reglab/statecodes huggingface dataset:
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.429 - Proofs of loss.

A health insurance policy shall contain a provision as follows: "PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within 90 days after the termination of the period for which the insurer is liable and in case of claim for any other loss within 90 days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate or reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required." [1967 c.359 §435]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.432 - Time of payment of claims.

A health insurance policy shall contain a provision as follows: "TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid ______ (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof." [1967 c.359 §436]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.435 - Payment of claims.

(1) A health insurance policy shall contain a provision as follows: "PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured’s death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured."
(2) The following provisions, or either of them, may be included with the provision set forth in subsection (1) of this section at the option of the insurer:
(a) "If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to give a valid release, the insurer may pay such indemnity, up to an amount not exceeding $___ (insert an amount which shall not exceed $1,000), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of such payment."
(b) "Subject to any written direction of the insured in the application or otherwise all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical or surgical services may, at the insurer’s option and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person." [1967 c.359 §437]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.438 - Physical examinations and autopsy.

A health insurance policy shall contain a provision as follows: "PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law." [1967 c.359 §438]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.441 - Legal actions.

A health insurance policy shall contain a provision as follows: "LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the time written proof of loss is required to be furnished." [1967 c.359 §439]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.444 - Change of beneficiary.

(1) A health insurance policy shall contain a provision as follows: "CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries or to any other changes in this policy."
(2) The first clause of the provision set forth in subsection (1) of this section, relating to the irrevocable designation of beneficiary, may be omitted at the insurer’s option. [1967 c.359 §440]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.447 - Optional provisions.

Except as provided in ORS 742.021, provisions in a health insurance policy respecting the matters set forth in ORS 743.450 to 743.477 shall be in the words that appear in such sections. Any such provision contained in the policy shall be preceded individually by the appropriate caption appearing in such sections or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the Director of the Department of Consumer and Business Services may approve. [1967 c.359 §441; 2011 c.9 §93]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.450 - Change of occupation.

A health insurance policy may contain a provision as follows: "CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having changed occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurer for such more hazardous occupation. If the insured changes occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess pro rata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer prior to the occurrence of the loss for which the insurer is liable or prior to date of proof of change in occupation with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation." [1967 c.359 §442]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.453 - Misstatement of age.

A health insurance policy may contain a provision as follows: "MISSTATEMENT OF AGE: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age." [1967 c.359 §443]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.456 - Other insurance in same insurer.

(1) A health insurance policy may contain a provision as follows: "OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for _____ (insert type of coverage or coverages) in excess of $___ (insert maximum limit of indemnity or indemnities), the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to the estate of the insured."
(2) In lieu of the provisions set forth in subsection (1) of this section, the policy may contain a provision as follows: "OTHER INSURANCE IN THIS INSURER: Insurance effective at any one time on the insured under a like policy or policies in this company is limited to the one such policy elected by the insured, the beneficiary or the estate of the insured, as the case may be, and the insurer will return all premiums paid for all other such policies." [1967 c.359 §444]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.459 - Insurance with other insurers; expense incurred benefits.

(1) A health insurance policy may contain a provision as follows: "INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the ‘like amount’ of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage."
(2) If the policy provision set forth in subsection (1) of this section is included in a policy which also contains the policy provision set forth in ORS 743.462, there shall be added to the caption of the provision set forth in subsection (1) of this section the phrase "EXPENSE INCURRED BENE- FITS." The insurer may, at its option, include in this provision a definition of "other valid coverage," approved as to form by the Director of the Department of Consumer and Business Services, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the director. In the absence of such definition such term shall not include group insurance, automobile medical payments insurance or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying the policy provision set forth in this section with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workers’ compensation or employer’s liability statute), whether provided by a governmental agency or otherwise, shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying the policy provision set forth in this section no third party liability coverage shall be included as "other valid coverage." [1967 c.359 §445]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.462 - Insurance with other insurers; other than expense incurred benefits.

(1) A health insurance policy may contain a provision as follows: "INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurer had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined."
(2) If the policy provision set forth in subsection (1) of this section is included in a policy which also contains the policy provision set forth in ORS 743.459, there shall be added to the caption of the provision set forth in subsection (1) of this section the phrase "OTHER BENEFITS." The insurer may, at its option, include in this provision a definition of "other valid coverage," approved as to form by the Director of the Department of Consumer and Business Services, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and to any other coverage the inclusion of which may be approved by the director. In the absence of such definition such term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the policy provision set forth in this section with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workers’ compensation or employer’s liability statute), whether provided by a governmental agency or otherwise, shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying the policy provision set forth in this section no third party liability coverage shall be included as "other valid coverage." [1967 c.359 §446]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.465 - Relation of earnings to insurance.

(1) A health insurance policy may contain a provision as follows: "RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or the average monthly earnings of the insured for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of $200 or the sum of the monthly benefits specified in such coverages, whichever is the lesser, nor shall it operate to reduce benefits other than those payable for loss of time."
(2) The policy provision set forth in subsection (1) of this section may be inserted only in a 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. The insurer may, at its option, include in this provision a definition of "valid loss of time coverage," approved as to form by the Director of the Department of Consumer and Business Services, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the director or any combination of such coverages. In the absence of such definition such term shall not include any coverage provided for such insured pursuant to any compulsory benefit statute (including any workers’ compensation or employer’s liability statute), or benefits provided by union welfare plans or by employer or employee benefit organizations. [1967 c.359 §447]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.468 - Unpaid premium.

A health insurance policy may contain a provision as follows: "UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom." [1967 c.359 §448]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.471 - Cancellation.

A health insurance policy may contain a provision as follows: "CANCELLATION: The insurer may cancel this policy by written notice delivered to the insured, or mailed to the last address of the insured as shown by the records of the insurer. The notice must state the reason for cancellation and the date on which the cancellation shall be effective. Except as provided under the ‘GRACE PERIOD’ provision of this policy for nonpayment of premium, cancellation shall not become effective earlier than the 30th day after the date of the notice. After the policy has been continued beyond its original term, the insured may cancel this policy at any time by written notice delivered or mailed to the insurer, effective upon receipt or on such later date as may be specified in such notice. In the event of cancellation, the insurer will return promptly the unearned portion of any premium paid. If the insured cancels, the earned premium shall be computed by the use of the short rate table last filed with the state official having supervision of insurance in the state where the insured resided when the policy was issued. If the insurer cancels, the earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation." [1967 c.359 §449; 1989 c.784 §20]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.472 - Permissible reasons for cancellation or refusal to renew.

An insurer selling individual health insurance policies may cancel or refuse to renew an individual health insurance policy only if the insurer makes a determination to cancel or not to renew all policies of the same type and form as the individual policy, or if the ground for cancellation or nonrenewal is any of the following and is stated as a provision of the policy:
(1) A fraudulent or material misstatement made by the applicant in an application for the health policy. A material misstatement is subject to any time limit, as specified by law and included in the policy, for voiding the policy on the basis of a misstatement. For purposes of this subsection, a misstatement may include an incorrect statement or a misrepresentation, omission or concealment of fact;
(2) Excess or other insurance in the same insurer, as described in ORS 743.456;
(3) Nonpayment of premium; or
(4) Any other reason specified by the Director of the Department of Consumer and Business Services by rule. [1989 c.784 §18; 1991 c.182 §5]
Note:
743.472 was added to and made a part of 743.405 to 743.498 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 743.474 - Conformity with state statutes.

A health insurance policy may contain a provision as follows: "CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date hereby is amended to conform to the minimum requirements of such statutes." [1967 c.359 §450]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.477 - Illegal occupation.

A health insurance policy may contain a provision as follows: "ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the insured’s commission of or attempt to commit a felony or to which a contributing cause was the insured’s being engaged in an illegal occupation." [1967 c.359 §451]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.483 - Arrangement of provisions.

The provisions of a health insurance policy that are the subject of ORS 743.408 to 743.477, or any corresponding provisions that are used in lieu thereof in accordance with the Insurance Code, shall be printed in the consecutive order of such sections or, at the option of the insurer, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse or likely to mislead a person to whom the policy is offered, delivered or issued. [1967 c.359 §453; 2009 c.11 §95; 2011 c.9 §94]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.486 - Scope of term "insured" in statutory policy provisions.

As used in ORS 743.402 to 743.498, the word "insured" shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein. [1967 c.359 §454; 2011 c.9 §95]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.489 - Extension of coverage beyond policy period; effect of misstatement of age.

If any health insurance policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy shall continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy. [Formerly 741.170]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.492 - Policy return and premium refund provision.

Every health insurance policy except single premium nonrenewable policies shall have printed on its face or attached thereto a notice stating in substance that the person to whom the policy is issued shall be permitted to return the policy within 10 days of its delivery to the purchaser and to have the premium paid refunded if, after examination of the policy, the purchaser is not satisfied with it for any reason. If a policyholder or purchaser pursuant to such notice returns the policy to the insurer at its home or branch office or to the insurance producer through whom it was purchased, it shall be void from the beginning and the parties shall be in the same position as if no policy had been issued. [Formerly 741.180; 2003 c.364 §109]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.495 - Use of terms "noncancelable" or "guaranteed renewable"; synonymous terms.

(1) No health insurance policy shall contain the following unqualified terms except as provided in this subsection:
(a) The unqualified terms "noncancelable" or "noncancelable and guaranteed renewable" may be used only in a policy which the insured has the right to continue in force for life by the timely payment of premiums set forth in the policy, during which period the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force.
(b) The unqualified term "guaranteed renewable," except as provided in paragraph (a) of this subsection, may be used only in a policy which the insured has the right to continue in force for life by the timely payment of premiums, during which period the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force, except that the insurer may make changes in premium rates by classes.
(2) The limitations prescribed in subsection (1) of this section on the use of the term "noncancelable" shall also apply to any synonymous term such as "not cancelable" and such limitations on the use of the term "guaranteed renewable" shall also apply to any synonymous term such as "guaranteed continuable." [Formerly 741.190]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.498 - Statement in policy of cancelability or renewability.

(1) A health insurance policy which is noncancelable or guaranteed renewable as those terms are used in ORS 743.495, except that the insured’s right is for a limited period of more than one year rather than for life, shall contain the applicable one of the following statements, or such other statement which, in the opinion of the Director of the Department of Consumer and Business Services, is equally clear or more definite as to the subject matter:
(a) "THIS POLICY IS NONCANCELABLE ______" (designating the applicable period such as, for example, "to age ___ (specify)," or "for the period of ___ (specify) years from date of issuance") if the policy is noncancelable for such period.
(b) "THIS POLICY IS GUARANTEED RENEWABLE ______" (designating the applicable period such as, for example, "to age ___ (specify)," or "for the period of ___ (specify) years from date of issuance") if the policy is guaranteed renewable for such period.
(2) Except for policies meeting the conditions specified in ORS 743.495 or subsection (1) of this section, and except as provided in subsection (3) of this section, a health insurance policy shall contain the applicable one of the following statements, or such other statement which, in the opinion of the director, is equally clear or more definite as to the subject matter:
(a) "THIS POLICY MAY BE CANCELED BY THE INSURER ONLY FOR A REASON PERMITTED BY LAW" if the policy contains a provision for cancellation by the insurer.
(b) "THE INSURER MAY REFUSE TO RENEW THIS POLICY ONLY FOR A REASON PERMITTED BY LAW" if the policy is not guaranteed renewable.
(3) The limitations and requirements as to the use of terms contained in ORS 743.495 and this section shall not prohibit the use of other terms for policies having other guarantees of renewability, provided such terms, in the opinion of the director are accurate, clear and not likely to be confused with the terms contained in ORS 743.495 and this section, and are incorporated in a concise statement relating to the guarantees of renewability.
(4) The statement required by this section shall be printed in a type not smaller than the type used for captions. It shall appear prominently on the first page of the policy and shall be a part of the brief description if the policy has a brief description on its first page. [Formerly 741.200; 1989 c.784 §20a]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.521 - Leased workers; offering group health insurance.

(1) A leasing company may offer group health insurance to its leased workers. If the leasing company does not offer group health insurance to its leased workers, the client employer may offer group health insurance to the leased workers.
(2) If a leasing company offers group health insurance to its leased workers, the leasing company shall offer group health insurance to all its leased workers in the same manner. [Formerly 743.533]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.522 - Additional groups designated by director.

(1) As used in this section and ORS 743.521:
(a) "Client employer" means an employer to whom workers are provided under contract and for a fee on a leased basis by a worker leasing company licensed under ORS 656.850.
(b) "Employee" may include a retired employee.
(c) "Leased worker" means a worker provided by a worker leasing company licensed under ORS 656.850.
(2) Group health insurance may be offered to a resident of this state under a group health insurance policy issued to a group other than one of the groups described in ORS 731.098 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; and
(b) The premium for the policy is paid either from funds of a policyholder, from funds contributed by a covered person or from both. [1967 c.359 §461; 1975 c.229 §1; 1989 c.784 §13; 2001 c.943 §4; 2005 c.22 §492; 2013 c.681 §14]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.523 - Certain sales practices prohibited.

(1) No person selling group health insurance is authorized to sell membership in an association, including a labor union, for the purpose of qualifying an applicant who is an individual for group health insurance.
(2) No person selling membership in an association, including a labor union, is authorized to offer group health insurance for the purpose of selling membership in the association. [1989 c.784 §10]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.524 - Eligibility of association to be group health policyholder; rules.

(1) An insurer may not offer a policy of group health insurance to an association as the policyholder or offer coverage under such a policy, whether issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the association satisfies the requirements of an association under ORS 731.098 (2).
(2) An insurer shall submit evidence to the director that the association satisfies the requirements under ORS 731.098 (2). 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 health insurance to an association if the director determines that the association does not meet the standards under ORS 731.098 (2).
(5) The director may adopt rules to carry out this section. [1989 c.784 §11; 2005 c.22 §493; 2013 c.681 §14a]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.526 - Determination of whether trustees are policyholders; consequences; rules.

(1) An insurer may not offer a policy of group health insurance described in ORS 731.098 (3) that insures persons in this state or 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 this section and ORS 731.098 (3) are satisfied.
(2) 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 health insurance policy subject to the provisions of the Insurance Code. 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.
(3) An insurer shall submit evidence to the director showing that the requirements of subsection (2) of this section and ORS 731.098 (3) are satisfied. The director shall review the evidence and may request additional evidence as needed.
(4) An insurer shall submit to the director any changes in the evidence submitted under subsection (3) of this section.
(5) The director may adopt rules to carry out this section. [1989 c.784 §12; 2005 c.22 §494; 2013 c.681 §56]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.531

[1967 c.359 §464; 1985 c.747 §71; 1989 c.784 §23; 2015 c.588 §3; renumbered 743B.460 in 2015]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.535 - Health benefit coverage for guaranteed association.

(1) As used in this section, "guaranteed association" means an association that:
(a) The Director of the Department of Consumer and Business Services has determined under ORS 743.524 meets the requirements described in ORS 731.098 (2); and
(b) Is a statewide nonprofit organization representing the interests of individuals licensed under ORS chapter 696.
(2) A carrier may offer a health benefit plan to a guaranteed association if the plan provides health benefits covering 500 or more members or dependents of members of the association.
(3) When a carrier offers coverage to a guaranteed association under subsection (2) of this section, the carrier shall offer coverage to all members of the association and all dependents of the members of the association without regard to the actual or expected health status of any member or any dependent of a member of the association.
(4) A carrier offering a health benefit plan under subsection (2) of this section shall establish premium rates as follows:
(a) For the initial 12-month period of coverage, the carrier shall submit to the director a certified statement that the premium rates charged to the guaranteed association are actuarially sound. The statement must be signed by an actuary certifying the accuracy of the rating methodology as established by the American Academy of Actuaries.
(b) For any subsequent 12-month period of coverage, according to a rating methodology as established by the American Academy of Actuaries.
(5) A member of a guaranteed association may apply for coverage offered by a carrier under subsection (2) of this section only:
(a) If the member has been an active member of the association for no less than 30 days;
(b) During an annual open enrollment period offered by the association; and
(c) After meeting any additional eligibility requirements agreed upon by the association and the carrier.
(6) Notwithstanding subsection (5) of this section, if a member or a dependent of a member of a guaranteed association terminates coverage under the health benefit plan, the member or dependent shall be excluded from coverage for 12 months from the date of termination of coverage. The member may enroll for coverage of the member or the dependent during an annual open enrollment period following the expiration of the exclusion period. [Formerly 743.757]
Note:
Definitions for 743.535 may be found in 743B.005.
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.536 - "Blanket health insurance" defined.

"Blanket health insurance" means that form of a health insurance covering groups of persons defined in this section and issued on one of the following bases:
(1) Under a policy issued to a common carrier or to an operator, owner or lessee of a means of transportation, who shall be deemed the policyholder, insuring a group of persons who may become passengers and which group is defined by reference to their travel status on such common carrier or means of transportation.
(2) Under a policy issued to an employer, who shall be deemed the policyholder, insuring any group of employees, dependents or guests, defined by reference to specified hazards incident to an activity or activities or operations of the policyholder.
(3) Under a policy issued to a college, school or other institution of learning, a school district or districts, or school jurisdictional unit, or to the head, principal or governing board of any such educational unit, who or which shall be deemed the policyholder, insuring students, teachers or employees.
(4) Under a policy issued to a religious, charitable, recreational, educational, or civic organization, or branch thereof, which shall be deemed the policyholder, insuring any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by such policyholder.
(5) Under a policy issued to a sports team, camp or sponsor thereof, who shall be deemed the policyholder, insuring members, campers, employees, officials or supervisors.
(6) Under a policy issued to a volunteer fire department, first aid, civil defense, or other such volunteer organization, which shall be deemed the policyholder, insuring any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by such policyholder.
(7) Under a policy issued to a newspaper or other publisher, which shall be deemed the policyholder, insuring its carriers.
(8) Under a policy issued to an association, including a labor union, which has a constitution and bylaws and which has been organized and is maintained in good faith for purposes other than that of obtaining insurance, which shall be deemed the policyholder, insuring any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by such policyholder.
(9) Under a policy issued to cover any other risk or class of risks which, in the discretion of the Director of the Department of Consumer and Business Services, may be properly eligible for blanket health insurance. The discretion of the director may be exercised on an individual risk basis or class of risks basis, or both. [Formerly 743.534]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.537 - Required provisions for blanket health insurance policies.

A blanket health insurance policy shall contain provisions which in the opinion of the Director of the Department of Consumer and Business Services are not less favorable to the policyholder and the individual insureds than the provisions described in ORS 743.411, 743.423, 743.426, 743.429, 743.432, 743.438 and 743.441. [1967 c.359 §466]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.540 - Application and certificates not required for blanket health insurance policies.

An individual application need not be required from a person insured under a blanket health insurance policy, nor shall it be necessary for the insurer to furnish each person a certificate. [1967 c.359 §467]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.543 - Payment of benefits under blanket health insurance policies.

All benefits under a blanket health insurance policy shall be payable to the person insured, or to the designated beneficiary or beneficiaries of the person, or to the estate of the person, except that if the person insured is a minor or otherwise not competent to give a valid release, such benefits may be made payable to the parent, guardian or other person actually supporting the person. However, the policy may provide that all or a portion of any indemnities provided by such policy on account of hospital, nursing, medical or surgical services may, at the option of the insurer and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services; but the policy may not require that the services be rendered by a particular hospital or person. Payment so made shall discharge the obligation of the insurer with respect to the amount of insurance so paid. [1967 c.359 §468]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.546 - Exemption of policy form approval for blanket health insurance policies.

The Director of the Department of Consumer and Business Services may exempt from the policy form filing and approval requirements of ORS 742.003, for so long as the director deems proper, any blanket health insurance policy to which in the opinion of the director such requirements may not practicably be applied, or may dispense with such filing and approval whenever, in the opinion of the director, it is not desirable or necessary for the protection of the public. [1967 c.359 §469]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.551 - Student health benefit plans; rules.

(1) As used in this section, "student health benefit plan" means a plan that is subject to rules adopted by the United States Department of Health and Human Services under 42 U.S.C. 18118(c).
(2) Notwithstanding any other provision of law, the Department of Consumer and Business Services shall by rule and in a manner consistent with federal law in effect on January 1, 2017, adopt requirements for student health benefit plans. [2013 c.681 §4; 2017 c.152 §3]
Note:
743.551 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 743.556

[1987 c.411 §2; 1989 c.721 §55; 1991 c.67 §198; 1991 c.470 §19; 1991 c.654 §2; 1999 c.1086 §1; 2001 c.900 §217; 2003 c.33 §5; 2005 c.705 §1; 2007 c.71 §240; renumbered 743A.168 in 2007]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.560

[1991 c.673 §§3,4; 1993 c.454 §1; 1997 c.716 §24; 2001 c.943 §11; 2013 c.681 §58; renumbered 743B.320 in 2015]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.610

[Formerly 743.850; 2009 c.73 §§3,4; 2011 c.500 §§6b,6c; 2012 c.24 §3; 2013 c.681 §16; renumbered 743B.347 in 2015]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.650 - Long Term Care Insurance Act; purpose; application.

(1) ORS 743.650 to 743.665 may be known and cited as the "Long Term Care Insurance Act."
(2) The purpose of ORS 743.650 to 743.665 is to:
(a) Promote the public interest in long term care insurance;
(b) Promote the availability of long term care insurance policies;
(c) Protect applicants for long term care insurance from unfair or deceptive sales or enrollment practices;
(d) Establish standards for long term care insurance;
(e) Facilitate public understanding and comparison of long term care insurance policies;
(f) Facilitate flexibility and innovation in the development of long term care insurance coverage; and
(g) Ensure that Oregon residents who purchase insurance for long term care shall have access to policies providing for a comprehensive range of benefits.
(3) The requirements of ORS 743.650 to 743.665, 748.603 and 750.055 apply to policies and certificates delivered or issued for delivery in this state on or after December 31, 1989. ORS 743.650 to 743.665, 748.603 and 750.055 are not intended to supersede the obligations of entities subject to ORS 743.650 to 743.665, 748.603 and 750.055 to comply with the substance of other applicable insurance laws insofar as such laws do not conflict with ORS 743.650 to 743.665, 748.603 and 750.055, except that laws and rules designed and intended to apply to Medicare supplement insurance policies shall not be applied to long term care insurance. A policy that is not advertised, marketed or offered as long term care insurance or nursing home insurance is not required to meet the requirements of ORS 743.650 to 743.665, 748.603 and 750.055. [1989 c.1022 §§1,2,3; 2007 c.486 §1]
2023 Oregon Revised Statutes › Volume : 18 - Financial Institutions, Insurance › Chapter 743 - Health and Life Insurance and Annuities › Section 743.653 - Prohibition on certain policies.

Group long term care insurance coverage may not be offered to a resident of this state under a group policy issued in another state to a group described in ORS 743.652 (4)(d), unless this state or another state having statutory and regulatory long term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met. [1989 c.1022 §5; 1991 c.67 §199; 2007 c.486 §3; 2011 c.69 §4]