ORS Chapter 731 — Administration and General

ORS 731.036. Persons completely exempt from application of Insurance Code. Except as provided in ORS 743.029 or as specifically provided by law, the Insurance Code does not apply to any of the following to the extent of the subject matter of the exemption: (1) A bail bondsman, other than a corporate surety and its agents. (2) A fraternal benefit society that has maintained lodges in this state and other states for 50 years prior to January 1, 1961, and for which a certificate of authority was not required on that date. (3) A religious organization providing insurance benefits only to its employees, if the organization is in existence and exempt from taxation under section 501(c)(3) of the federal Internal Revenue Code on September 13, 1975. (4) Public bodies, as defined in ORS 30.260, that either individually or jointly establish a self-insurance program for tort liability in accordance with ORS 30.282. (5) Public bodies, as defined in ORS 30.260, that either individually or jointly establish a self-insurance program for property damage in accordance with ORS 30.282. (6) Cities, counties, school districts, community college districts, community college service districts or districts, as defined in ORS 198.010 and 198.180, that either individually or jointly insure for health insurance coverage, excluding disability insurance, their employees or retired employees, or their dependents, or students engaged in school activities, or combination of employees and dependents, with or without employee or student contributions, if all of the following conditions are met: (a) The individual or jointly self-insured program meets the following minimum requirements: (A) In the case of a school district, community college district or community college service district, the number of covered employees and dependents and retired employees and dependents aggregates at least 500 individuals; (B) In the case of an individual public body program other than a school district, community college district or community college service district, the number of covered employees and dependents and retired employees and dependents aggregates at least 500 individuals; and (C) In the case of a joint program of two or more public bodies, the number of covered employees and dependents and retired employees and dependents aggregates at least 1,000 individuals; (b) The individual or jointly self-insured health insurance program includes all coverages and benefits required of group health insurance policies under ORS chapters 743, 743A and 743B; (c) The individual or jointly self-insured program must have program documents that define program benefits and administration; (d) Enrollees must be provided copies of summary plan descriptions including: (A) Written general information about services provided, access to services, charges and scheduling applicable to each enrollees coverage; (B) The programs grievance and appeal process; and (C) Other group health plan enrollee rights, disclosure or written procedure requirements established under ORS chapters 743, 743A and 743B; (e) The financial administration of an individual or jointly self-insured program must include the following requirements: (A) Program contributions and reserves must be held in separate accounts and used for the exclusive benefit of the program; (B) The program must maintain adequate reserves. Reserves may be invested in accordance with the provisions of ORS chapter 293. Reserve adequacy must be calculated annually with proper actuarial calculations including the following: (i) Known claims, paid and outstanding; (ii) A history of incurred but not reported claims; (iii) Claims handling expenses; (iv) Unearned contributions; and (v) A claims trend factor; and (C) The program must maintain adequate reinsurance against the risk of economic loss in accordance with the provisions of ORS 742.065 unless the program has received written approval for an alternative arrangement for protection against economic loss from the Director of the Department of Consumer and Business Services; (f) The individual or jointly self-insured program must have sufficient personnel to service the employee benefit program or must contract with a third party administrator licensed under ORS chapter 744 as a third party administrator to provide such services; (g) The public body, or the program administrator in the case of a joint insurance program of two or more public bodies, files with the Director of the Department of Consumer and Business Services copies of all documents creating and governing the program, all forms used to communicate the coverage to enrollees, the schedule of payments established to support the program and, annually, a financial report showing the total incurred cost of the program for the preceding year. A copy of the annual audit required by ORS 297.425 may be used to satisfy the financial report filing requirement; and (h) Each public body in a joint insurance program is liable only to its own employees and no others for benefits under the program in the event, and to the extent, that no further funds, including funds from insurance policies obtained by the pool, are available in the joint insurance pool. (7) All ambulance services. (8) A person providing any of the services described in this subsection. The exemption under this subsection does not apply to an authorized insurer providing such services under an insurance policy. This subsection applies to the following services: (a) Towing service. (b) Emergency road service, which means adjustment, repair or replacement of the equipment, tires or mechanical parts of a motor vehicle in order to permit the motor vehicle to be operated under its own power. (c) Transportation and arrangements for the transportation of human remains, including all necessary and appropriate preparations for and actual transportation provided to return a decedents remains from the decedents place of death to a location designated by a person with valid legal authority under ORS 97.130. (9)(a) A person described in this subsection who, in an agreement to lease or to finance the purchase of a motor vehicle, agrees to waive for no additional charge the amount specified in paragraph (b) of this subsection upon total loss of the motor vehicle because of physical damage, theft or other occurrence, as specified in the agreement. The exemption established in this subsection applies to the following persons: (A) The seller of the motor vehicle, if the sale is made pursuant to a motor vehicle retail installment contract. (B) The lessor of the motor vehicle. (C) The lender who finances the purchase of the motor vehicle. (D) The assignee of a person described in this paragraph. (b) The amount waived pursuant to the agreement shall be the difference, or portion thereof, between the amount received by the seller, lessor, lender or assignee, as applicable, that represents the actual cash value of the motor vehicle at the date of loss, and the amount owed under the agreement. (10) A self-insurance program for tort liability or property damage that is established by two or more affordable housing entities and that complies with the same requirements that public bodies must meet under ORS 30.282 (6). As used in this subsection: (a) Affordable housing means housing projects in which some of the dwelling units may be purchased or rented, with or without government assistance, on a basis that is affordable to individuals of low income. (b) Affordable housing entity means any of the following: (A) A housing authority created under the laws of this state or another jurisdiction and any agency or instrumentality of a housing authority, including but not limited to a legal entity created to conduct a self-insurance program for housing authorities that complies with ORS 30.282 (6). (B) A nonprofit corporation that is engaged in providing affordable housing. (C) A partnership or limited liability company that is engaged in providing affordable housing and that is affiliated with a housing authority described in subparagraph (A) of this paragraph or a nonprofit corporation described in subparagraph (B) of this paragraph if the housing authority or nonprofit corporation: (i) Has, or has the right to acquire, a financial or ownership interest in the partnership or limited liability company; (ii) Has the power to direct the management or policies of the partnership or limited liability company; (iii) Has entered into a contract to lease, manage or operate the affordable housing owned by the partnership or limited liability company; or (iv) Has any other material relationship with the partnership or limited liability company. (11) Except as provided in ORS 735.500 and 735.510, a person certified by the Department of Consumer and Business Services to operate a retainer medical practice. (12) A fund established by the Board of Governors of the Oregon State Bar under ORS 9.080. (13) An association or group of eligible employers, as defined in ORS 735.520, that administers a self-insured program to provide health insurance coverage, excluding disability insurance, to their employees or retired employees or their dependents or a combination of employees and dependents, with or without employee contributions, if all of the following conditions are met: (a) The number of covered employees and dependents and retired employees and dependents aggregates at least 500 individuals; (b) The program includes all coverages and benefits required of group health insurance policies under ORS chapters 743, 743A and 743B; (c) The program has program documents that define program benefits and administration; (d) Enrollees of the program are provided copies of summary plan descriptions including: (A) Written general information about services provided, access to services, charges and scheduling applicable to each enrollees coverage; (B) The programs grievance and appeal process; and (C) Other group health plan enrollee rights, disclosure or written procedure requirements established under ORS chapters 743, 743A and 743B; (e) Program contributions and reserves are held in separate accounts and used for the exclusive benefit of the program; (f) The program maintains adequate reserves, which may be invested in accordance with the provisions of ORS chapter 293, calculated annually with proper actuarial calculations including the following: (A) Known claims, paid and outstanding; (B) A history of incurred but not reported claims; (C) Claims handling expenses; (D) Unearned contributions; and (E) A claims trend factor; (g) The program maintains adequate reinsurance against the risk of economic loss in accordance with the provisions of ORS 742.065 unless the program has received written approval for an alternative arrangement for protection against economic loss from the Director of the Department of Consumer and Business Services; (h) The program has sufficient personnel to service the program or contracts with a third party administrator licensed under ORS chapter 744 as a third party administrator to provide such services; and (i) The program files with the director copies of all documents creating and governing the program, all forms used to communicate the coverage to enrollees, the schedule of payments established to support the program and, annually, a financial report showing the total incurred cost of the program for the preceding year.