reglab/statecodes huggingface dataset:
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.303 - Requirements for issuance of group life insurance policies.

Policies of group life insurance are subject to the following requirements:
(1) The policy shall be issued upon the lives of persons who are associated in a common group formed for purposes other than the obtaining of insurance, except that either of the following kinds of policies may be issued to persons other than those in a common group:
(a) Group policies of credit life insurance; or
(b) Group policies of mortgage life insurance on first and second mortgages secured by real estate.
(2) No fewer than two lives are insured at the date of issue of the policy.
(3) The amounts of insurance under the policy shall be based on some plan precluding individual selection, except that optional supplemental insurance may be available to persons insured under the policy, if the amounts of such supplemental insurance are based upon age, salary, rank or similar objective standards.
(4) The premium for the policy must be paid from the funds of the group policyholder or from funds contributed by persons insured under the policy, or from both sources.
(5) For the purposes of this section, the term "mortgage" includes trust deeds.
(6) As used in this section, "trust deed" has the meaning given in ORS 86.705. [1967 c.359 §412; 1971 c.231 §44; 1991 c.182 §4; 1993 c.426 §1; 2007 c.560 §2]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.306 - Required provisions in group life insurance policies.

(1) Except as provided in subsection (2) of this section a group life insurance policy shall contain in substance the provisions described in ORS 743.309 to 743.342.
(2) The provisions described in ORS 743.327 to 743.339 shall not apply to policies of group credit life insurance. [1967 c.359 §413]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.309 - Nonforfeiture provisions.

If a group life insurance policy is on a plan of insurance other than the term plan, it shall contain nonforfeiture provision or provisions which in the opinion of the Director of the Department of Consumer and Business Services are equitable to the insured persons and to the policyholder, but nothing in this section shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies. [1967 c.359 §414]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.312 - Grace period.

A group life insurance policy shall contain a provision that the policyholder is entitled to a grace period of 31 days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period. [1967 c.359 §415]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.315 - Incontestability.

A group life insurance policy shall contain a provision that the validity of the policy shall not be contested, except for nonpayment of premiums, after it has been in force for two years from its date of issue; and that no statement made by any person insured under the policy relating to the insurability of the person shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of two years during such person’s lifetime nor unless it is contained in a written instrument signed by the person. [1967 c.359 §416]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.318 - Application; representations by policyholders and insureds.

A group life insurance policy shall contain a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such person or the beneficiary of the person. [1967 c.359 §417]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.321 - Evidence of insurability.

A group life insurance policy shall contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the coverage. [1967 c.359 §418]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.324 - Misstatement of age.

A group life insurance policy shall contain a provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, such provision to contain a clear statement of the method of adjustment to be used. [1967 c.359 §419]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.327 - Payments under policy; payment of interest upon failure to pay proceeds.

(1) A group life insurance policy shall contain a provision that any sum becoming due by reason of the death of a person insured shall be payable to the beneficiary designated by the person insured, subject to the provisions of the policy in the event there is no designated beneficiary, as to all or any part of such sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of such sum not exceeding $500 to any person appearing to the insurer to be equitably entitled thereto by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured.
(2) If the insurer fails to pay the proceeds of or make payment under the policy within 30 days after receipt of due proof of death and of the interest of the claimant, and if the beneficiary elects to receive a lump sum settlement, the insurer shall pay interest on any money due and unpaid after expiration of the 30-day period. The insurer shall compute the interest from the date of the insured’s death until the date of payment, at a rate not lower than that paid by the insurer on other withdrawable policy owner funds. At the end of the 30-day period, the insurer shall notify the designated beneficiary or beneficiaries at their last-known address that interest at the applicable rate will be paid on the lump sum proceeds from the date of death of the insured.
(3) Nothing in this section shall be construed to allow an insurer to withhold payment of money payable under a group life insurance policy to any designated beneficiary for a period longer than reasonably necessary to transmit the payment. [1967 c.359 §420; 1983 c.754 §3]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.330 - Issuance of certificates.

A group life insurance policy shall contain a provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which the person is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in ORS 743.333, 743.336 and 743.339. [1967 c.359 §421]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.333 - Termination of individual coverage.

A group life insurance policy shall contain a provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, such person shall be entitled to have issued by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits, provided application for the individual policy shall be made, and the first premium paid to the insurer, within 31 days after such termination, and provided further that:
(1) The individual policy shall, at the option of such person, be on any one of the forms, except term insurance, then customarily issued by the insurer at the age and for the amount applied for;
(2) The individual policy shall be in an amount not in excess of the amount of life insurance which ceases because of such termination, less the amount of any life insurance for which such person is or becomes eligible under the same or any other group policy within 31 days after such termination, provided that any amount of insurance which shall have matured on or before the date of such termination as an endowment payable to the person insured, whether in one sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount which is considered to cease because of such termination; and
(3) The premium on the individual policy shall be at the insurer’s then customary rate applicable to the form and amount of the individual policy, to the class of risk to which such person then belongs, and to the age attained on the effective date of the individual policy. [1967 c.359 §422]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.336 - Termination of policy or class of insured persons.

A group life insurance policy shall contain a provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured thereunder at the date of such termination whose insurance terminates and who has been so insured for at least five years prior to such termination date shall be entitled to have issued by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by ORS 743.333, except that the group policy may provide that the amount of such individual policy shall not exceed the smaller of:
(1) The amount of the person’s life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under any group policy issued or reinstated by the same or another insurer within 31 days after such termination; and
(2) $10,000. [1967 c.359 §423; 1989 c.784 §16]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.339 - Death during period for conversion to individual policy.

A group life insurance policy shall contain a provision that if a person insured under the group policy dies during the period within which the person would have been entitled to have an individual policy issued in accordance with ORS 743.333 or 743.336 and before such an individual policy shall have become effective, the amount of life insurance which the person would have been entitled to have issued under such individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium therefor has been made. [1967 c.359 §424]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.342 - Statement furnished to insured under credit life insurance policy.

A group credit life insurance policy shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form which will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid thereunder by reason of death shall be applied to reduce or extinguish the indebtedness. [1967 c.359 §425]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.345 - Assignability of group life policies.

Nothing in the Insurance Code or in any other law shall be construed to prohibit any person insured under a group life insurance policy from making an assignment of all or any part of the incidents of ownership under such policy, including but not limited to the privilege to have issued an individual policy of life insurance pursuant to the provisions of ORS 743.333 to 743.339 and the right to name a beneficiary. Subject to the terms of the policy or an agreement between the insured, the group policyholder and the insurer relating to assignment of incidents of ownership under the policy, such an assignment by an insured is valid for the purpose of vesting in the assignee, in accordance with any provisions included in the assignment as to the time at which it is to be effective, all of such incidents of ownership so assigned, but without prejudice to the insurer on account of any payment it may make, or individual policy it may issue in accordance with ORS 743.333 to 743.339, prior to receipt of notice of the assignment. [1971 c.231 §6; 2005 c.22 §491]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.348 - Certain sales practices prohibited.

(1) No person selling group life insurance is authorized to sell membership in a common group for the purpose of qualifying an applicant who is an individual for group life insurance.
(2) No person selling membership in a common group is authorized to offer group life insurance for the purpose of selling membership in the common group. [1989 c.784 §6]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.351 - Eligibility of association to be group life policyholder; rules.

(1) An insurer shall not offer a policy of group life insurance in this state to an association as the policyholder or offer coverage under such a policy, whether the policy is issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the association satisfies the following requirements:
(a) The association must have had an active existence for at least one year;
(b) The association must insure under the policy the employees or members of the association, or employees of members of the association, for the benefit of persons other than the association or its officers or trustees; and
(c) The association must be maintained primarily for purposes other than the procurement of insurance.
(2) An insurer shall submit evidence to the director that the association satisfies the requirements of subsection (1) of this section. The director shall review the evidence and may request additional evidence as needed.
(3) An insurer shall submit to the director any changes in the evidence submitted under subsection (2) of this section.
(4) The director may order an insurer to cease offering group life insurance to an association if the director determines that the association does not meet the requirements under subsection (1) of this section.
(5) For purposes of this section:
(a) An association includes a labor union.
(b) "Employees" may include retired employees.
(6) The director may adopt rules to carry out this section. [1989 c.784 §7]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.354 - Requirements for certain group life policies issued to trustees of certain funds; rules.

(1) An insurer shall not offer in this state a policy of group life insurance that is described in this section and insures persons in this state, or shall not offer coverage under such a policy, whether the policy is to be issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the requirements of subsections (2) and (3) of this section are satisfied. This section applies to a policy to be issued to the trustees of a fund established for:
(a) Two or more employers in the same or related industry;
(b) One or more labor unions;
(c) One or more employers and one or more labor unions; or
(d) An association determined by the director to satisfy the requirements of ORS 743.351 (1).
(2) A policy of group life insurance shall provide coverage for the benefit of employees of the employers, members of the unions or members of the association. The policy may include as employees the officers and managers of the employer, and the individual proprietor or partners if the employer is an individual proprietor or a partnership. In addition to such employees, the policy may also insure retired employees and the trustees or their employees, or both, if their duties are principally connected with the trust.
(3) The director shall determine with respect to a policy whether the trustees are the policyholder. If the director determines that the trustees are the policyholder and if the policy is issued or proposed to be issued in this state, the policy is subject to the Insurance Code. If the director determines that the trustees are not the policyholder, the evidence of coverage that is issued or proposed to be issued in this state to a participating employer, labor union or association shall be deemed to be a group life insurance policy subject to the Insurance Code. For purposes of this section, the director may determine that the trustees are not the policyholder if:
(a) The evidence of coverage issued or proposed to be issued to a participating employer, labor union or association is in fact the primary statement of coverage for the employer, labor union or association; and
(b) The trust arrangement is under the actual control of the insurer.
(4) An insurer shall submit evidence to the director showing that the requirements of subsections (2) and (3) of this section are satisfied. The director shall review the evidence and may request additional evidence as needed.
(5) An insurer shall submit to the director any changes in the evidence submitted under subsection (4) of this section.
(6) The director may adopt rules to carry out this section. [1989 c.784 §8]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.356 - Continuing coverage upon replacement of group life policy.

When coverage under a group life insurance policy is replaced by coverage under another group life insurance policy, the insurer offering the policy that is replaced shall continue to provide coverage for each certificate holder under the replaced policy whose premium payments are suspended because the certificate holder is disabled. [1989 c.784 §9]
Note:
743.356 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 743 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.358 - Borrowing by certificate holders under group life policy.

(1) An insurer of a group life insurance policy may authorize certificate holders under the policy to borrow upon the policy, subject to the following provisions:
(a) The insurer may require a certificate holder, in order to borrow on the policy, to have been a certificate holder under the policy for a minimum period specified by the insurer.
(b) The insurer may require that no premium on the policy be in default beyond the grace period for payment.
(2) An insurer authorizing a certificate holder under a group life insurance policy may establish a minimum loan amount, but the amount may not exceed $1,000.
(3) An insurer may charge a fixed interest rate not exceeding eight percent per year, or an adjustable interest rate. The policy provision establishing an adjustable interest rate must comply with ORS 743.187. The exemption from a limitation on interest rates under state law established in ORS 743.187 for individual life insurance policies also applies to interest rates established pursuant to this section.
(4) The loan value of a certificate shall be equal to 90 percent of the cash surrender value of the certificate at the time of the loan, less any existing indebtedness not already deducted, including any unpaid interest. This subsection does not apply to certificates issued under a group policy for which the loan value is established by federal law. [1991 c.182 §9]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.360 - Alternative group life insurance coverage.

(1) Group life insurance coverage offered to a resident in this state under a group life insurance policy issued to a group other than one described in ORS 743.351 or 743.354 may be delivered if:
(a) The Director of the Department of Consumer and Business Services finds that:
(A) The issuance of the policy is in the best interest of the public;
(B) The issuance of the policy would result in economies of acquisition or administration; and
(C) The benefits are reasonable in relation to the premiums charged;
(b) The premium for the policy is paid either from funds of a policyholder, from funds contributed by a covered person or from both; and
(c) An insurer has the discretion to exclude or limit coverage for a voluntary plan on any person for whom evidence of individual insurability is not satisfactory to the insurer.
(2) The requirements of ORS 743.303 do not apply to a policy authorized under subsection (1) of this section. [2001 c.943 §3]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.371 - Definitions for credit life and credit health insurance provisions.

(1) "Credit life insurance" means insurance on the life of a debtor pursuant to or in connection with a specific loan or other credit transaction.
(2) "Credit health insurance" means insurance on a debtor to provide indemnity for payments becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy.
(3) "Creditor" means the lender of money or vendor or lessor of goods, services, property, rights or privileges for which payment is arranged through a credit transaction, or any successor to the right, title or interest of any such lender, vendor or lessor, and an affiliate, associate or subsidiary of any of them or any director, officer or employee of any of them or any other person in any way associated with any of them.
(4) "Debtor" means a borrower of money or a purchaser or lessee of goods, services, property, rights or privileges for which payment is arranged through a credit transaction.
(5) "Indebtedness" means the total amount payable by a debtor to a creditor in connection with a loan or other credit transaction. [Formerly 739.565 and then 743.561]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.372 - Applicability of credit life and credit health insurance provisions.

(1) All life or health insurance in connection with loans or other credit transactions shall be subject to ORS 743.371 to 743.380, except:
(a) Insurance in connection with a loan or other credit transaction of more than 10 years’ duration; or
(b) Insurance, the issuance of which is an isolated transaction on the part of the insurer not related to an agreement or a plan for insuring debtors of the creditor.
(2) Notwithstanding subsection (1) of this section, credit life and credit health insurance may be issued for up to 10 years in connection with a loan or other credit transaction of any duration. [Formerly 739.570 and then 743.564]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.373 - Forms of credit life and credit health insurance.

Credit life and credit health insurance shall be issued only in the following forms:
(1) Individual policies of life insurance issued to debtors on the term plan.
(2) Individual policies of health insurance issued to debtors on a term plan, or disability benefit provisions in individual policies of credit life insurance.
(3) Group policies of life insurance issued to creditors providing insurance upon the lives of debtors on the term plan.
(4) Group policies of health insurance issued to creditors on a term plan insuring debtors, or disability benefit provisions in group credit life insurance policies. [Formerly 739.575 and then 743.567]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.374 - Limits on amount of credit life insurance.

(1) The initial amount of credit life insurance shall not exceed the total amount repayable under the contract of indebtedness and, where an indebtedness is repayable in substantially equal installments, the amount of insurance shall at no time exceed the scheduled or actual amount of unpaid indebtedness, whichever is greater.
(2) Notwithstanding the provisions of subsection (1) of this section, insurance on agricultural credit transaction commitments not exceeding 18 months in duration may be written up to the amount of the loan commitment, on a nondecreasing or level term plan.
(3) Notwithstanding the provisions of subsection (1) of this section, insurance on educational credit transaction commitments may include the portion of such commitment that has not been advanced by the creditor. [Formerly 743.570]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.375 - Limit on amount of credit health insurance.

The total amount of periodic indemnity payable by credit health insurance in the event of disability, as defined in the policy, shall not exceed the aggregate of the periodic scheduled unpaid installments of the indebtedness; and the amount of each periodic indemnity payment shall not exceed the original indebtedness divided by the number of periodic installments. [Formerly 741.425 and then 743.573]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.376 - Duration of credit life and credit health insurance.

(1) The term of any credit life or credit health insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor, except that, where a group policy provides coverage with respect to existing obligations, the insurance on a debtor with respect to such indebtedness shall commence on the effective date of the policy. Where evidence of insurability is required and such evidence is furnished more than 30 days after the date when the debtor becomes obligated to the creditor, the term of the insurance may commence on the date on which the insurer determines the evidence to be satisfactory, and in such event there shall be an appropriate refund or adjustment of any charge to the debtor for insurance.
(2) The term of the insurance shall not extend more than 15 days beyond the scheduled maturity date of the indebtedness except when extended without additional cost to the debtor.
(3) If the indebtedness is discharged because of renewal or refinancing prior to the scheduled maturity date, the insurance in force shall be terminated before any new insurance may be issued in connection with the renewed or refinanced indebtedness.
(4) In all cases of termination of the insurance prior to the scheduled maturity date of the indebtedness, a refund shall be paid or credited as provided in ORS 743.378. [Formerly 739.585 and then 743.576]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.378 - Charges and refunds to debtor.

(1) Each individual policy or group certificate of credit life or credit health insurance, or both, shall provide that in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of an amount paid by the debtor for insurance shall be paid or credited promptly to the person entitled thereto. However, the Director of the Department of Consumer and Business Services shall prescribe a minimum refund and no refund which would be less than such minimum need be made. The formula to be used in computing such refund shall be filed with and approved by the director.
(2) If a creditor requires a debtor to make any payment for credit life insurance or credit health insurance and an individual policy or group certificate of insurance is not issued, the creditor shall immediately give written notice to such debtor and shall promptly make an appropriate credit to the account.
(3) The amount charged to a debtor for credit life insurance and for credit health insurance shall not exceed the respective premiums charged by the insurer, as computed at the time the charge to the debtor is determined. [Formerly 739.600 and then 743.582]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.379 - Status of remuneration to creditor.

Notwithstanding the provisions of any other law of this state which may expressly or by construction provide otherwise, any commission or service fee or other benefit or return to any creditor arising out of the sale or provision of credit life and credit health insurance shall not be deemed interest or charges in connection with loans or credit transactions. [Formerly 739.603 and then 743.585]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.380 - Claim report and payment.

(1) All claims under policies of credit life or credit health insurance, or both, shall be promptly reported to the insurer or its designated claim representative and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the policy.
(2) All claims shall be paid either by draft drawn upon the insurer or by check of the insurer to the order of the claimant to whom payment is due pursuant to the policy provisions or, upon direction of such claimant, to the one specified. [Formerly 739.610 and then 743.588]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.402 - Exceptions to individual health insurance policy requirements.

ORS 743.405 to 743.498 and 743A.160 do not apply to or affect:
(1) Any workers’ compensation insurance policy or any liability insurance policy with or without supplementary expense coverage therein;
(2) Any policy of reinsurance;
(3) Any blanket or group policy of insurance, except as expressly provided in ORS 750.055; or
(4) Any life insurance policy, or policy supplemental thereto which contains only such provisions relating to health insurance as:
(a) Provide additional benefits in case of death or dismemberment or loss of sight by accident; or
(b) Operate to safeguard such policy against lapse, or to give a special surrender value or special benefit or an annuity in the event the insured shall become totally and permanently disabled, as defined by the policy or supplemental policy. [Formerly 741.022; 2001 c.356 §5; 2013 c.698 §19; 2017 c.206 §3]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.405 - General requirements for health insurance policies.

An individual health insurance policy must meet the following requirements:
(1) The policy must include a statement of the entire money and other considerations due.
(2) The policy must state the time at which the insurance takes effect and terminates.
(3) The policy may purport to insure only one person, unless an adult member of a family applies for coverage of family members or other dependents.
(4) The policy may not be issued individually to an individual in a group of persons described in ORS 731.098 for the purpose of separating the individual from health insurance benefits offered or provided in connection with a group health benefit plan.
(5)(a) Except as provided in ORS 743.498, the style, arrangement and overall appearance of the policy may not give undue prominence to any portion of the text, and every printed portion of the text of the policy and of any indorsements or attached papers shall be plainly printed in lightfaced type of a style in general use, the size of which shall be uniform and not less than 12-point type.
(b) As used in this subsection, "text" includes all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and captions and subcaptions.
(6) The policy must state the exceptions and reductions of indemnity. Except those required by ORS 743.411 to 743.477, exceptions and reductions shall be printed at the insurer’s option either included with the applicable benefit provision or under an appropriate caption such as EXCEPTIONS, or EXCEPTIONS AND REDUCTIONS. However, if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction must be included with the applicable benefit provision.
(7) Each form constituting the policy, including riders and indorsements, must be identified by a form number in the lower left-hand corner of the first page of the policy.
(8) The policy may not contain provisions purporting to make any portion of the charter, rules, constitution or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of or reference to a statement of rates or classification of risks, or short rate table filed with the Director of the Department of Consumer and Business Services. [Formerly 741.120; 1999 c.987 §5; 2009 c.11 §94; 2011 c.9 §91; 2011 c.500 §6; 2013 c.681 §12]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.406 - Required provisions in group health insurance policies.

A group health insurance policy shall contain in substance the following provisions:
(1) A provision that, in the absence of fraud, all statements made by applicants, the policyholder or an insured person shall be deemed representations and not warranties, and that no statement made for the purpose of effecting insurance shall avoid the insurance or reduce benefits unless contained in a written instrument signed by the policyholder or the insured person, a copy of which has been furnished to the policyholder or to the person or the beneficiary of the person.
(2) A provision that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group a statement in summary form of the essential features of the insurance coverage of the employee or member, to whom the insurance benefits are payable, and the applicable rights and conditions set forth in ORS 743B.340, 743B.341 and 743B.343 to 743B.347. If dependents are included in the coverage, only one statement need be issued for each family unit.
(3) A provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy. [Formerly 743.528]
Note:
743.406 was made a part of ORS chapter 743 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.408 - Mandatory provisions.

Except as provided in ORS 742.021, a health insurance policy shall contain the provisions set forth in ORS 743.411 to 743.444. The provisions shall be preceded individually by the caption appearing in the sections or, at the option of the insurer, by the appropriate individual or group captions or subcaptions as the Director of the Department of Consumer and Business Services may approve. [1967 c.359 §428; 2011 c.9 §92]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.411 - Entire contract; changes.

A health insurance policy shall contain a provision as follows: "ENTIRE CONTRACT; CHANGES: This policy, including the indorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be indorsed hereon or attached hereto. No insurance producer has authority to change this policy or to waive any of its provisions." [1967 c.359 §429; 2003 c.364 §107]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.414 - Time limit on certain defenses; incontestability.

(1) A health insurance policy shall contain a provision as follows: "TIME LIMIT ON CERTAIN DEFENSES: After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, commencing after the expiration of that period."
(2) The policy provision set forth in subsection (1) of this section shall not be so construed as to affect any legal requirement for avoidance of a policy or denial of a claim during such initial two-year period, or to limit the application of ORS 743.450 to 743.462 in the event of misstatement with respect to age or occupation or other insurance.
(3) A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium until at least age 50 or, in the case of a policy issued after age 44, for at least five years from its date of issue, may contain in lieu of the provision set forth in subsection (1) of this section the following provision, from which the clause in parentheses may be omitted at the insurer’s option: "INCONTESTABLE: After this policy has been in force for a period of two years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application."
(4) The policy shall contain a provision as follows, which shall be a separate paragraph under the same caption as, and immediately following, the provision set forth in subsection (1) or (3) of this section: "No claim for loss incurred or disability, as defined in the policy, commencing after two years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy." [1967 c.359 §430; 1969 c.159 §1]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.416 - Due date for first premium payment.

An insurer offering an individual health benefit plan may establish a due date for payment of the first premium for the plan no earlier than 15 days after the date that the coverage begins or 15 days after the insurer sends the initial invoice to the insured, whichever is later. [2021 c.205 §3]
Note:
743.416 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.417 - Grace period for subsequent premium payments; cancellation and nonrenewal.

(1) A policy of health insurance issued to an individual residing in this state shall specify a minimum grace period following the premium due date for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force. Unless a longer grace period is provided by federal law, the grace period must be at least:
(a) Ten days for a policy other than an individual health benefit plan; and
(b) Thirty days for an individual health benefit plan.
(2) A policy that contains a cancellation provision may add at the end of the provision described in subsection (1) of this section the following clause or an equivalent clause approved by the Department of Consumer and Business Services: "subject to the right of the insurer to cancel in accordance with the cancellation provision hereof."
(3) A policy in which the insurer reserves the right to refuse renewal shall have the following clause, or an equivalent clause approved by the department, at the beginning of the provision described in subsection (1) of this section: "Unless not less than 30 days prior to the premium due date the insurer has delivered to the insured or has mailed to the last address of the insured as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted. The insurer shall state in the notice the reason for its refusal to renew this policy."
(4) Subsections (2) and (3) of this section may not be construed to permit the cancellation of or refusal to renew a policy if the cancellation or refusal to renew is otherwise prohibited by the Insurance Code or rules adopted by the department to carry out the provisions of the Insurance Code. [1967 c.359 §431; 1989 c.784 §19; 2001 c.943 §9; 2013 c.681 §13; 2021 c.205 §5]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.420 - Reinstatement.

(1) A health insurance policy, other than a health benefit plan as defined in ORS 743B.005, shall contain a provision as follows: "REINSTATEMENT: If any renewal premium is not paid within the grace period, a subsequent acceptance of premium by the insurer or by any insurance producer duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy; provided, however, that if the insurer or such insurance producer requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the 45th day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than 10 days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions indorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than 60 days prior to the date of reinstatement."
(2) The last sentence of the provision set forth in subsection (1) of this section may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums until at least age 50 or, in the case of a policy issued after age 44, for at least five years from its date of issue. [1967 c.359 §432; 2001 c.943 §10; 2003 c.364 §108; 2013 c.681 §13a]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.423 - Notice of claim.

(1) A health insurance policy shall contain a provision as follows: "NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at ___ (insert the location of such office as the insurer may designate for the purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer."
(2) In a policy providing a loss-of-time benefit which may be payable for at least two years, an insurer may at its option insert the following between the first and second sentences of the provision set forth in subsection (1) of this section: "Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, the insured shall, at least once in every six months after having given notice of claim, give to the insurer notice of continuance of such disability, except in the event of legal incapacity. The period of six months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured’s right to any indemnity which would otherwise have accrued during the period of six months preceding the date on which such notice is actually given." [1967 c.359 §433]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.426 - Claim forms.

A health insurance policy shall contain a provision as follows: "CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished within 15 days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made." [1967 c.359 §434]