reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1430 - Form and manner for behavioral health benefits reporting

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer
			 offering individual or group health benefit plans must submit its annual report
			 for behavioral health benefits no later than March 1 of each year.
(2) General requirements for reporting and
			 submitting information on behavioral health benefits include, submitting
			 information from the previous calendar year in an electronic format specified
			 by the department that adheres to standards set forth on the department's
			 website.
(3) Beginning March 1,
			 2022, annual reporting on behavioral health benefits shall include:
(a) The following information submitted in
			 accordance with standards posted on the department's website and in compliance
			 with federal reporting requirements specified in
			 42
			 U.S.C. 300gg-26(a)(8)(A),  29 U.S.C. 1185a(a)(8)(A), and
			 26
			 U.S.C. 9812(a)(8)(A):
(A) Plan or coverage terms or other relevant
			 terms regarding the nonquantitative treatment limitations and a clear
			 description of all mental health or substance use disorder and medical or
			 surgical benefits to which each such term applies in each respective benefits
			 classification.
(B) Factors used to
			 determine if nonquantitative treatment limitations will apply to mental health
			 or substance use disorder benefits and medical or surgical benefits.
(C) Evidentiary standards used for the
			 factors identified in paragraph B of this subsection, when applicable, provided
			 that every factor is defined, and any other source or evidence relied upon to
			 design and apply the nonquantitative treatment limitations to mental health or
			 substance use disorder benefits and medical or surgical benefits.
(D) The comparative analyses demonstrating
			 that the processes, strategies, evidentiary standards, and other factors used
			 to apply the nonquantitative treatment limitations to mental health or
			 substance use disorder benefits, as written and in operation, are comparable
			 to, and are applied no more stringently than, the processes, strategies,
			 evidentiary standards, and other factors used to apply the nonquantitative
			 treatment limitations to medical or surgical benefits in the benefits
			 classification.
(E) The specific
			 findings and conclusions reached by the insurer with respect to the health
			 insurance coverage, including any results of the analyses described in
			 paragraphs A to D of this subsection that indicate that the plan or coverage is
			 or is not in compliance with Oregon Laws 2021, chapter 629, section
			 2.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1500 - Purpose; Statutory Authority; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-053-1500  to 836-053-1510  are
			 adopted for the purpose of implementing sections 1 to 4, chapter 575, Oregon
			 Laws 2015 and section 7, chapter 26, Oregon Laws 2016.
(2) The requirements set forth in OAR
			 836-053-1500  to 836-053-1510  apply to prominent carriers.
Stat. Auth: ORS
				  731.244; sec 1 - 4, ch 575, OLs
				  2015, sec 7, ch 26, OL 2016
Stats. Implemented: Sections 1 & 3, ch. 575, OL 2015,sec
				  7, ch. 26, OL 2016
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1505 - Definitions for OAR 836-053-1500 to 836-053-1510

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-053-1500  to 836-053-1510:
(1) The definitions set forth in Section 2,
			 chapter 575, Oregon Laws 2015 apply to the use of those terms in these
			 rules.
(2) "Prominent carrier"
			 means:
(a) A carrier with annual premium
			 income of $200 million or more in direct health premiums written in Oregon and
			 is not also licensed as a Coordinated Care Organization;
(b) The Public Employees' Benefit Board;
			 and
(c) The Oregon Educators
			 Benefit Board.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1510 - Prominent Carrier Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Not later than October 1 of each year
			 from 2016 through 2018, each prominent carrier shall submit to the Department
			 of Consumer and Business Services all non-claims based primary care
			 expenditures for the prior calendar year using the approved file layout and
			 format set forth on the website of the Division of Financial Regulation of the
			 Department of Consumer and Business Services at dfr.oregon.gov.
(2) Each prominent carrier shall submit to
			 department all non-claims based total health care expenditures for the prior
			 calendar year using the approved file layout and format set forth on the
			 website of the Division of Financial Regulation of the Department of Consumer
			 and Business Services at dfr.oregon.gov.
(3) Each category included in the approved
			 file format is mutually exclusive; therefore, expenditures shall only be
			 accounted for in one category.
(4)
			 All data shall be submitted to the department no later than October 1 of each
			 year that the prominent carrier is required to report under section (1) of this
			 rule.
(5) Claims-based primary care
			 and total health care expenditures will be calculated for each prominent
			 carrier by the Oregon Health Authority using data from the All-Payer All-Claims
			 Database.
(6) Expenditures for
			 services or activities outside the primary care setting, regardless of a
			 primary care capacity building intent, are not considered primary care
			 expenditures for purposes of this report.
Statutory/Other Authority: ORS
				  731.244, sec. 7, ch. 26, OL 2016
				  & 2015 OL Ch. 575 Sec. 1 & 3
Statutes/Other Implemented: 2015 OL Ch. 575 Sec. 1 & 3,
				  sec. 7, ch. 26 & OL 2016
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1520 - Purpose; Statutory Authority; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
The requirements set out in OAR 836-053-1520  to 836-053-1530 apply to insurers offering health benefit plans, as defined in ORS
				743B.005,
				that reimburse the costs of services provided by a national primary care
				medical home payment model, conducted by the Center for Medicare and Medicaid
				Innovation in accordance with
				42 U.S.C.
				1315a, that includes performance incentive
				payments for primary care.
Statutory/Other Authority: ORS
				  731.244
Statutes/Other Implemented: 2017 Or Law ch 489
				  §7
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1525 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 836-053-1520  to
				836-053-1530:
(1) "APAC Data Reporting
			 Program" means the all payer all claims data reporting program pursuant to ORS
			 442.464,
			 442.466,
			 and
			 442.993.
(2) "APM" means alternative payment
			 methodologies.
(3) "Annual
			 supplemental provider level APM Summary report" means a data set composed of
			 total and primary care-related dollars disbursed, by payment arrangement and
			 line of business in the APAC Data Reporting Program pursuant to OAR
			 409-025-0120(8)  and OAR 409-025-0120(9).
(4) "Comprehensive Primary Care Plus (CPC+)"
			 means a national primary care medical home payment model, conducted by the
			 Center for Medicare and Medicaid Innovation in accordance with
			 42 U.S.C.
			 1315a, that includes performance-based
			 incentive payments for primary care.
(5) "Patient-Centered Primary Care Home
			 (PCPCH)" means a health care team or clinic, defined in ORS
			 414.655,
			 that meets the standards and has been recognized under OAR
			 409-055-0040.
Statutory/Other Authority: ORS
				  731.244
Statutes/Other Implemented: Or Law ch 489
				  §7
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1530 - Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No
			 later than September 30 of each year beginning September 30, 2019, an insurer
			 participating in CPC+ shall submit to the Department of Consumer and Business
			 Services the Annual Supplemental Provider Level APM Summary report using the
			 APAC Data Reporting Program for the prior calendar year.
(2) No later than September 30 of each year
			 beginning September 30, 2019, an insurer participating in CPC+ shall submit to
			 the Department of Consumer and Business Services a PCPCH APM Reporting Form
			 (PCPCH-APM-1) for the prior calendar year providing the following information:
(a) The number of PCPCHs in their
			 network;
(b) The number of PCPCHs
			 in their network with an APM in their contract;
(c) The number of PCPCHs in their network
			 offered an APM.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1600 - Purpose; Statutory Authority; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
								836-053-1600  to 836-053-1615  are adopted
			 for the purpose of implementing ORS
			 743B.287.
(2)
								836-053-1600  to 836-053-1615  apply to
			 payments required under ORS
			 743B.287(6).
Statutory/Other Authority: ORS
				  743B.287
Statutes/Other Implemented: ORS
				  743B.287
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1605 - Definitions for 836-053-1600 to 836-053-1615

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Anesthesia Conversion factor" means the
			 dollar value assigned to the following geographic rating area where the
			 procedure is performed:
(a) Area 1 is
			 $68.00;
(b) Area 2 is
			 $70.40;
(c) Area 3 is
			 $67.85;
(d) Area 4 is
			 $75.88;
(e) Area 5 is
			 $68.00;
(f) Area 6 is $66.17;
			 and
(g) Area 7 is $70.77.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1610 - Non-anesthesia-related claims

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Out-of-network reimbursement for non-anesthesia-related claims shall be no less
			 than:
Base rate x Modifier adjustment x CPI adjustment
(2) Out-of-network reimbursement
			 for a non-anesthesia-related claim that does not have a base rate listed on the
			 Non-Anesthesia Fee Schedule shall be at a rate agreed upon in good faith by the
			 insurer and the provider to be usual and customary for in-network commercial
			 claims, using best efforts to establish a rate within a reasonable amount of
			 time.
Statutory/Other Authority: ORS
				  743B.287
Statutes/Other Implemented: ORS
				  743B.287
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1615 - Anesthesia-related claims

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Out-of-network reimbursement for anesthesia-related claims, including obstetric
			 anesthesia claims, shall be no less than:
(Base units + Time units + Physical status units) x Anesthesia
				Conversion factor x Q modifier adjustment x CPI adjustment
(2) Out-of-network reimbursement for an
			 anesthesia-related claim that does not have a number of base units published in
			 the CY 2018 Physician Fee Schedule Final Rule shall be reimbursed at a rate
			 calculated with a number of base units agreed upon in good faith by the insurer
			 and provider to be usual and customary for in-network commercial claims, using
			 best efforts to establish a rate within a reasonable amount of time.
Statutory/Other Authority: ORS
				  743B.287
Statutes/Other Implemented: ORS
				  743B.287
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-1630 - Drug Price Transparency Insurer Reporting

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the
			 purposes of this rule, "insurer" means a licensed insurance company, health
			 care services contractor, or health maintenance organization that issues health
			 benefit plans as defined in ORS
			 743B.005(16) in
			 this state.
(2) No later than May 1
			 of each year, an insurer with 200 or more enrollees in the state of Oregon must
			 report to the department the information described in ORS
			 743.025(2) in
			 the form and manner prescribed by the department. For drugs reimbursed by the
			 insurer under both pharmacy and medical benefits in health benefit plans during
			 the prior calendar year, the reporting must include all of the following:
(a) The 25 most frequently prescribed
			 drugs.
(b) The 25 most costly
			 drugs. In determining this list, the insurer must consider total annual
			 spending, including the net impact of any rebates or other price concessions if
			 applicable.
(c) The 25 drugs that
			 have caused the greatest increase in total plan spending from one year to the
			 next. In determining this list, the insurer must consider the net impact on
			 total plan spending of any rebates or other price concessions if
			 applicable.
(d) The impact of the
			 costs of prescription drugs on premium rates, on a per member per month basis,
			 including the net impact of any rebates or other price concessions if
			 applicable.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0000 - Election of Lower Limits for Uninsured Motorist Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule is
			 adopted under the authority of ORS
			 731.244 for the purpose of
			 implementing ORS 742.502.
(2) This rule establishes in Exhibit 1 an
			 example of the form of statement electing lower limits for uninsured motorist
			 coverage in a motor vehicle liability insurance policy that may be used to
			 comply with the requirement in ORS
			 742.502 for a statement of
			 election. A form used by an insurer or insurance producer that is in
			 substantial compliance with this rule is considered to be approved by the
			 department. A form is in substantial compliance if the for contains all of the
			 following elements in any order: An example of a form that may be used by an
			 insurer or insurance producer to comply with this rule is posted on the
			 Division of Financial Regulation website of the Department of Consumer and
			 Business Services at dfr.oregon.gov. If an insurer or insurance producer uses
			 this form, or any other selection form that has been approved by the
			 department, the form is considered to be approved by the department. Any other
			 form electing lower limits for uninsured motorist coverage in a motor vehicle
			 liability insurance policy must be approved by the department and must contain
			 all of the following elements in any order:
(a) An acknowledgement by the named insured
			 that the named insured was offered uninsured motorist coverage with the limits
			 equal to those for bodily injury liability;
(b) A brief summary, which is not part of the
			 insurance contract, of uninsured and underinsured motorist coverages;
(c) A statement of the price for coverage per
			 insured vehicle with limits equal to the named insured's bodily injury
			 liability limits and the price for coverage per insured vehicle with the lower
			 limits requested by the named insured;
(d) A statement to the effect that the
			 statement shall remain in force until rescinded in writing by a named insured
			 or until such time as motor vehicle bodily injury liability limits are changed;
			 and
(e) Provision for signature of
			 a named insured, to be made within 60 days of the time the named insured makes
			 the election, and for the date of signature.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0020 - Timely Notice of Denial of Charges to Provider

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule is adopted under the authority
			 of ORS 731.244 for the purpose of implementing ORS 742.524.
(2) When an insurer is required to provide
			 notice of a denial of charges within 60 days of receipt, it shall be presumed
			 that the provider has received the denial within three days after it is served
			 by mail.
(3) If an insurer serves
			 the denial electronically or by fax, it shall be presumed that the provider has
			 received it on the day it is transmitted.
Stat. Auth.: ORS 731.244
Stats. Implemented: ORS
				  742.524
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0201 - Statutory Authority and Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
OAR 836-054-0201  to 836-054-0210  are adopted pursuant to the
				general rulemaking authority of the Director of the Department of Consumer and
				Business Services to specify requirements for large deductible provisions of
				workers' compensation insurance policies which may be approved according to ORS
				742.001 to
				742.007
Stat. Auth.: ORS
				  731.244
Stats.
				  Implemented:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0205 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-054-0201  to 836-054-0210:
(1) "Insurer" means any insurer authorized to
			 write workers' compensation insurance and includes the State Accident Insurance
			 Fund Corporation.
(2) "Large
			 Deductible" means a provision in a workers' compensation policy, or added by
			 endorsement thereto, which allows a policyholder to be financially responsible
			 for claims incurred under the policy up to a percentage of premium, a stated
			 amount per claim, or other limit specified in the provision in exchange for a
			 prospective premium reduction.
(3)
			 "Workers' Compensation Insurance" means insurance providing coverage for the
			 obligations of an employer arising from illness or injury to workers whether
			 such obligation is imposed by ORS Chapters 654 and 656, similar laws of the
			 United States, or agreements between states.
(4) "Workers' Compensation Premium
			 Assessment" means the assessment imposed on insurers, self-insured employers,
			 and self-insured employer groups by the Director of the Department of Consumer
			 and Business Services pursuant to ORS
			 656.612.
Stat. Auth.: ORS
				  731.244
Stats.
				  Implemented:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0300 - Loan to Value

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A mortgage
			 insurer may provide insurance with respect to an obligation that does not
			 exceed, solely or in combination with liens existing at the time the insured
			 loan is made, 105 percent of the fair market value of the securing real
			 property at the time the loan is made if permitted by the insurer's domicile
			 and if the obligation insured is secured by a mortgage, deed of trust or other
			 instrument constituting a first lien or charge.
(2) A mortgage insurer may provide insurance
			 with respect to an obligation that does not exceed, solely or in combination
			 with liens existing at the time the insured loan is made, 110 percent of the
			 fair market value of the securing real property at the time the loan is made if
			 permitted by the insurer's domicile and if the insured obligation is secured by
			 a mortgage, deed of trust or other instrument constituting a junior lien or
			 junior charge. In determining the 110 percent limitation, the full amount of a
			 line of credit to be secured by a junior lien shall be considered the amount of
			 the loan.
(3) This rule is adopted
			 under the authority of ORS
			 731.244 for the purpose of
			 implementing ORS 742.282(1)(a).
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  742.282
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0400 - Purpose and Scope of OAR 836-054-0410

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of OAR 836-054-0400  to 836-054-0410  is to wind down
				an emergency order by the director of the Department of Consumer and Business
				Services. Under ORS
				731.870,
				the director may order the temporary postponement of insurance policy
				nonrenewals. This rule provides that expiration of an emergency order is a
				valid reason to cancel a commercial liability policy under ORS
				742.702 if the emergency order was the sole reason the policy was renewed.
Statutory/Other Authority: ORS
				  731.244 & ORS
				  742.702
Statutes/Other Implemented: ORS
				  742.702  & ORS
				  731.870
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0410 - Cancellations

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer may cancel a commercial liability policy if:
(1) The insurer was required to renew the
			 policy by an emergency order issued by the director;
(2) The cancellation is not due to claims
			 resulting solely from the circumstances on which the emergency order was based,
			 except in cases of fraud or material misrepresentation;
(3) The insurer has provided 45 days written
			 notice to the insured and insurance producer, if any; and
(4) The cancellation does not violate any
			 other law or order by the director.
Statutory/Other Authority: ORS
				  731.244 & ORS
				  742.702
Statutes/Other Implemented: ORS
				  742.702  & ORS
				  731.870
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 58 - MOTOR VEHICLE LIABILITY INSURANCE › Section 836-058-0010 - Permitted Reasons to Exclude Named Person

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer may exclude by name a person other than the named
				insured from the coverage required by ORS
				742.450(2)(a)
				to be provided in a motor vehicle liability insurance policy issued for
				delivery in this state, for any of the following reasons:
(1) The excluded person is higher rated than
			 the named insured and the difference between the annualized premium that the
			 named insured would pay on the liability coverage under the policy including
			 the higher rated person and the annualized premium that the named insured would
			 pay on the policy excluding the higher rated person would cause financial
			 hardship as described in this section to the named insured. For the purpose of
			 this section:
(a) A financial hardship is
			 caused only if the difference exceeds $1,000;
(b) Premium owing to rating for a high
			 performance vehicle or a sports car shall be excluded for the purpose of
			 determining whether financial hardship is caused.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 58 - MOTOR VEHICLE LIABILITY INSURANCE › Section 836-058-0020 - Exclusion from Excess Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 An insurer who excludes one or more persons as provided by law from any
			 coverage in excess of the coverage required by ORS
			 742.450(2)(a)
			 to be provided in a motor vehicle liability insurance policy issued for
			 delivery in this state must state in the policy or indorsement the policy
			 limits applicable to the person.
(2) The disclosure requirement of section (1)
			 of this rule does not apply with respect to a person also excluded from
			 coverage under a motor vehicle liability insurance policy under ORS
			 742.450(6)(a)
			 or OAR 836-058-0010.
Stat. Auth.: ORS
				  731.244 & ORS
				  742.031
Stats. Implemented: ORS
				  742.450(1) -
				  ORS 742.450(2)
				  & ORS 742.464
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0000 - Statutory Authority; Purpose; Effective Date

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-060-0000  through 836-060-0060  are
			 adopted pursuant to the general rulemaking authority of the Director in ORS
			 731.244.
(2) The purpose of OAR 836-060-0000  through
			 836-060-0060  is to protect the interests of debtors and the public by providing
			 a system of rate, policy form and operating standards for the transaction of
			 credit life and credit health insurance in Oregon. These rules interpret and
			 implement ORS 733.306,
			 742.003,
			 742.005,
			 743.015,
			 743.371 to
			 743.380,
			 746.160,
			 746.220, and
			 746.240.
(3) OAR 836-060-0000  through 836-060-0060  as
			 amended become effective on January 1, 2001, and apply as follows:
(a) Except as otherwise provided in this
			 section, on January 1, 2001, all forms not in compliance with OAR 836-060-0000  through 836-060-0060  as amended become disapproved for use in Oregon. No such
			 form may be issued or delivered after that date unless it has been changed and
			 resubmitted to and approved by the Director, or unless an approved rider has
			 been attached bringing the form into compliance with 836-060-0000  through
			 836-060-0060  as amended;
(b)
			 Certificates, notices of proposed insurance and premium rates for existing
			 group policies shall conform to OAR 836-060-0000  through 836-060-0060  as
			 amended not later than the anniversary date of the group policy on or next
			 following January 1, 2001;
(c) Any
			 replacement or amendment of a group credit insurance policy in an attempt to
			 delay or circumvent application of these rules shall nonetheless be subject to
			 OAR 836-060-0000  through 836-060-0060  as amended. No group credit insurance
			 policy in force may be rewritten or redated in order to delay or circumvent the
			 effect of OAR 836-060-0000  through 836-060-0060  as amended;
(d) All forms received for filing on or after
			 October 10, 2000 must comply with OAR 836-060-0000  through 836-060-0060  as
			 amended. No such form may be issued or delivered on or after January 1, 2001
			 unless the form has been submitted to and approved by the Director.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-060-0000  through 836-060-0060:
(1) "Closed-End Credit" means credit other
			 than open-end credit.
(2) "Credit
			 Health Insurance" means the kind of insurance defined in ORS
			 743.371 and limited by ORS
			 743.372.
(3) "Credit Insurance" means credit life
			 insurance or credit health insurance or both.
(4) "Credit Life Insurance" means the kind of
			 insurance defined in ORS
			 743.371 and limited by ORS
			 743.372.
(5) "Credit Transaction" means any
			 transaction by the terms of which the repayment of money loaned, or payment for
			 goods, services or properties sold or leased, is to be made at a future date or
			 dates.
(6) "Indebtedness" means
			 total amount repayable, including principal, interest and finance
			 charges.
(7) "Open-End Credit"
			 means credit extended by a creditor under an agreement in which:
(a) The creditor reasonably contemplates
			 repeated transactions;
(b) The
			 creditor imposes a finance charge from time to time on an outstanding unpaid
			 balance; and
(c) The amount of
			 credit that may be extended to the debtor during the term of the agreement, up
			 to any limit set by the creditor, is generally made available to the extent
			 that any outstanding balance is repaid.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0011 - Rights and Treatment of Debtors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Multiple Plans of Insurance. If a
			 creditor makes available to debtors more than one plan of credit life insurance
			 or more than one plan of credit health insurance, the creditor must inform each
			 debtor of all such plans.
(2)
			 Substitution. When a creditor requires credit life insurance, credit health
			 insurance or both as additional security for an indebtedness, the creditor
			 shall give the debtor the option of furnishing the required amount of insurance
			 through existing policies of insurance owned or controlled by the debtor, or of
			 procuring and furnishing the required coverage through any insurer authorized
			 to transact insurance in this state. The debtor shall be informed by the
			 creditor before the transaction is completed of this right to provide
			 alternative coverage.
(3) Evidence
			 of Coverage. All credit insurance shall be evidenced by an individual policy
			 or, in the case of group insurance, by a certificate of insurance. The policy
			 or certificate shall be delivered to the debtor in accordance with ORS
			 743.377, and shall set forth the
			 information required by
			 743.377 and other provisions of
			 the Insurance Code.
(4) Claims
			 Processing. All credit insurance claims shall be processed in accordance with
			 ORS 743.380.
(5) Claim Standards. The following
			 requirements apply to claims:
(a) All claim
			 payments shall go first to pay the balance of the indebtedness of the insured.
			 Any residual benefit shall be paid to the insured or the designated beneficiary
			 or the estate of the debtor;
(b)
			 All claims are covered upon the earlier of the date of acceptance by the
			 insurer for insurability or 30 days after the date of the application for
			 coverage if not rescinded. Except for falsified statements, no claim may be
			 denied for reason of ineligibility or uninsurability if the coverage is issued
			 and not rescinded before the date of the claim; and
(c) All claims for consumer credit insurance
			 are subject to ORS 746.230 and OAR 836-080-0205  to
			 OAR 836-080-0235.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0016 - Policy Forms and Related Material

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Permissible Forms. Credit insurance shall
			 be issued only in the forms described in ORS
			 743.373.
(2) Rates and Forms Filing Requirements. All
			 credit insurance policy forms, certificates of insurance, notices of proposed
			 insurance, applications for insurance, endorsements and riders to be delivered
			 or issued for delivery in this state and the schedules of premium rates
			 pertaining thereto shall be filed with the Director as required by ORS
			 743.015.
Stat. Auth.: ORS 731, ORS 742, ORS 743 & ORS 746
Stats. Implemented: ORS
				  743.015 & ORS
				  743.373
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0021 - Determination of Reasonableness of Benefits in Relation to Premium Charge

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General
			 Standard. Under ORS 742.005, benefits provided by
			 credit insurance policies must be reasonable in relation to the premium
			 charged. This requirement is satisfied, in the opinion of the Director, if the
			 premium develops, or reasonably may be expected to develop a loss ratio of not
			 less than 60 percent.
(2) With the
			 exception of deviations approved under OAR 836-060-0043, the rates established
			 in 836-060-0026  and 836-060-0031, as adjusted periodically pursuant to
			 836-060-0041, are the prima facie rates and shall be conclusively presumed to
			 satisfy the standard set forth in section (1) of this rule.
(3) Nonstandard Coverage. If an insurer files
			 for approval a form providing coverage different from that described in OAR
			 836-060-0026  and 836-060-0031, the insurer shall demonstrate to the
			 satisfaction of the Director that the premium rates to be charged for such
			 coverage will develop, or reasonably may be expected to develop, a loss ratio
			 not less than that contemplated for standard coverage, or are actuarially
			 consistent with the rates used for standard coverages.
(4) Prima facie rates are presumed sufficient
			 to cover up to two months of delinquencies.
(5) Coverage Without Separate Charge. If no
			 specific charge is made to the debtor for credit insurance, sections (1) to (3)
			 of this rule do not apply. In this case, any premium rates which exceed the
			 premium rate standards set out in OAR 836-060-0026  and 836-060-0031  must be
			 filed with the Director. For purposes of this section, a specific charge is
			 made to the debtor if an identifiable charge for insurance is disclosed in the
			 credit or other instrument furnished the debtor which sets out the financial
			 elements of the credit transactions, or if there is a differential in finance,
			 interest, service or other similar charge made to debtors who are in like
			 circumstances except for their insured or noninsured status.
Stat. Auth.: ORS
				  731.244
Stats. Implemented:ORS
				  742.003 &
				  742.005
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0026 - Credit Life Insurance Rates

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Unless data submitted to the Director under OAR 836-060-0043  justify a higher
			 rate in the Director's opinion, credit life insurance premium rates for the
			 insured portion of an indebtedness repayable in equal monthly installments,
			 when the insured portion of the indebtedness decreases uniformly by the amount
			 of the monthly installment paid, shall not exceed the rates ("prima facie"
			 rates) set forth in subsections (a) and (b) of this section. Subsections (c),
			 (d) and (e) of this section prescribe the corresponding "prima facie" premium
			 rates for other types of credit life insurance benefits. The prima facie
			 premium rates are as follows:
(a) $.65 per
			 month per $1,000 of outstanding insured indebtedness, if premiums are payable
			 on a monthly outstanding balance basis ($.59 if underwritten);
(b) If premiums are payable on a single
			 premium basis and the amount of the insurance decreases in equal monthly
			 amounts, the prima facie rates per $100 of initial insured indebtedness shall
			 equal:
(A) $.42 per year on credit terms of 63
			 months or less ($.38 if underwritten); and
(B) On credit terms over 63 months
(n+1)
20
times $.65 ($.59 if underwritten), where n is the credit term
				in months. The rates so calculated are to be immediately rounded to two-decimal
				precision, i.e. to the nearest cent.
(c) If premiums are payable on a single
			 premium basis and the benefit provided is level term, the prima facie rate is
			 $.76 per $100 ($.68 if underwritten) of insured indebtedness per year of term.
			 The rate for a fractional part of a year shall be calculated pro rata and
			 immediately rounded to two-decimal precision, i.e. to the nearest
			 cent.
(d) The joint coverage rate
			 shall be 165% of the rounded rate for single person coverage;
(e) If coverage is a combination of level
			 term and decreasing term with equal decrements, the rate shall be a combination
			 of the appropriate rate for level term and the appropriate rate for decreasing
			 term with equal decrements;
(f) For
			 coverage for outstanding indebtedness when only the principal is insured and
			 the interest is paid on a scheduled basis to provide equal monthly repayments
			 of indebtedness (simple interest loans), the premium shall be actuarially
			 consistent with other premiums calculations described in this rule;
(g) For other benefits, except for benefits
			 described in subsection (2)(e), of this rule, rates shall be actuarially
			 consistent with the rates specified in this section.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0027 - Credit Life Reserves

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For
			 policies or certificates issued prior to January 1, 2001, the minimum reserve
			 standard is the Commissioners 1958 Extended Term Insurance Table and 4.5%
			 interest.
(2) For policies or
			 certificates issued on or after January 1, 2001, the minimum reserve standard
			 is the Male Commissioners 1980 Standard Ordinary Mortality Table and 4.5%
			 interest.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  733.306(8)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0031 - Credit Health Insurance Rates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Unless data submitted to the Director
			 under OAR 836-060-0043  justify a higher rate in the Director's opinion, credit
			 health insurance premium rates for the insured portion of an indebtedness
			 repayable in equal monthly installments, where the insured portion of the
			 indebtedness decreases uniformly by the amount of the monthly installment paid,
			 shall not exceed the rates ("prima facie" rates) set forth in subsections (a)
			 and (b) of this section. Subsections (c), (d) and (e) of this section prescribe
			 the corresponding "prima facie" premium rates for other types of credit health
			 insurance benefits. The prima facie premium rates are as follows:
(a) As set forth in Tables 1 and 2, if
			 premiums are payable on a single premium basis for the duration of the
			 coverage;
(b) As set forth in
			 Tables 1 and 2, if premiums are payable on a monthly outstanding insured
			 indebtedness basis for a closed-end loan;
(c) The actuarial equivalent of the rates
			 specified in subsections (a) and (b) of this section, if the coverage provided
			 is a constant maximum indemnity for a given period of time;
(d) An appropriate combination of the premium
			 rate for a constant maximum indemnity for a given period of time and the
			 premium rate for a maximum indemnity which decreases in even amounts per month,
			 if the coverage provided starts as a constant maximum indemnity for a given
			 period of time after which the maximum indemnity begins to decrease in even
			 amounts per month;
(e) For credit
			 health insurance on an open-end credit account, per $1,000 of outstanding
			 insured indebtedness, the following rates shall apply to the following minimum
			 benefit plans:
(A) 14-day nonretroactive plan
			 -- $1.66-$1.49 if underwritten;
(B)
			 30-day nonretroactive plan -- $1.40-$1.26 if underwritten;
(C) 14-day retroactive plan -- $1.89-$1.70 if
			 underwritten;
(D) 30-day
			 retroactive plan -- $1.74-$1.57 if underwritten;
(f) For other benefits, except for benefits
			 described in section (2)(g) of this rule, rates shall be actuarially consistent
			 with the rates specified in this section;
(g) For critical period credit health
			 coverage, maximum rates shall be computed by using the conversion ratios based
			 on the 1974 Basic Tables of Credit A & H Claim Costs published by National
			 Association of Insurance Commissioners, NAIC Proceedings, 1975 Volume 1, pp.
			 676-691, and the extension as published in 1970 Volume 1, pp. 332-333. The
			 factors are published in Exhibit 2.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0036 - Refund Formulas

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 insurer shall file for approval by the Director its refund formulas prior to
			 their use. The following methods are considered appropriate for the plans
			 described:
(a) Pro Rata Method. The pro rata
			 unearned gross premium method shall be used for level term credit life
			 insurance or credit health insurance where under the insured is covered for a
			 constant maximum indemnity for a given period of time, after which the maximum
			 indemnity begins to decrease in even amounts per month, and credit insurance
			 coverage under which premiums are collected from the debtor on a basis other
			 than the single premium basis;
(b)
			 Actuarial method commonly referred to as the Rule of Anticipation. A refund of
			 unearned premium used for decreasing term credit life insurance may be made as
			 provided in this subsection. The amount of the refund shall be not less than
			 the total premium, less the greater of:
(A)
			 Ten percent of the premiums or $75, whichever is less; or
(B) The premium earned to the installment due
			 date of the loan nearest the date of prepayment, for the periods of time the
			 loan balances were actually outstanding. For purposes of refund computations
			 under this paragraph, the installment due date of the loan preceding the date
			 of prepayment shall be considered to be nearest if prepayment occurs 15 days or
			 less after that installment date. If prepayment occurs more than 15 days after
			 the preceding installment due date, the next succeeding installment due date
			 shall be considered to be nearest to the date of prepayment.
(c) Any method that develops
			 refunds that are at least as favorable to the debtor as refunds based on the
			 actuarial method described in subsection (b) of this section.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0041 - Experience Reports

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Each insurer
			 transacting credit insurance in this state shall submit an Oregon-specific
			 Credit Insurance Experience Exhibit to the National Association of Insurance
			 Commissioners (NAIC). If this report is discontinued as an NAIC report, the
			 report must be sent directly to the Director by June 1 of each year.
(2) Notwithstanding section (1) of this rule,
			 each insurer transacting credit insurance that is underwritten shall submit to
			 the Director an Oregon-specific Credit Insurance Experience Exhibit for the
			 underwritten business. The information shall be reported on the NAIC form and
			 submitted by June 1 of each year. An insurer need not comply with this section
			 if the NAIC Credit Insurance Experience Exhibit includes a separate accounting
			 for underwritten business.
(3) The
			 experience reports required by this rule replace all other annual reports to
			 the Director of credit insurance experience. The experience reports required by
			 this rule are separate and distinct from the annual financial statement and are
			 not for use in determining the financial condition of an insurer.
(4) The Director shall review the loss ratio
			 development every four years and compare it with the standards set forth in OAR
			 836-060-0021  and the prima facie rates set forth for underwritten and
			 non-underwritten in 836-060-0026  and 836-060-0031  as adjusted and determine
			 therefrom the statewide loss ratio using no less than three years of
			 experience. The Director shall compare the expected loss ratio with the actual
			 loss ratio for the preceding review period determined from the incurred claims
			 and earned premiums at prima facie rates reported under this rule, and publish
			 the adjusted actual statewide prima facie rates to be used by insurers. If
			 published, the rates are adjusted for the difference between:
(a) Actual claims and expected claims;
			 and
(b) Any other additional
			 premium changes necessary to meet the loss ratio standards of OAR
			 836-060-0021.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 60 - INSURANCE POLICIES (ORS CHAPTER 743) › Section 836-060-0043 - Use of Rates - Direct Business Only

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer that files rates or has rates
			 on file that are not in excess of the prima facie rates shown in OAR
			 836-060-0026  and 836-060-0031, to the extend adjusted pursuant to 836-060-0041  may use those rates without further proof of their reasonableness except as may
			 be required by the Director.
(2) An
			 insurer may file for approval of and may use rates that are higher than the
			 prima facie rates shown in OAR 836-060-0026  and 836-060-0031, to the extent
			 adjusted pursuant to 836-060-0041, if it can be expected that the use of such
			 higher rates will result in a ratio of claims incurred to premiums earned
			 (assuming the use of such higher rates) that is commensurately higher,
			 depending on the upward deviation, for those accounts to which the higher rates
			 apply and that the upward deviations will not result on a statewide basis for
			 that insurer of a ratio of claims incurred to premiums earned of less than the
			 expected loss ratio underlying the current prima facie rate developed or
			 adjusted pursuant to 836-060-0041. The insurer must justify the rates by
			 showing its compensation structure, including compensation to lenders and other
			 producers. If rates higher than the prima facie rates shown in 836-060-0026  and
			 836-060-0031, to the extent adjusted pursuant to 836-060-0041, are filed for
			 approval, the filing shall specify the account to which the rates apply. Such
			 rates may be applied on an equitable basis approved by the Director only to one
			 or more accounts of the insurer for which the experience has been less
			 favorable than expected.
(3) This
			 section establishes approval periods of deviated rates, as follows:
(a) A deviated rate shall be in effect for a
			 period of time not longer than the experience period used to establish such
			 rate (i.e. one year, two years or three years). An insurer may file for a new
			 rate before the end of a rate period, but not more often than once during any
			 twelve-month period. A deviated rate expires at the end of the rate period
			 unless refiled and approved again by the Director;
(b) Notwithstanding section (1) of this rule,
			 if an account changes insurers, the succeeding insurer may use the rate
			 approved to be used for the account by the prior insurer only if the rate is
			 filed by the succeeding insurer and approved for use on the account for the
			 remainder of the rate approval period approved for the prior insurer or until a
			 new rate is approved for use on such account, if sooner.