reglab/housing_qa huggingface dataset:
OR Rev Stat § 741.340 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.340 - Health benefit plans offered through exchange.

The Oregon Health Authority, in developing and offering the health benefit package required by ORS 413.011 (1)(j), may not establish policies or procedures that discourage insurers from offering more comprehensive health benefit plans that provide greater consumer choice at a higher cost. The health benefit package approved by the Oregon Health Policy Board shall: (1) Promote the provision of services through an integrated health home model that reduces unnecessary hospitalizations and emergency department visits. (2) Require little or no cost sharing for evidence-based preventive care and services, such as care and services that have been shown to prevent acute exacerbations of disease symptoms in individuals with chronic illnesses. (3) Create incentives for individuals to actively participate in their own health care and to maintain or improve their health status. (4) Require a greater contribution by an enrollee to the cost of elective or discretionary health services. (5) Include a defined set of health care services that are affordable, financially sustainable and based upon the prioritized list of health services developed and updated by the Health Evidence Review Commission under ORS 414.690. [Formerly 413.064]
OR Rev Stat § 741.342 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.342 - Small Business Health Options Program.

Health benefit plans offered through a Small Business Health Options Program, as defined in ORS 741.300, are subject to ORS 743.004, 743.022, 743.535 and 743B.003 to 743B.127 and to other provisions of the Insurance Code applicable to small employer group health insurance. [2015 c.3 §36] Note: 741.342 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 741 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
OR Rev Stat § 741.381 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.381 - Application of antitrust laws.

The activities of insurers working under the direction of the Oregon Health Authority and the Department of Consumer and Business Services pursuant to ORS 413.011 (1)(j) or participating in the health insurance exchange administered under ORS 741.002 do not constitute a conspiracy or restraint of trade or an illegal monopoly, nor are they carried out for the purposes of lessening competition or fixing prices arbitrarily. [Formerly 413.075; 2012 c.38 §19; 2015 c.3 §26]
OR Rev Stat § 741.390 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.390 - False or misleading filings prohibited.

A person may not file or cause to be filed with the Oregon Health Authority any article, certificate, report, statement, application or any other information related to the health insurance exchange required or permitted by the authority to be filed, that is known by the person to be false or misleading in any material respect. [2011 c.415 §24; 2015 c.3 §28; 2021 c.569 §29]
OR Rev Stat § 741.400 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.400 - Service of eligibility notices; when notice becomes final order; opportunity to contest actual receipt of notice.

(1) The Oregon Health Authority may serve by regular mail or, if requested by the recipient, by electronic mail a notice described in ORS 183.415 of the authority’s determination of: (a) A person’s eligibility to purchase or to continue to purchase a qualified health plan through the health insurance exchange; (b) A person’s eligibility for a premium tax credit for purchasing a qualified health plan or the amount of the person’s premium tax credit; or (c) A person’s eligibility for cost-sharing reductions for qualified health plans and the amount of the person’s cost-sharing reduction. (2) The legal presumption described in ORS 40.135 (1)(q) does not apply to a notice that is served by regular or electronic mail in accordance with subsection (1) of this section. (3) Except as provided in subsection (4) of this section, a contested case notice served in accordance with subsection (1) of this section that complies with ORS 183.415 but for service by regular or electronic mail becomes a final order against a party and is not subject to ORS 183.470 (2), upon the earlier of the following: (a) If the party fails to request a hearing, the day after the date prescribed in the notice as the deadline for requesting a hearing. (b) The date the authority or the Office of Administrative Hearings mails an order dismissing a hearing request because: (A) The party withdraws the request for hearing; or (B) Neither the party nor the party’s representative appears on the date and at the time set for hearing. (4) The authority shall prescribe by rule a period of not less than 60 days after a notice becomes a final order under subsection (3) of this section within which a party may request a hearing under this subsection. If a party requests a hearing within the period prescribed under this subsection, the authority shall do one of the following: (a) If the authority finds that the party did not receive the written notice and did not have actual knowledge of the notice, refer the request for hearing to the Office of Administrative Hearings for a contested case proceeding on the merits of the authority’s intended action described in the notice. (b) Refer the request for hearing to the Office of Administrative Hearings for a contested case proceeding to determine whether the party received the written notice or had actual knowledge of the notice. The authority must show that the party had actual knowledge of the notice or that the authority mailed the notice to the party’s correct address or sent an electronic notice to the party’s correct electronic mail address. (5) If a party informs the authority that the party did not receive a notice served by regular or electronic mail in accordance with subsection (1) of this section, the authority shall advise the party of the right to request a hearing under subsection (4) of this section. [2013 c.678 §2; 2015 c.3 §29; 2021 c.569 §30]
OR Rev Stat § 741.425 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.425

[1961 c.182 §5; 1967 c.359 §474; renumbered 743.573]
OR Rev Stat § 741.455 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.455

[1961 c.182 §11; 1967 c.359 §566; renumbered 744.575]
OR Rev Stat § 741.500 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.500 - Required documentation; rules.

(1)(a) The Oregon Health Authority shall adopt by rule the information that must be documented in order for a person to qualify for: (A) Qualified health plan coverage through the health insurance exchange; (B) Premium tax credits; and (C) Cost-sharing reductions. (b) The documentation specified by the authority under this subsection shall include but is not limited to documentation of: (A) The identity of the person; (B) The status of the person as a United States citizen, or lawfully admitted noncitizen, and a resident of this state; (C) Information concerning the income and resources of the person as necessary to establish the person’s financial eligibility for coverage, for premium tax credits and for cost-sharing reductions, which may include income tax return information and a Social Security number; and (D) Employer identification information and employer-sponsored health insurance coverage information applicable to the person. (2) The authority shall adopt by rule the information that must be documented in order to determine whether the person is exempt from a requirement to purchase or be enrolled in a health plan under section 5000A of the Internal Revenue Code or other federal law. (3) The authority shall implement systems that provide electronic access to, and use, disclosure and validation of data needed to administer the exchange, to comply with federal data access and data exchange requirements and to streamline and simplify exchange processes. (4) Information and data that the authority obtains under this section may be exchanged with other state or federal health insurance exchanges, with state or federal agencies and, subject to ORS 741.510, for the purpose of carrying out exchange responsibilities, including but not limited to: (a) Establishing and verifying eligibility for: (A) A state medical assistance program; (B) The purchase of qualified health plans through the exchange; and (C) Any other programs that are offered through the exchange; (b) Establishing and verifying the amount of a person’s federal tax credit, cost-sharing reduction or premium assistance; (c) Establishing and verifying eligibility for exemption from the requirement to purchase or be enrolled in a health plan under section 5000A of the Internal Revenue Code or other federal law; (d) Complying with other federal requirements; or (e) Improving the operations of the exchange and for program analysis. [2011 c.415 §14; 2015 c.3 §30; 2021 c.569 §31]
OR Rev Stat § 741.520 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.520 - Agreements with other agencies regarding sharing and use of confidential information; contents.

(1) The Director of the Oregon Health Authority may enter into agreements governing the sharing and use of information consistent with this section and ORS 741.510 with other state or federal health insurance exchanges or regulatory authorities, the Department of Consumer and Business Services, the Department of Revenue, law enforcement agencies or federal authorities. (2) An agreement under this section must specify the duration of the agreement, the purpose of the agreement, the methods that may be employed for terminating the agreement and any other necessary and proper matters. (3) An agreement under this section does not relieve the director of any obligation or responsibility imposed by law. (4) The director may expend funds and may supply services for the purpose of carrying out an agreement under this section. [2011 c.415 §16; 2015 c.3 §32; 2021 c.569 §33]
OR Rev Stat § 741.540 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.540 - Complaints and investigations confidential; permitted disclosures.

(1) A complaint made to the Oregon Health Authority or the Department of Consumer and Business Services with respect to any prospective or certified qualified health plan, and the record thereof, shall be confidential and may not be disclosed except as provided in ORS 741.510 and 741.520. No such complaint, or the record thereof, shall be used by the authority or the department in any action, suit or proceeding except in the investigation or prosecution of apparent violations of ORS 741.310 or other law. (2) Data gathered pursuant to an investigation of a complaint by the authority or the department shall be confidential, may not be disclosed except as provided in ORS 741.510 and 741.520 and may not be used in any action, suit or proceeding except in the investigation or prosecution of apparent violations of ORS 741.310 or other law. (3) Notwithstanding subsections (1) and (2) of this section, the authority and the department shall establish a method for making available to the public an annual statistical report containing the number, percentage, type and disposition of complaints received by the authority and the department against each health plan that is certified or that has been certified as a qualified health plan by the authority. [2011 c.415 §23; 2015 c.3 §33; 2021 c.569 §34]
OR Rev Stat § 741.800 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.800 - Insurer to notify health care provider of qualified health plan coverage.

Upon receipt of any inquiry from a health care provider regarding the eligibility, coverage or benefits of an insured under an enrollee’s plan, an insurer shall notify the health care provider, in the manner prescribed by the insurer, that the coverage is provided through a qualified health plan. [2015 c.580 §3]
OR Rev Stat § 741.801 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.801 - Insurer to notify health care provider that enrollee is in grace period; effect of failure to provide notice.

(1) As used in this section and ORS 741.800: (a) "Enrollee" means a person who is: (A) Enrolled in a qualified health plan purchased through the health insurance exchange; (B) Responsible for paying the premium on the qualified health plan and has paid at least one premium; and (C) Receiving an advance payment of the premium tax credit under section 36B of the Internal Revenue Code. (b) "Grace period" means the period of three consecutive months during which an enrollee’s coverage continues under a qualified health plan without the payment of premiums. (c) "Health insurance exchange" has the meaning given that term in ORS 741.300. (d) "Qualified health plan" means a plan that is certified as a qualified health plan in accordance with ORS 741.310. (2) If an enrollee fails to pay a premium for a qualified health plan, the insurer shall notify any health care provider that the enrollee is in a grace period if the provider requests information from the insurer regarding the eligibility, coverage or benefits of the insureds under the enrollee’s plan. (3) If an insurer terminates the coverage of an enrollee based on the nonpayment of premiums during a grace period, the insurer shall pay a claim for reimbursement by a health care provider of a service performed during the grace period if: (a) The insurer fails to notify the health care provider as required by subsection (2) of this section; (b) The service is covered by the enrollee’s plan; and (c) The health care provider requests the information described in subsection (2) of this section not more than seven business days before providing the service and the insurer provides the information to the health care provider no later than two business days after the date of the provider’s request. (4) The requirements of this section may not be waived by agreement, and any provision of a contract entered into on or after January 1, 2016, that purports to waive the requirements of this section or that conflicts with the requirements of this section is null and void. [2015 c.580 §2]
OR Rev Stat § 741.802 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.802 - Authority to produce written informational materials.

The Oregon Health Authority shall produce written materials containing information for consumers about the requirements for paying the premiums for qualified health plans. The authority shall distribute the materials to health care providers upon request. [2015 c.580 §4; 2021 c.569 §35]
OR Rev Stat § 741.900 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 741 - Health Insurance Exchange|Section 741.900 - Civil penalties.

(1) The Director of the Oregon Health Authority, in accordance with ORS 183.745, may impose a civil penalty for a violation of ORS 741.390 of no more than $10,000. (2) All penalties recovered under this section shall be deposited in the Health Insurance Exchange Fund. [2011 c.415 §25; 2015 c.3 §34; 2021 c.569 §36]
OR Rev Stat § 742.001 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 742 - Insurance Policies Generally; Property and Casualty Policies|Section 742.001 - Scope of ORS chapters 742, 743, 743A and 743B.

Except as specifically provided in ORS 750.055 and 750.333, this chapter and ORS chapters 743, 743A and 743B apply to all insurance policies delivered or issued for delivery in this state except: (1) Reinsurance. (2) Wet marine and transportation insurance policies. (3) Surplus lines insurance policies. [Formerly 743.003; 2005 c.185 §14; 2017 c.206 §2]
OR Rev Stat § 742.003 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 742 - Insurance Policies Generally; Property and Casualty Policies|Section 742.003 - Filing and approval of policy forms; rules.

(1) Except where otherwise provided by law, no basic policy form, or application form where written application is required and is to be made a part of the policy, or rider, indorsement or renewal certificate form shall be delivered or issued for delivery in this state until the form has been filed with and approved by the Director of the Department of Consumer and Business Services. This section does not apply to: (a) Forms of unique character which are designed for and used with respect to insurance upon a particular risk or subject; (b) Forms issued at the request of a particular life or health insurance policy owner or certificate holder and which relate to the manner of distribution of benefits or to the reservation of rights and benefits thereunder; (c) Forms of group life or health insurance policies, or both, that have been agreed upon as a result of negotiations between the policyholder and the insurer; or (d) Forms complying with specific requirements regarding delivery or issuance for delivery in this state established by the director by rule. (2) Except as provided in ORS 743.019, the director shall within 30 days after the filing of any such form approve or disapprove the form. The director shall give written notice of such action to the insurer proposing to deliver such form and when a form is disapproved the notice shall show wherein such form does not comply with the law. (3) The 30-day period referred to in subsection (2) of this section may be extended by the director for an additional period not to exceed 30 days if the director gives written notice within the first 30-day period to the insurer proposing to deliver the form that the director needs such additional time for the consideration of such form. (4) The director may at any time request an insurer to furnish the director a copy of any form exempted under subsection (1) of this section. [Formerly 736.300 and then 743.006; 2001 c.943 §7; 2015 c.88 §4]
OR Rev Stat § 742.005 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 742 - Insurance Policies Generally; Property and Casualty Policies|Section 742.005 - Grounds for disapproval of policy forms.

The Director of the Department of Consumer and Business Services shall disapprove any form requiring the director’s approval: (1) If the director finds it does not comply with the law; (2) If the director finds it contains any provision, including statement of premium, or has any label, description of its contents, title, heading, backing or other indication of its provisions, which is unintelligible, uncertain, ambiguous or abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued; (3) If, in the director’s judgment, its use would be prejudicial to the interests of the insurer’s policyholders; (4) If the director finds it contains provisions which are unjust, unfair or inequitable; (5) If the director finds sales presentation material disapproved by the director pursuant to ORS 742.009 is being used with respect to the form; or (6) If, with respect to any of the following forms, the director finds the benefits provided therein are not reasonable in relation to the premium charged: (a) Individual health insurance policy forms, including benefit certificates issued by fraternal benefit societies and individual policies issued by health care service contractors, but excluding policies referred to in ORS 743.402 as exempt from the application of ORS 743.405 to 743.498 and 743A.160; (b) Small employer group health benefit plan forms for small employers as that term is defined in ORS 743B.005, including small employer group policies issued by health care service contractors; or (c) Credit life and credit health insurance forms subject to ORS 743.371 to 743.380. [Formerly 743.009; 1991 c.182 §1; 1999 c.987 §4; 2017 c.206 §15]
OR Rev Stat § 742.007 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 742 - Insurance Policies Generally; Property and Casualty Policies|Section 742.007 - Director’s withdrawal of approval.

(1) The Director of the Department of Consumer and Business Services may, at any time after a hearing held not less than 20 days after written notice to the insurer, withdraw the director’s approval of any form on any ground set forth in ORS 742.005. The written notice of such hearing shall state the reason for the proposed withdrawal. (2) When the director notifies an insurer of a hearing on a form under subsection (1) of this section, if the director in the director’s own discretion determines that the public may suffer serious injury because of continued use of the form, the director also may order the insurer to suspend delivery of the form in this state until the director has decided whether to withdraw approval of the form. (3) No insurer shall deliver in this state: (a) A form subject to an order of suspension under subsection (2) of this section, after the effective date of the order and until the director withdraws the order. (b) A form for which the director has withdrawn approval, after the effective date of such withdrawal. The effective date of withdrawal shall be as the director may prescribe but not less than 30 days after the giving of notice of withdrawal. [Formerly 743.012]
OR Rev Stat § 742.008 (2021)
2021 Oregon Revised Statutes|Volume : 18 - Financial Institutions, Insurance|Chapter 742 - Insurance Policies Generally; Property and Casualty Policies|Section 742.008 - Health savings account exemption from prohibition on deductible.

(1) As used in this section: (a) "Health benefit plan" has the meaning given that term in ORS 743B.005. (b) "Health savings account" means an account established under section 223 of the Internal Revenue Code. (2) This section applies to a health benefit plan that is: (a) Offered by a carrier as a plan that qualifies for a health savings account distribution; and (b) Subject to a provision of the Insurance Code that prohibits a health benefit plan from applying a deductible to a specified health care service that is reimbursed by the health benefit plan. (3) The Department of Consumer and Business Services may approve a filing under ORS 742.003 for a health benefit plan described in subsection (2) of this section if: (a) The health benefit plan would be approved but for the failure of the plan to comply with the provision described in subsection (2)(b) of this section; (b) A deductible must be applied to the specified health care service for the plan to qualify for a distribution from a health savings account; and (c) The health benefit plan complies with all other applicable provisions of the Insurance Code. [2018 c.43 §3] Note: 742.008 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 742 or any series therein. See Preface to Oregon Revised Statutes for further explanation.