutes/Other Implemented: ORS 743.015 & 743.373 History: ID 24-1990, f. 12-28-90, cert. ef. 1-1-91 IC 1-1983, f. 1-28-83, ef. 2-1-83 Repealed by IC 13-1982, f. 11-30-82, ef. 12-1-82 IC 7-1982, f. 2-12-82, ef. 6-1-82
836-060-0021 Determination of Reasonableness of Benefits in Relation to Premium Charge (1) General Standard. Under ORS 742.005, benefits provided by credit insurance policies must be reasonable in relation to the premium charged. This requirement is satisfied, in the opinion of the Director, if the premium develops, or reasonably may be expected to develop a loss ratio of not less than 60 percent. (2) With the exception of deviations approved under OAR 836-060-0043, the rates established in 836-060-0026 and 836-060-0031, as adjusted periodically pursuant to 836-060-0041, are the prima facie rates and shall be conclusively presumed to satisfy the standard set forth in section (1) of this rule. (3) Nonstandard Coverage. If an insurer files for approval a form providing coverage different from that described in OAR 836-060-0026 and 836-060-0031, the insurer shall demonstrate to the satisfaction of the Director that the premium rates to be charged for such coverage will develop, or reasonably may be expected to develop, a loss ratio not less than that contemplated for standard coverage, or are actuarially consistent with the rates used for standard coverages. (4) Prima facie rates are presumed sufficient to cover up to two months of delinquencies. (5) Coverage Without Separate Charge. If no specific charge is made to the debtor for credit insurance, sections (1) to (3) of this rule do not apply. In this case, any premium rates which exceed the premium rate standards set out in OAR 836-060-0026 and 836-060-0031 must be filed with the Director. For purposes of this section, a specific charge is made to the debtor if an identifiable charge for insurance is disclosed in the credit or other instrument furnished the debtor which sets out the financial elements of the credit transactions, or if there is a differential in finance, interest, service or other similar charge made to debtors who are in like circumstances except for their insured or noninsured status. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.003 & 742.005 History: ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 26-1990, f. 12-28-90, cert. ef. 1-1-91 IC 1-1983, f. 1-28-83, ef. 2-1-83 Repealed by IC 13-1982, f. 11-30-82, ef. 12-1-82 IC 7-1982, f. 2-12-82, ef. 6-1-82
836-060-0027 Credit Life Reserves (1) For policies or certificates issued prior to January 1, 2001, the minimum reserve standard is the Commissioners 1958 Extended Term Insurance Table and 4.5% interest. (2) For policies or certificates issued on or after January 1, 2001, the minimum reserve standard is the Male Commissioners 1980 Standard Ordinary Mortality Table and 4.5% interest. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 733.306(8) History: ID 12-2000, f. 11-14-00, cert. ef. 1-1-01
836-060-0036 Refund Formulas (1) An insurer shall file for approval by the Director its refund formulas prior to their use. The following methods are considered appropriate for the plans described: (a) Pro Rata Method. The pro rata unearned gross premium method shall be used for level term credit life insurance or credit health insurance where under the insured is covered for a constant maximum indemnity for a given period of time, after which the maximum indemnity begins to decrease in even amounts per month, and credit insurance coverage under which premiums are collected from the debtor on a basis other than the single premium basis; (b) Actuarial method commonly referred to as the Rule of Anticipation. A refund of unearned premium used for decreasing term credit life insurance may be made as provided in this subsection. The amount of the refund shall be not less than the total premium, less the greater of: (A) Ten percent of the premiums or $75, whichever is less; or (B) The premium earned to the installment due date of the loan nearest the date of prepayment, for the periods of time the loan balances were actually outstanding. For purposes of refund computations under this paragraph, the installment due date of the loan preceding the date of prepayment shall be considered to be nearest if prepayment occurs 15 days or less after that installment date. If prepayment occurs more than 15 days after the preceding installment due date, the next succeeding installment due date shall be considered to be nearest to the date of prepayment. (c) Any method that develops refunds that are at least as favorable to the debtor as refunds based on the actuarial method described in subsection (b) of this section. (2) In the event of termination, no charge for credit insurance may be made for the first 15 days of a loan month, and a full month may be charged for 16 days or more of a loan month. (3) The refund formula shall be set forth in the individual policy or group certificate. (4) The requirement of ORS 743.378 that refund formulas be filed with the Director is fulfilled by inclusion of the refund formulas in the individual policy or group certificate filed with the Director. (5) No refund of $5 or less need be made. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 743.378 History: ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 24-1990, f. 12-28-90, cert. ef. 1-1-91 IC 1-1983, f. 1-28-83, ef. 2-1-83 Repealed by IC 13-1982, f. 11-30-82, ef. 12-1-82 IC 7-1982, f. 2-12-82, ef. 6-1-82
836-060-0041 Experience Reports (1) Each insurer transacting credit insurance in this state shall submit an Oregon-specific Credit Insurance Experience Exhibit to the National Association of Insurance Commissioners (NAIC). If this report is discontinued as an NAIC report, the report must be sent directly to the Director by June 1 of each year. (2) Notwithstanding section (1) of this rule, each insurer transacting credit insurance that is underwritten shall submit to the Director an Oregon-specific Credit Insurance Experience Exhibit for the underwritten business. The information shall be reported on the NAIC form and submitted by June 1 of each year. An insurer need not comply with this section if the NAIC Credit Insurance Experience Exhibit includes a separate accounting for underwritten business. (3) The experience reports required by this rule replace all other annual reports to the Director of credit insurance experience. The experience reports required by this rule are separate and distinct from the annual financial statement and are not for use in determining the financial condition of an insurer. (4) The Director shall review the loss ratio development every four years and compare it with the standards set forth in OAR 836-060-0021 and the prima facie rates set forth for underwritten and non-underwritten in 836-060-0026 and 836-060-0031 as adjusted and determine therefrom the statewide loss ratio using no less than three years of experience. The Director shall compare the expected loss ratio with the actual loss ratio for the preceding review period determined from the incurred claims and earned premiums at prima facie rates reported under this rule, and publish the adjusted actual statewide prima facie rates to be used by insurers. If published, the rates are adjusted for the difference between: (a) Actual claims and expected claims; and (b) Any other additional premium changes necessary to meet the loss ratio standards of OAR 836-060-0021. [ED. NOTE: Forms referenced are available from the agency.] Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 742.005(6)(c) History: ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 24-1990, f. 12-28-90, cert. ef. 1-1-91 IC 1-1983, f. 1-28-83, ef. 2-1-83 Repealed by IC 13-1982, f. 11-30-82, ef. 12-1-82 IC 7-1982, f. 2-12-82, ef. 6-1-82
836-060-0046 Supervision of Credit Insurance Operations (1) Once every rate review period established under OAR 836-060-0041(4), each insurer transacting credit insurance in this state shall be responsible for conducting a thorough review of creditors with respect to the insurer's credit insurance business with such creditors, to assure compliance with the Oregon Insurance Code and 836-060-0000 through 836-060-0060. (2) The insurer shall maintain written records of these reviews for review by the Director. The records shall: (a) Review and report the creditor's activities according to OAR 836-060-0011(5); and (b) Verify the prompt and timely payment of claims and accuracy of refunds. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 743.377, 743.378, 743.380 & 746.160 History: ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 24-1990, f. 12-28-90, cert. ef. 1-1-91 IC 1-1983, f. 1-28-83, ef. 2-1-83 Repealed by IC 13-1982, f. 11-30-82, ef. 12-1-82 IC 7-1982, f. 2-12-82, ef. 6-1-82