reglab/statecodes huggingface dataset:
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.005 - Protection of health information report.

(1) As used in this section:
(a) "Covered entity" has the meaning given that term in ORS 192.556 but excludes state agencies.
(b) "Protected health information" has the meaning given that term in ORS 192.556.
(2) A covered entity that is required to file an annual financial statement under ORS 731.574 shall file with the Department of Consumer and Business Services, along with the financial statement, a protection of health information report. The report may be in the form of a letter, must be signed by the chief executive officer of the covered entity and must:
(a) State the responsibility of the covered entity’s management to establish and maintain adequate safeguards and procedures for protecting the confidentiality of personally identifiable and protected health information that the covered entity retains in electronic and hard copy form;
(b) Contain assurances that the signing officer has disclosed to the governing board of the covered entity:
(A) All significant deficiencies in the design or operation of recordkeeping systems or controls that could adversely affect the covered entity’s ability to protect the confidentiality of personally identifiable and protected health information;
(B) Any breaches of the security of personally identifiable and protected health information, whether material or not, that involve management or other employees who have a significant role in the covered entity’s recordkeeping systems or controls; and
(C) All necessary steps that have been taken to address deficiencies in the design or operation of recordkeeping systems or controls and to resolve any material weaknesses identified to or by the covered entity’s auditors; and
(c) Contain assurances that the signing officer has identified for the governing board of the covered entity any material weaknesses in the recordkeeping systems or controls.
(3) The protection of health information report is confidential and not subject to disclosure under ORS 192.311 to 192.478. [2015 c.133 §2]
Note:
743.005 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 743.007 - Data reporting.

(1) A carrier offering a health benefit plan, an insurer offering insurance against the risk of economic loss assumed under a less than fully insured employee health plan described in ORS 742.065 and a third party administrator licensed under ORS 744.702 shall annually submit to the Department of Consumer and Business Services, in a form and manner prescribed by the department, data concerning the number of covered lives of the carrier, insurer or third party administrator, reported by line of business and by zip code.
(2) The department shall aggregate the data collected under subsection (1) of this section and may publish reports on the number of covered lives in Oregon, by line of business and by region. [Formerly 743.818]
Note:
743.007 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 743.008 - Reporting requirements; rules.

The Department of Consumer and Business Services shall develop by rule reporting requirements as necessary for the consistent and efficient implementation of ORS 743B.200, 743B.202, 743B.250 and 743B.423. In order to minimize duplicative reporting requirements, the department shall accept copies of reports prepared for national accreditation organizations as sufficient to meet the reporting requirements developed pursuant to this section to the extent that the reports include the information required by the department pursuant to this section. [Formerly 743.819]
Note:
Definitions for 743.008 may be found in 743B.001.
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.010 - Health insurance policy and health benefit plan forms; expenditures on primary care; rules.

(1) In addition to all other powers of the Director of the Department of Consumer and Business Services with respect thereto, the director may issue rules with respect to policy forms and health benefit plan forms described in ORS 742.005 (6)(a) and (b):
(a) Establishing minimum benefit standards;
(b) Requiring the ratio of benefits to premiums to be not less than a specified percentage in order to be considered reasonable, and requiring the periodic filing of data that will demonstrate the insurer’s compliance;
(c) Establishing requirements intended to discourage duplication or overlapping of coverage and replacement, without regard to the advantage to policyholders, of existing policies by new policies; and
(d) Establishing requirements for carriers offering health benefit plans to spend at least 12 percent of total medical expenditures on payments for primary care.
(2) As used in this section:
(a) "Primary care" means family medicine, general internal medicine, naturopathic medicine, obstetrics and gynecology, pediatrics or general psychiatry.
(b) "Total medical expenditures" means payments to reimburse the cost of physical and mental health care provided to enrollees, excluding prescription drugs, vision care and dental care, whether paid on a fee-for-service basis or as part of a capitated rate or other type of payment mechanism. [1979 c.857 §2; 1997 c.96 §1; 1999 c.987 §4a; 2017 c.489 §§5,15]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.015 - Filing and approval of credit life and credit health insurance forms; filing of rates.

(1) All credit life and credit health insurance policies subject to ORS 743.371 to 743.380, and all certificates of insurance, notices of proposed insurance, applications for insurance, indorsements and riders used in connection with such kinds of policies, delivered or issued for delivery in this state and the schedules of premium rates pertaining thereto shall be filed with the Director of the Department of Consumer and Business Services. Such forms are subject to approval, disapproval or withdrawal of approval by the director as provided in ORS 742.003, 742.005 and 742.007.
(2) An insurer may revise the schedules of premium rates from time to time and shall file the revised schedules with the director. An insurer may not issue any credit life or credit health insurance policy for which the premium rate exceeds that determined by the schedules of the insurer as then on file with the director.
(3) If a group policy of credit life or credit health insurance has been or is delivered in another state, the insurer shall file only the group certificate, the individual application and the notice of proposed insurance delivered or issued for delivery in this state as specified in ORS 743.377 (2) and (4). The director shall approve the group certificate, the individual application and the notice of proposed insurance if the forms conform with the requirements specified in ORS 743.377 (2) and (4) and the schedules of premium rates applicable to the insurance evidenced by the certificate or notice are not in excess of the insurer’s schedules of premium rates filed with the director. [Formerly 739.595; 1969 c.336 §12; 1971 c.231 §20; 2005 c.185 §3]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.020 - Rate filing to include statement of administrative expenses; rules.

An insurer licensed by the Department of Consumer and Business Services shall include in any rate filing under ORS 743.018 with respect to individual and small employer health benefit plans, as defined in ORS 743B.005, a statement of administrative expenses in the form and manner prescribed by the department by rule. The statement must include, but is not limited to:
(1) A statement of administrative expenses on a per member per month basis; and
(2) An explanation of the basis for any proposed premium rate increases or decreases. [2009 c.595 §29; 2019 c.441 §3]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.022 - Premium rates for individual health benefit plans.

Premium rates for individual health benefit plans shall be subject to the following provisions:
(1) Each carrier must file the carrier’s initial geographic average rate and any changes to the geographic average rate for its individual health benefit plans with the Director of the Department of Consumer and Business Services.
(2) The premium rates charged during a rating period for individual health benefit plans issued to individuals shall not vary from the individual geographic average rate, except that the premium rate may be adjusted to reflect differences in benefit design, age, tobacco use and family composition. For age adjustments to the individual plans, a carrier shall apply uniformly its schedule of age adjustments for individual health benefit plans as approved by the director.
(3) A carrier may not increase the rates of an individual health benefit plan more than once in a 12-month period except as approved by the director. Annual rate increases shall be effective on the anniversary date of the individual health benefit plan’s issuance. The percentage increase in the premium rate charged for an individual health benefit plan for a new rating period may not exceed the sum of the following:
(a) The percentage change in the carrier’s geographic average rate for its individual health benefit plan measured from the first day of the prior rating period to the first day of the new period; and
(b) Any adjustment attributable to differences in benefit design, age, tobacco use and family composition.
(4) A carrier offering an individual health benefit plan in this state shall include:
(a) In one risk pool, all of the insureds residing in this state who are covered in the carrier’s individual health benefit plans that are not grandfathered health plans or student health plans; and
(b) In a separate risk pool, all of the insureds residing in this state who are covered in the carrier’s individual grandfathered health plans. [Formerly 743.767]
Note:
Definitions for 743.022 may be found in 743B.005.
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.025 - Annual report of information related to prescription drugs covered by health benefit plans; reports to Legislative Assembly.

(1) As used in this section, "health benefit plan" has the meaning given that term in ORS 743B.005.
(2) An insurer shall annually report the following information to the Department of Consumer and Business Services, in the form and manner prescribed by the department, regarding drugs reimbursed by the insurer under health benefit plans issued by the insurer in this state:
(a) The 25 most frequently prescribed drugs;
(b) The 25 most costly drugs as a portion of total annual spending;
(c) The 25 drugs that have caused the greatest increase in total plan spending from one year to the next; and
(d) The impact of the costs of prescription drugs on premium rates.
(3) The department shall conduct a public hearing annually on prescription drug prices, information reported to the department under ORS 646A.689 and information described in subsection (2) of this section.
(4) The department shall regularly update the interim committees of the Legislative Assembly related to health on the information described in subsection (2) of this section.
(5) Subsection (2) of this section applies to an insurer that issues health benefit plans for sale in this state that include a prescription drug benefit. [2018 c.7 §5; 2023 c.466 §10]
Note:
743.025 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 743.027

[1967 c.359 §342a; 1991 c.182 §2; 2009 c.331 §1; 2015 c.629 §60; renumbered 743.038 in 2015]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.028 - Uniform health insurance claim forms.

The Director of the Department of Consumer and Business Services shall prescribe uniform health insurance claim forms which shall be used by all insurers transacting health insurance in this state and by all state agencies that require health insurance claim forms for their records. [1973 c.109 §2]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.029 - Uniform standards for health care financial and administrative transactions; rules.

(1) The Department of Consumer and Business Services may adopt by rule uniform standards applicable to persons listed in subsection (2) of this section for health care financial and administrative transactions, including uniform standards for:
(a) Eligibility inquiry and response;
(b) Claim submission;
(c) Payment remittance advice;
(d) Claims payment or electronic funds transfer;
(e) Claims status inquiry and response;
(f) Claims attachments;
(g) Prior authorization;
(h) Provider credentialing; or
(i) Health care financial and administrative transactions identified by the stakeholder work group described in ORS 743.031.
(2) Any uniform standards adopted under subsection (1) of this section apply to:
(a) Health insurers.
(b) Prepaid managed care health services organizations as defined in ORS 414.025.
(c) Coordinated care organizations as defined in ORS 414.025.
(d) Third party administrators.
(e) Any person or public body that either individually or jointly establishes a self-insurance plan, program or contract, including but not limited to persons and public bodies that are otherwise exempt from the Insurance Code under ORS 731.036.
(f) Health care clearinghouses or other entities that process or facilitate the processing of health care financial and administrative transactions from a nonstandard format to a standard format.
(g) Any other person identified by the department that processes health care financial and administrative transactions between a health care provider and an entity described in this subsection.
(3) In developing or updating any uniform standards adopted under subsection (1) of this section, the department shall consider recommendations from the Oregon Health Authority under ORS 743.031. [Formerly 743.061]
Note:
743.029 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 743.031 - Stakeholder work group to recommend uniform standards.

(1) The Oregon Health Authority shall convene a stakeholder work group to recommend uniform standards for health care financial and administrative transactions, including, to the extent allowed by law, standards applicable to commercial health insurance plans, self-funded plans and state governmental health plans and programs.
(2) The authority shall report uniform standards recommended under subsection (1) of this section to the Department of Consumer and Business Services for consideration in the adoption of uniform standards by the department under ORS 743.029.
(3) The stakeholder work group, in recommending uniform standards under subsection (1) of this section, shall consider or incorporate any applicable national standards for administrative simplification and timelines for implementation of national standards for administrative simplification that are established pursuant to federal law. [Formerly 743.062]
Note:
743.031 and 743.034 were enacted into law by the Legislative Assembly but were 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 743.034 - Coordination with Oregon Health Authority concerning uniform standards; Department of Human Services to be subject to standards.

(1) The Department of Consumer and Business Services and the Oregon Health Authority shall confer before the department finalizes rules implementing uniform standards under ORS 743.029, for the purpose of reconciling any differences between the department’s and the authority’s requirements for health care financial and administrative transactions described in ORS 743.029. If the Department of Consumer and Business Services proposes to amend any rule concerning uniform standards for health care financial and administrative transactions under ORS 743.029 or the authority proposes to amend any rule in a manner that would be inconsistent with the uniform standards, the agency proposing to amend the rules shall notify the other agency. The agencies shall confer before a final rule is adopted to ensure that the standards remain uniform and consistent to the extent practicable.
(2) The Department of Human Services shall be subject to the uniform standards adopted by the Department of Consumer and Business Services and the authority under ORS 743.029 that are applicable to the operations of the Department of Human Services. [Formerly 743.064]
Note:
See note under 743.031.
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.035 - Uniform prior authorization form for prescription drug benefits; consultation with Oregon Health Authority; rules.

(1) The Department of Consumer and Business Services, in consultation with the Oregon Health Authority, shall develop by rule a form that providers in this state shall use to request prior authorization for prescription drug benefits. The form must:
(a) Be uniform for all providers;
(b) Not exceed two pages;
(c) Be electronically available and transmissible; and
(d) Include a provision under which additional information may be requested and provided.
(2) If a person described in ORS 743.029 (2) requires prior authorization for prescription drug benefits, the person must allow the use of the form developed under subsection (1) of this section.
(3) The department may adopt rules to implement this section. [Formerly 743.065; 2021 c.154 §9]
Note:
743.035 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 743.038 - Consent of individual required for life and health insurance; exceptions.

A life or health insurance policy upon an individual, except a policy of group life insurance or of group or blanket health insurance, may not be made or effectuated unless at the time of the making of the policy the individual insured, being of competent legal capacity to contract, applies therefor or has consented thereto in writing, except in the following cases:
(1) A spouse may effectuate such insurance upon the other spouse.
(2) Any person having an insurable interest in the life of a minor, or any person upon whom a minor is dependent for support and maintenance, may effectuate insurance upon the life of or pertaining to such minor.
(3) Family policies may be issued insuring any two or more members of a family on an application signed by either parent, a stepparent or a spouse in a marriage.
(4) A person may effectuate insurance that provides for the funeral expenses of an adult who is dependent upon the person for support and maintenance.
(5) A person may effectuate insurance that provides for the funeral expenses of an adult if the person:
(a) Is closely related to the adult by blood or by law or has a substantial interest in the adult engendered by love and affection; and
(b) Has a lawful and substantial interest in having the life, health and bodily safety of the adult continue. [Formerly 743.027]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.039 - Alteration of application for life or health insurance.

(1) An application for a life insurance policy may not provide for alterations by any person other than the applicant in either the application or the policy to be issued thereon with respect to the amount of insurance, classification of risk, plan of insurance or the benefits unless the application contains a statement that no such changes are effective until approved in writing by the applicant.
(2) No alteration of any written application for any health insurance policy shall be made by any person other than the applicant without the written consent of the applicant, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant. [1967 c.359 §346]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.040 - Personal insurance, insurable interest and beneficiaries.

(1) Any individual of competent legal capacity may procure or effect an insurance policy on the individual’s own life or body for the benefit of any person. However, except as provided in ORS 743.044, no person shall procure or cause to be procured any insurance policy upon the life or body of another unless the benefits under such policy are payable to the individual insured or the personal representatives of the individual, or to a person having, at the time such policy was entered into, an insurable interest in the individual insured.
(2) If the beneficiary, assignee or other payee under any policy made in violation of this section receives from the insurer any benefits thereunder accruing upon the death, disablement or injury of the individual insured, the individual insured or the individual’s executor or administrator, as the case may be, may maintain an action to recover such benefits from the person so receiving them.
(3) An insurer shall be entitled to rely upon all statements, declarations and representations made by an applicant for insurance relative to the matter of insurable interest. No insurer shall incur legal liability, except as set forth in the policy, by virtue of any untrue statements, declarations or representations so relied upon in good faith by the insurer.
(4) This section does not apply to annuity policies. [Formerly 743.024]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.041 - Payment discharges insurer.

Whenever the proceeds of or payments under a life or health insurance policy become payable in accordance with the terms of such policy, or the exercise of any right or privilege under such policy, and the insurer makes payment in accordance with the terms of the policy or in accordance with any written assignment of the policy, the person so designated as being entitled to the proceeds or payments shall be entitled to receive them and to give full acquittance therefor, and such payments shall fully discharge the insurer from all claims under the policy unless, before payment is made, the insurer has received at its home office written notice by or on behalf of some other person that such other person claims to be entitled to such proceeds or payments or some interest in the policy. [Formerly 743.084]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.043 - Assignment of policies.

A policy may be assignable or not assignable, as provided by its terms. Subject to its terms relating to assignability, any life or health insurance policy, under the terms of which the beneficiary may be changed upon the sole request of the insured or owner, may be assigned either by pledge or transfer of title, by an assignment executed by the insured or owner alone and delivered to the insurer, whether or not the pledgee or assignee is the insurer. Any such assignment shall entitle the insurer to deal with the assignee as the owner or pledgee of the policy in accordance with the terms of the assignment, until the insurer has received at its home office written notice of termination of the assignment or pledge, or written notice by or on behalf of some other person claiming some interest in the policy in conflict with the assignment. [Formerly 743.087]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.044 - Life insurance for benefit of charity.

(1) Life insurance policies may be effected although the person paying the consideration has no insurable interest in the life of the person insured if a charitable, benevolent, educational or religious institution is designated irrevocably as the beneficiary.
(2) In making such policies the person paying the premium shall make and sign the application therefor as owner. The application also must be signed by the person whose life is to be insured. Such a policy shall be valid and binding between and among all of the parties thereto.
(3) The person paying the consideration for such insurance shall have all rights conferred by the policy to loan value at any time during the premium-paying period, but not at maturity, notwithstanding such person has no insurable interest in the life of the person insured. [Formerly 743.030]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.046 - Exemption of proceeds of individual life insurance other than annuities.

(1) When a policy of insurance is effected by any person on any person’s own life or on another life in favor of some person other than that person having an insurable interest in the life insured, the lawful beneficiary thereof, other than that person or that person’s legal representative, is entitled to its proceeds against the creditors or representatives of the person effecting the policy.
(2) The person to whom a policy of life insurance is made payable may maintain an action thereon in the person’s own name.
(3) A policy of life insurance payable to a beneficiary other than the estate of the insured, having by its terms a cash surrender value available to the insured, is exempt from execution issued from any court in this state and in the event of bankruptcy of such insured is exempt from all demands in legal proceeding under such bankruptcy.
(4) Subject to the statute of limitations, the amount of any premiums paid in fraud of creditors for such insurance, with interest thereon, shall inure to their benefit from the proceeds of the policy. The insurer issuing the policy shall be discharged of all liability thereon by payment of its proceeds in accordance with its terms unless, before such payment, the insurer has received at its home office written notice by or in behalf of some creditor, with specifications of the amount claimed, claiming to recover for certain premiums paid in fraud of creditors.
(5) The insured under any policy within this section shall not be denied the right to change the beneficiary when such right is expressly reserved in the policy.
(6) This section does not apply to annuity policies. [Formerly 739.405 and then 743.099]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.047 - Exemption of proceeds of group life insurance.

(1) A policy of group life insurance or the proceeds thereof payable to a person or persons other than the individual insured or the individual’s estate shall be exempt from debts and claims of creditors or representatives of the individual insured and, in the event of bankruptcy of the individual insured, from all demands in legal proceedings under such bankruptcy.
(2) The provisions of subsection (1) of this section do not apply to group life insurance issued to a creditor covering the creditor’s debtors to the extent that such proceeds are applied to payment of the obligation for the purpose of which the insurance was so issued. [Formerly 743.102]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.049 - Exemption of proceeds of annuity policies; assignability of rights.

(1) The benefits, rights, privileges and options which are due or prospectively due an annuitant under any annuity policy issued before, on or after June 8, 1967, shall not be subject to execution, nor shall the annuitant be compelled to exercise any such rights, powers or options, nor shall creditors be allowed to interfere with or terminate the policy, except:
(a) As to amounts paid for or as premium on any such annuity with intent to defraud creditors, with interest thereon, and of which the creditor has given the insurer written notice at its home office prior to the making of the payments to the annuitant out of which the creditor seeks to recover. Any such notice shall specify the amount claimed or such facts as will enable the insurer to ascertain such amount, and shall set forth such facts as will enable the insurer to ascertain the annuity policy, the annuitant and the payments sought to be avoided on the ground of fraud.
(b) The total exemption of benefits presently due and payable to any annuitant periodically or at stated times under all annuity policies under which the person is an annuitant shall not at any time exceed $500 per month for the length of time represented by such installments. Such periodic payments in excess of $500 per month shall be subject to garnishee execution to the same extent as are wages and salaries.
(c) If the total benefits presently due and payable to any annuitant under all annuity policies under which the person is an annuitant shall at any time exceed payment at the rate of $500 per month, the court may order such annuitant to pay to a judgment creditor or apply on the judgment, in installments, the portion of such excess benefits as to the court may appear just and proper, after due regard for the reasonable requirements of the judgment debtor and family, if dependent upon the judgment debtor, as well as any payments required to be made by the annuitant to other creditors under prior court orders.
(2) If the policy so provides, the benefits, rights, privileges or options accruing under the policy to a beneficiary or assignee shall not be transferable nor subject to commutation, and if the benefits are payable periodically or at stated times, the same exemptions and exceptions contained in this section for the annuitant shall apply with respect to such beneficiary or assignee. [Formerly 743.105; 1991 c.182 §3]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.050 - Exemption of proceeds of health insurance.

Except as may otherwise be expressly provided by the policy, the proceeds or avails of all health insurance policies and of provisions providing benefits on account of the insured’s disability which are supplemental to life insurance policies, issued before, on or after June 8, 1967, shall be exempt from all liability for any debt of the insured, and from any debt of the beneficiary existing at the time the proceeds are made available for the use of the beneficiary. [Formerly 743.108]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.053 - Prohibition on requirement that death or dismemberment occur in less than 180 days after accident.

A life insurance policy or health insurance policy, whether group or individual, that contains provisions providing benefits in case of death or dismemberment by accident shall not require that the death or dismemberment occur less than 180 days after the date of the accident in order for benefits to be paid under the policy. [1991 c.182 §8]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.101 - Purpose.

(1) The purpose of the Life and Health Insurance Policy Language Simplification Act is to establish minimum standards for language used in policies and certificates of life insurance and health insurance delivered or issued for delivery in this state in order to facilitate ease of reading.
(2) ORS 743.100 to 743.109 is not intended to increase the risk assumed by insurers or to supersede their obligation to comply with the substance of other Insurance Code provisions applicable to insurance policies. ORS 743.100 to 743.109 is not intended to impede flexibility and innovation in the development of policy forms or content or to lead to the standardization of policy forms or content. [Formerly 743.353]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.103 - Definitions for ORS 743.100 to 743.109.

As used in ORS 743.100 to 743.109, "policy" has the meaning given in ORS 731.122 and, in addition, includes a certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state. [Formerly 743.357]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.104 - Scope of ORS 743.100 to 743.109.

(1) ORS 743.100 to 743.109 apply to all policies delivered or issued for delivery in this state, except:
(a) Any policy that is a security subject to federal jurisdiction.
(b) Any group policy covering a group of 1,000 or more lives at date of issue, other than a group credit life insurance policy or a group credit health insurance policy. However, this paragraph shall not exempt any certificate issued pursuant to a group policy.
(c) Any group annuity contract that serves as a funding vehicle for a pension, profit-sharing or deferred compensation plan.
(d) Any form used in connection with, as a conversion from, as an addition to, or, pursuant to a contractual provision, in exchange for, a policy delivered or issued for delivery on a form approved or permitted to be issued prior to the date the form must be approved under section 9, chapter 708, Oregon Laws 1979.
(e) The renewal of a policy delivered or issued for delivery prior to the date the policy form must be approved under section 9, chapter 708, Oregon Laws 1979.
(f) Any certificate issued pursuant to a group policy not delivered or issued for delivery in this state.
(2) A non-English language policy will be deemed to comply with ORS 743.106 if the insurer certifies that the policy is translated from an English language policy that complies with ORS 743.106. [Formerly 743.362]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.107 - When director may authorize lower standards.

The Director of the Department of Consumer and Business Services may authorize a lower score than the Flesch reading ease test score required by ORS 743.106 when, in the director’s sole discretion, the director finds that a lower required score:
(1) Will provide a more accurate reflection of the readability of a policy form;
(2) Is warranted by the nature of a particular policy form or type or class of policy forms; or
(3) Is caused by certain policy language drafted to conform to the requirements of any state law, regulation or agency interpretation. [Formerly 743.368]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.109 - Approval of certain policy forms containing specified provisions; conditions for approval.

A policy form meeting the requirements of ORS 743.106 shall not be disapproved because of other provisions of the Insurance Code that specify the content of policies, if the policy form provides the policyholders and claimants protection not less favorable than they would be entitled to under such provisions. [Formerly 743.370]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.150 - Scope of ORS 743.150, 743.153 and 743.156.

This section and ORS 743.153 and 743.156 apply only to policies of life insurance, other than group life insurance. [1967 c.359 §372]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.154 - Acceleration of death benefits; rules.

(1) A life insurance policy or a rider to a life insurance policy may provide for the acceleration of death benefits as part of the life insurance coverage. For purposes of this section, accelerated death benefits are benefits that:
(a) Are payable to the policy owner or certificate holder during the lifetime of the insured, in anticipation of death or upon the occurrence of specified life-threatening or catastrophic conditions as defined by the policy or rider;
(b) Reduce the death benefit otherwise payable under the life insurance policy; and
(c) Are payable upon the occurrence of a single qualifying event that results in the payment of a benefit amount fixed at the time of acceleration.
(2) For purposes of this section, a qualifying event is one or more of the following:
(a) A medical condition that will result in a drastically limited life span, as specified in the policy or rider, not exceeding 24 months.
(b) A medical condition that has required or requires extraordinary medical intervention, such as a major organ transplant or continuous artificial life support, without which the insured would die.
(c) Any condition that usually requires continuous confinement in an eligible institution, as defined in the policy or rider, if the insured is expected to remain there for the rest of the insured’s life.
(d) A medical condition that in the absence of extensive or extraordinary medical treatment will result in a drastically limited life span. Such conditions may include but are not limited to one or more of the following:
(A) Coronary artery disease resulting in an acute infarction or requiring surgery;
(B) Permanent neurological deficit resulting from cerebral vascular accident;
(C) End-stage renal failure; or
(D) Human immunodeficiency virus or acquired immune deficiency syndrome.
(e) Any other event determined by the Director of the Department of Consumer and Business Services to be life-threatening.
(3) A policy or rider that provides for the acceleration of death benefits:
(a) Must also provide for the continuation of the policy as to the amount of the death benefit that is not accelerated.
(b) Must allow the policy owner or the certificate holder to request payment at any time during the period that the qualifying event continues.
(4) A policy or rider that provides for the acceleration of death benefits under this section shall not be described or marketed by an insurer as long term care insurance or as providing long term care benefits.
(5) The director shall adopt rules establishing minimum benefits, criteria for the payment of accelerated benefits, disclosure requirements and actuarial standards. [1991 c.571 §2; 1993 c.17 §1; 2019 c.280 §15]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.156 - Statement of premium.

A life insurance policy shall contain a provision separately stating the premium for each benefit provision of the policy for which such separate statement is necessary, as determined by the Director of the Department of Consumer and Business Services, to give adequate disclosure of the terms of the policy. [1967 c.359 §374]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.159 - Scope of ORS 743.162 to 743.243.

ORS 743.162 to 743.243 apply only to policies of life insurance other than group life insurance, and do not apply to annuity or pure endowment policies. Such sections apply to such policies that are policies of variable life insurance, except to the extent the provisions of such sections are obviously inapplicable to variable life insurance or are in conflict with other provisions of such sections that are expressly applicable to variable life insurance. [1967 c.359 §375; 1973 c.435 §16]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.165 - Grace period.

A life insurance policy shall contain a provision that a grace period of 30 days, or, at the option of the insurer, of one month of not less than 30 days, or of four weeks in the case of industrial life insurance policies the premiums for which are payable more frequently than monthly, shall be allowed within which the payment of any premium after the first may be made, during which period of grace the policy shall continue in full force. The insurer may impose an interest charge not in excess of six percent per annum for the number of days of grace elapsing before the payment of the premium. If a claim arises under the policy during such period of grace the amount of any premium due or overdue, together with interest and any deferred installment of the annual premium, may be deducted from the policy proceeds. [1967 c.359 §377]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.168 - Incontestability.

(1) A life insurance policy shall contain a provision that the policy shall be incontestable after it has been in force for two years from its date of issue during the lifetime of the insured, except for nonpayment of premiums. At the option of the insurer the two-year limit within which the policy may be contested shall not apply to the provisions for benefits in the event of total and permanent disability and provisions which grant additional insurance specifically against death by accident.
(2) A provision in a life insurance policy providing that such policy shall be incontestable after a specified period shall preclude only a contest of the validity of the policy, and shall not preclude the assertion at any time of defenses based upon provisions in the policy which exclude or restrict coverage, whether or not such restrictions or exclusions are excepted in such provision. [1967 c.359 §378]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.171 - Incontestability and limitation of liability after reinstatement.

(1) A reinstated policy of life insurance may be contested on account of fraud or misrepresentation of facts material to the reinstatement only for the same period following reinstatement, and with the same conditions and exceptions, as the policy provides with respect to contestability after original issuance.
(2) When any policy of life insurance is reinstated, such reinstated policy may exclude or restrict liability to the same extent that such liability could have been or was excluded or restricted when the policy was originally issued, and such exclusion or restriction shall be effective from the date of reinstatement. [1967 c.359 §379]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.177 - Statements of insured.

A life insurance policy shall contain a provision that all statements made by or on behalf of the insured shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense of a claim under the policy unless contained in a written application and unless a copy of such application is indorsed upon or attached to the policy when issued. [1967 c.359 §381]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.180 - Misstatement of age.

A life insurance policy shall contain a provision that if it is found at any time before final settlement under the policy that the age of the insured or of any other person whose age is considered in determining the premium or benefit accruing under the policy has been misstated, the amount payable or benefit accruing under the policy shall be such as the premium would have purchased at the correct age or ages, or the premium may be adjusted and credit given to the insured or to the insurer, according to the insurer’s published rate at date of issue. [1967 c.359 §382]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.183 - Dividends.

(1) A life insurance policy other than a nonparticipating policy shall contain a provision that the policy shall participate in the divisible surplus of the insurer annually, beginning not later than the end of the third policy year. Any policy containing provision for participation beginning at the end of the first or the second policy year may provide that dividends for either or both of such years shall be paid subject to the payment of the premium for the next ensuing year. The owner of the policy shall have the right each year to have the dividend arising from such participation paid in cash, and if the policy provides other dividend options, it shall further provide which dividend option is effective if the owner does not elect one of such options on or before the expiration of the period of grace allowed for the payment of the premium.
(2) In participating industrial life insurance policies, in lieu of the provision required in subsection (1) of this section, there shall be a provision that, beginning not later than the end of the fifth policy year, the policy shall participate annually in the divisible surplus in the manner set forth in the policy.
(3) This section does not apply to any form of paid-up insurance or temporary insurance or endowment insurance issued or granted in exchange for lapsed or surrendered policies. [1967 c.359 §383]