reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0135 - Test Audits

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A Analysis
			 of Test Audit Results shall be completed on each test audit.
(2) The test auditor shall interview the
			 insured or an authorized representative of the insured in order to solicit the
			 insured's cooperation and also to obtain all factual data necessary for proper
			 completion of the test audit.
(3)
			 If a current inspection is in the file, the test auditor shall verify data
			 contained in that report.
(4) Each
			 test audit, using the audit detail form, shall contain the following:
(a) A reconciliation of payroll subject to
			 premium charge, which must be made with the independent control records of the
			 State Unemployment Insurance quarterly reports and FICA quarterly
			 report;
(b) A review of the cash
			 disbursements journal to develop the remuneration paid to contract labor and
			 casual labor;
(c) A detailed review
			 of at least one pay period to verify proper classification;
(d) A review of time cards to verify proper
			 treatment of overtime remuneration;
(e) A review of original entry records to
			 verify proper application of the "division of single employee's payroll" rules
			 (OAR 836-042-0050  to 836-042-0060);
(f) A listing by name, duties and earnings of
			 all persons assigned to the "standard exceptions" classifications. When size of
			 the risk makes the listing impractical, spot checks must be made;
(g) A listing by name, title, duties and
			 earnings of all covered executive officers, partners or individuals;
(h) A summary, by classification, of all
			 chargeable payrolls;
(i) A summary
			 of differences between the test audit and the insurer audit.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0150 - Summary of Test Audit Results

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Test audit results shall be summarized quarterly for the individual insurer or
			 insurer group, as well as for the industry as a whole. The summary must include
			 all prior quarters up to but not exceeding a total of six quarters. The summary
			 must reflect separately the results of field audits, desk audits, and reviews
			 of payroll reports. An example of this report template is located on the
			 Department of Consumer and Business Services, Insurance Division website at
www.insurance.oregon.gov
.
(2) The summary of test audit results must be
			 reported quarterly to the insurer's home office to the attention of the
			 designated contact. If the insurer' home office is located outside Oregon, a
			 copy of the summary results must also be forwarded to the Oregon branch or
			 division office that reports directly to the home office. It shall be the
			 insurer's responsibility to keep the bureau advised of the responsible contact
			 to whom the summary results should be directed.
(3) The bureau shall meet with each insurer
			 to review its results and when requested, may offer remedial suggestions when
			 such action is indicated.
(4) The
			 bureau shall maintain sufficient records to permit accurate reporting to the
			 insurer and the director.
(5)
			 Copies of all individual insurer and summary reports shall be submitted to the
			 director upon completion.
Exhibits referenced are available from the
				  agency.
Statutory/Other Authority: ORS
				  731.244 & 737.318
Statutes/Other Implemented: ORS
				  737.318
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0155 - Test Audit Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 insurer that fails to achieve the Minimum Standard of the Test Audit
			 Performance for six consecutive quarters shall meet with the director, or the
			 director' designated representative, to provide a detailed explanation of the
			 remedial measures the insurer is taking to restore overall audit proficiency to
			 an acceptable level. An insurer meets the Minimum Standard when the insurer
			 satisfies the requirement that the number of premium differences in excess of
			 $500 or two percent of the insured's standard premium, whichever is greater,
			 must not exceed the critical number shown in the Table of Minimum Standards
			 Exhibit 2.
(2) If an insurer still
			 fails to achieve the Minimum Standard following presentation of remedial
			 measures to the director, as required in section (1) of this rule, the director
			 may impose a penalty, including possible suspension of the insurer's
			 certificate of authority.
(3) For
			 the purposes of this rule, only policies that exceed $5,000 in annual standard
			 premium after test audit will be used to determine whether an insurer achieves
			 the Minimum Standard.
Exhibits referenced are available from the
				  agency.
Statutory/Other Authority: ORS
				  731.244 & 737.318
Statutes/Other Implemented: ORS
				  737.318
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0165 - Monitoring Audit Program System

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 The director shall examine every insurer at least once each three years for the
			 purpose of determining its compliance with:
(a) The statistical reporting requirements of
			 OAR 836-042-0045;
(b) The premium
			 audit program requirements of OAR 836-043-0110  and 836-043-0115; and
(c) The minimum standards of insured
			 education programs of OAR 836-043-0120.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0175 - Statutory Authority; Purpose; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-043-0175  to 836-043-0185  are
			 adopted by the Director of the Department of Consumer and Business Services
			 pursuant to the provisions of ORS
			 737.310.
(2) The purpose of these rules is to
			 prescribe minimum standards for notice by insurers to insureds regarding
			 approved rate classifications.
(3)
			 These rules apply to all authorized workers' compensation insurers and the
			 State Accident Insurance Fund Corporation.
Stat. Auth.: ORS
				  731.244 &
				  737.310
Stats. Implemented: ORS
				  737.310
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0180 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-043-0175  to 836-043-0185  unless the context
				requires otherwise:
(1) "Bureau" means
			 the licensed rating organization of this state for workers' compensation
			 insurance.
(2) "Classification"
			 means a grouping of insurance risks according to a classification system used
			 by an insurer.
(3) "Classification
			 System" means a schedule of classifications and a rule or set of rules used by
			 an insurer for determining the classifications applicable to an
			 insured.
(4) "Insurer" means any
			 insurer authorized to transact workers' compensation insurance or the State
			 Accident Insurance Fund Corporation.
(5) "Reclassification" means an addition or
			 removal of a classification by an insurer to a policy for an insured when the
			 previous classification is improper or inadequate.
(6) "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 Chapter
			 656, similar laws of the United States or agreement between states.
Stat. Auth.: ORS
				  731.244 &
				  737.310
Stats. Implemented: ORS
				  737.310
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0185 - Insurer Classification Notice

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When an insurer issues a workers'
			 compensation insurance policy to an insured for the first time, an insurer
			 shall provide each insured a written rate classification notice describing the
			 work activities of each classification assigned. This information may be
			 delivered via electronic means, as provided for under ORS Chapter 84.
(2) The rate classification notice shall
			 include the following information:
(a) The
			 complete description for each classification assigned as contained in the
			 insurers' classification system filed with and approved by the
			 director;
(b) An adequate
			 description of work activities for such classification as reviewed by the
			 director;
(c) One or more
			 publications that include basic ratemaking and classification information and
			 necessary records and reporting procedures for the division of payroll of an
			 individual employee among classifications assigned as provided for under OAR
			 836-042-0060;
(d) An amendatory
			 endorsement to the policy for reclassification assignments during the policy
			 year as provided for under ORS
			 737.310(13).
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0200 - Statutory Authority; Purpose; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-043-0200  to 836-043-0240  are
			 adopted by the Director pursuant to ORS
			 731.244,
			 737.310(13) and
			 737.526(1) to
			 aid in the effectuation of insurer filings under
			 737.205, the review of workers'
			 compensation insurance filings under
			 737.320 and the hearing process
			 under 737.505 for persons aggrieved by
			 the application of the rating system.
(2) The purpose of these rules is to
			 establish an Oregon Workers' Compensation Rating System Review and Advisory
			 Committee by which the authorized workers' compensation rating organization for
			 this state may:
(a) Exchange information and
			 experience data with its members and the Director;
(b) Consult and cooperate with its members
			 and the Director with respect to National Council on Compensation Insurance
			 filings and to application of workers' compensation rating system;
			 and
(c) Hear insured grievances
			 regarding the application of its rating system.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0220 - Committee Participation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Committee shall consist of seven voting and one nonvoting member as follows:
(a) Five voting members shall be insurers,
			 one of which shall be the State Accident Insurance Fund Corporation. No two
			 insurers that share common ownership or management so as to meet the definition
			 of a controlled group under
Sections 851(c)(3) or 1563(a)
of
			 the
Internal Revenue Code
shall serve together on the
			 Committee;
(b) One voting member
			 shall be an Oregon Workers' Compensation insured;
(c) One voting member shall be a "public
			 body" as defined by ORS
			 192.410(1);
(d) The nonvoting member shall be the
			 Director or the Director's designee.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0240 - Committee Activities

Current through Register Vol. 63, No. 7, July 1, 2024
The subject matter jurisdiction of the Committee shall include
				but not be limited to the following:
(1) Any insured or insurer grievance
			 regarding the application of any part of the NCCI rating system adopted by the
			 insurer, including but not limited to:
(a) A
			 classification;
(b) Classification
			 system;
(c) Experience rating
			 system or component thereof; or
(d)
			 Rating plans including the retrospective rating plans, component parts and
			 tables.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0300 - Qualifications for Workers' Compensation Rating Oganizations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Prior to operating in Oregon, a worker's
			 compensation rating organization shall apply to the Director for a license. The
			 Director shall act on the application within 60 days of the application. Prior
			 to approving any applicant's license, the Director shall determine that the
			 organization meets the qualifications and requirements of ORS
			 737.355(1).
(2) The rating organization shall include
			 with its application the following documents:
(a) Copies of its articles of
			 incorporation,
(b)
			 Bylaws,
(c) Biographies of its
			 corporate officers,
(d) A
			 description of its operation,
(e)
			 Copies of its last three quarterly financial statements,
(f) A copy of its two most recent annual
			 report,
(g) Copies of its
			 Securities and Exchange Commission filings, if any.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0310 - Exchange of Data Among Workers' Compensation Rating Organizations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Not later than
			 the 25th day of each month, each licensed workers' compensation rating
			 organization shall report to the statistical agent all edited data reported by
			 its member insurers under OAR 836-042-0045  during the prior month that the
			 rating organization finds useable for experience rating.
(2) The data to be reported by each rating
			 organization under section (1) of this rule includes all financial data by
			 policy year, accident year and calendar year.
Stat. Auth.: ORS
				  731.244 and
				  737.355
Stats. Implemented: ORS
				  737.355
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0320 - Competitive Selection Process; Designation of a Workers' Compensation Statistical Agent

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When the
			 Director licenses more than one workers' compensation rating organization, the
			 Director shall notify each licensed rating organization of the Director's
			 intent to begin a competitive process for selecting a statistical agent for
			 gathering workers' compensation insurance data. Only a licensed workers'
			 compensation rating organization may apply for designation as the statistical
			 agent.
(2) The notification
			 required in section (1) of this rule shall describe the competitive process and
			 establish a deadline for applications and related submissions.
(3) Upon receipt of notice of the Director's
			 intent to begin a selection process, and licensed rating organization may, in
			 writing to the Director, waive its right to pursue selection as the designated
			 statistical agent.
(4) Each
			 applicant for designation as the statistical agent must submit the following
			 with its proposal:
(a) A compilation plan
			 that provides for:
(A) A flow of required
			 data to the state;
(B) A flow of
			 statewide compiled data to all rating organizations and their member insurers,
			 and interested agents and insured employers; and
(C) A flow of individual insured employer
			 data necessary for employerexperience rating and other individual employer
			 rating of the insured employers of each rating organization's members to each
			 rating organization and their member insurers, and the authorized agents of the
			 insured employers and the insured employers;
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0000 - Purpose, Statutory Authority and Implementation

Current through Register Vol. 63, No. 7, July 1, 2024
OAR 836-050-0000  to 836-050-0020  are adopted under the
				authority of ORS 731.244,
				742.156 and
				742.158, for the purpose of
				implementing 742.156 and
				742.158, relating to assumption
				reinsurance.
Stat. Auth.: ORS
				  731.244,
				  742.156,
				  742.158
Stats. Implemented: ORS
				  742.156,
				  742.158
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0010 - Notice of Transfer

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 insurer transferring obligations or risks through an assumption reinsurance
			 agreement subject to ORS
			 742.150, shall provide or cause
			 to be provided to each policyholder or certificate holder a notice of transfer
			 by first-class mail, addressed to the last-known address of the policyholder or
			 certificate holder or to the address to which premium notices or other policy
			 documents are sent. For insurance business on which premiums are collected on a
			 weekly or monthly basis by an insurance producer of the insurer, the notice of
			 transfer must be sent by personal delivery with acknowledged receipt. Notice of
			 transfer must also be sent to the transferring insurer's insurance producer or
			 brokers of record on the affected policies.
(2) The notice of transfer must state or
			 provide:
(a) The date the transfer and
			 novation of the policyholder's policy or certificate holder's certificate are
			 proposed to take place;
(b) The
			 names, addresses and telephone numbers of the assuming insurer and the
			 transferring insurer;
(c) That the
			 policyholder or certificate holder may either consent to or reject the transfer
			 and novation;
(d) The procedures
			 and time limit for consenting to or rejecting the transfer and
			 novation;
(e) A summary of any
			 effect that consenting to or rejecting the transfer and novation will have on
			 the policyholder's or certificate holder's rights;
(f) A statement that the assuming insurer is
			 authorized to transact the type of insurance being assumed in the state in
			 which the policyholder or certificate holder resides, or is otherwise
			 authorized under ORS 742.150 to
			 742.162 to assume such
			 insurance;
(g) The name and address
			 of the representative of the transferring insurer to whom the policyholder or
			 certificate holder should send its written statement of acceptance or rejection
			 of the transfer and novation;
(h)
			 The address and phone number of the insurance regulatory office of the state in
			 which the policyholder or certificate holder resides so that the policyholder
			 or certificate holder may write or call the office for further information
			 regarding the financial information of the assuming insurer;
(i) A statement that the insurer will furnish
			 to the policyholder or certificate holder, upon request, financial data for
			 both insurers, including at a minimum the data described in section (3) of this
			 rule; and
(j) An explanation of the
			 reason for the transfer.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0020 - Notice of Rejection

Current through Register Vol. 63, No. 7, July 1, 2024
A policyholder or certificate holder who elects to reject the
				transfer and novation of the policy under an assumption reinsurance agreement
				to which ORS 742.150 applied must give notice
				indicating rejection to the transferring insurer on a pre-addressed,
				postage-paid response card provided by the transferring insurer in the notice
				of transfer as required in OAR 836-050-0010  and
Exhibit 1
to that
				rule, or in another written notice by the policyholder or certificate
				holder.
Exhibits referenced are available from the
				  agency.
Stat. Auth.: ORS
				  731.244,
				  742.156,
				  742.158
Stats. Implemented: ORS
				  742.156,
				  742.158
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0105 - Statutory Authority; Purpose; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-050-0105  to 836-050-0120 are
			 adopted by the Director pursuant to ORS
			 743.028.
(2) The purpose of OAR 836-050-0105  to
			 836-050-0120 is to prescribe, as required by ORS
			 743.028, uniform health
			 insurance claims forms that must be accepted by all insurers transacting health
			 insurance in this state and by all state agencies that require health insurance
			 claim forms for their records.
(3)
			 OAR 836-050-0105  to 836-050-0120 do not apply to claims for vision care or
			 drugs, or to benefits paid on other than an expense-incurred basis.
(4) "Insurer" as used in OAR 836-050-0105  to
			 836-050-0120 includes health care service contractors and state agencies that
			 require health insurance claim forms for their records.
Stat. Auth.: ORS
				  731.244 & ORS
				  743.028
Stats. Implemented: ORS
				  743.028
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0110 - Uniform Claim Forms

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 insurer shall accept a properly completed claim submitted on the applicable
			 uniform form prescribed by the exhibits to this rule, or on the substantially
			 identical respective form approved by the American Medical Association's
			 Council on Medical Services or the American Dental Association's Council on
			 Dental Care Programs, as follows:
(a)
Exhibit 1
-- For claims other than dental care claims;
(b)
Exhibit 2
-- For dental care
			 claims.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0115 - Permitted Modifications to Uniform Forms

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer may add to the face of the
			 form its own identification and similar information, including insurer name and
			 logo and policy identification by color coding or otherwise. The captions may
			 be supplemented by instructions that merely facilitate the completion of the
			 form.
(2) An insurer may add to the
			 back of the form or, for
Exhibit 2
, to any blank area on the face
			 of the form, an item whose purpose is the certification of the status of the
			 patient as a person in the insured group or as a member of the family or
			 dependent of a person in the insured group. In the case of a claim form
			 required by a state agency, the back of the form may also contain such provider
			 certification and acknowledgment language as is required or permitted by
			 law.
(3) No alteration may be made
			 to the format of the face of the form. No addition to the form may impose any
			 additional requirement on any person, except for the certification item
			 permitted by section (2) of this rule.
(4) An insurer may screen the portions of the
			 uniform claim form that it does not require to be completed, if the screening
			 is done in such a way as to leave these portions usable by others.
The Exhibit(s) referenced in this rule is not printed in the
				  OAR Compilation. Copies are available from the
				  agency.
Stat. Auth.: ORS
				  731.244 & ORS
				  743.028
Stats. Implemented: ORS
				  743.028
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0150 - Advance Payments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 notice required by ORS
			 12.155 shall contain the
			 following:
(a) The time and location of the
			 occurrence in regard to which the advance payment is made.
(b) A statement to the effect that the amount
			 of any advance payment will be credited against any judgment entered in favor
			 of the payee.
(c) The following
			 words: "The period of limitation for commencement of an action for damages as
			 set by Chapter 12 of Oregon Revised Statutes will expire on _____", or such
			 other similar words as the Director of the Department of Consumer and Business
			 Services approves.
(d) The
			 signature of a person authorized to act for the insurer.
(e) The date on which notice is transmitted
			 to the party entitled to the advance payment.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0200 - Purpose, Scope and Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-050-0200  to 836-050-0215  provide
			 for equitable coverage under life and health insurance policies for conditions
			 relating to HIV-infection, including AIDS and ARC. OAR 836-050-0200  to
			 836-050-0215  apply to all health insurance policies, including those of
			 fraternal benefit societies and health care service contractors, issued or
			 delivered for issue in Oregon. OAR 836-050-0200, 836-050-0205, 836-050-0207,
			 and 836-050-0210  apply to all life insurance policies, including those of
			 fraternal benefit societies, issued or delivered for issue in Oregon.
(2) For purposes of OAR 836-050-0200  to
			 836-050-0215:
(a) "AIDS" means Acquired
			 Immunodeficiency Syndrome;
(b)
			 "ARC" means AIDS Related Complex;
(c) "HIV" means Human Immunodeficiency
			 Virus.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0205 - Authority

Current through Register Vol. 63, No. 7, July 1, 2024
OAR 836-050-0200  to 836-050-0215  are adopted by the Director
				pursuant to the general rulemaking authority of the Director under ORS
				731.244, for the purpose of
				carrying out the responsibilities of the Director under
				731.008 and
				731.016, regarding the
				protection of the insurance-buying public, under
				742.003 and
				742.005, regarding approval of
				forms, and under ORS 746.240, regarding definition of
				unfair practices in the transaction of insurance.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS
				  742.005 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0207 - Unfair Trade Practices

Current through Register Vol. 63, No. 7, July 1, 2024
Failure of an insurer to comply with OAR 836-050-0210  and
				836-050-0215  is an unfair trade practice under ORS
				746.240.
Stat. Auth.: ORS 433, ORS 731, 743 & 746
Stats. Implemented: ORS
				  742.005 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0210 - General Exclusions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All
			 health insurance policies, other than those providing coverage only for
			 specified diseases, shall cover HIV infection, including AIDS and ARC, as they
			 would any other serious medical condition.
(2) All life insurance policies, other than
			 those providing coverage for specific causes of death only, shall cover death
			 from AIDS or ARC as they would death from any other cause.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS
				  742.005 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0215 - Pre-existing Condition Exclusions; Health Insurance

Current through Register Vol. 63, No. 7, July 1, 2024
With respect to health insurance policies:
(1) Asymptomatic HIV infection shall not be
			 considered a preexisting condition with respect to subsequent claims related to
			 AIDS or ARC. "Asymptomatic HIV infection" is that which is identified solely
			 through use of a test for a virus or antibodies to the virus.
(2) The period of exclusion for HIV infection
			 claims, when physical symptoms were present before the coverage date, shall be
			 no longer than that for other pre-existing diseases.
Stat. Auth.: ORS 433, ORS 731, ORS 743 & ORS 746
Stats. Implemented: ORS
				  742.005 & ORS
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0230 - Purpose, Scope and Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-050-0230  to 836-050-0255  provide
			 for fair standards of underwriting for risks relating to HIV infection and
			 apply to all transactions of life and health insurance subject to the
Oregon Insurance Code
. Such transactions include the underwriting
			 of applicants for coverage under individual and group life and health
			 insurance, as well as the setting of group underwriting standards. OAR
			 836-050-0230  to 836-050-0255  apply to all insurers, including health care
			 service contractors and fraternal benefit societies, and all insurance
			 producers and insurance support organizations, that are engaged in the
			 transaction of life and health insurance under the
Oregon Insurance
			 Code
.
(2) For purposes of
			 OAR 836-050-0230  to 836-050-0255:
(a) "AIDS"
			 means Acquired Immunodeficiency Syndrome;
(b) "ARC" means AIDS Related
			 Complex;
(c) "HIV" means Human
			 Immunodeficiency Virus.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0235 - Rulemaking Authority

Current through Register Vol. 63, No. 7, July 1, 2024
OAR 836-050-0230  to 836-050-0255  are adopted by the Director
				pursuant to the general rulemaking authority of the Director under ORS
				731.244, for the purpose of
				carrying out the responsibilities of the Director under
				731.008 and
				731.016, regarding the
				protection of the insurance-buying public, under
				742.003 and
				742.005, regarding approval of
				forms, and under 746.240, regarding definition of
				unfair practices in the transaction of insurance; and for the purpose of
				assuring compliance by insurers with the requirements of
				433.045.
Stat. Auth.: ORS 433, ORS 731, 743 & 746
Stats. Implemented: ORS
				  433.045(7),
				  742.005 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0237 - Unfair Trade Practices

Current through Register Vol. 63, No. 7, July 1, 2024
Failure of an insurer to comply with any provision of OAR
				836-050-0240  or 836-050-0245, or the requirement in 836-050-0250(2)(a)  that
				testing for HIV infection be done only with the informed consent of the
				applicant for insurance, is an unfair trade practice under ORS
				746.240.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS
				  433.045(7),
				  742.005 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0240 - General Principles

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No
			 inquiry in an application for health or life insurance coverage, in an
			 investigation conducted by an insurer, insurance producer or insurance support
			 organization in connection with an application for such coverage, shall be
			 directed toward determining the applicant's sexual orientation.
(2) Sexual orientation shall not be used in
			 the underwriting process or in the determination of insurability.
(3) Insurance support organization shall be
			 directed by insurers not to investigate, directly or indirectly, the sexual
			 orientation of an applicant or a beneficiary.
(4) Testing for or asking medical questions
			 about HIV infection, including ARC and AIDS, is prohibited when not done in
			 conjunction with testing for or asking medical questions about other health
			 conditions. However, testing for HIV infection alone is permissible if the
			 applicant has answered affirmatively that the applicant has tested positive in
			 any HIV antibody test or has been diagnosed as having HIV infection, including
			 AIDS or ARC.
Stat. Auth.: ORS 433, 731, 743 & 746
Stats. Implemented: ORS
				  433.045(7),
				  742.005 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0245 - Medical and Lifestyle Application Questions and Underwriting Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No question
			 shall be used that is designed to establish the sexual orientation of the
			 applicant.
(2) The following
			 provisions govern medical questions relating to HIV infection:
(a) Questions relating to the applicant's
			 having or having been diagnosed as having HIV infection, including AIDS or ARC,
			 are permissible if the questions are factual and designed to establish the
			 existence of the condition. For example, insurer shall not ask such questions
			 as "do you believe you may have...?", or "have you had any indications of...?",
			 but insurers may ask "have you been diagnosed or treated for...?";
(b) Questions relating to HIV infection,
			 including AIDS and ARC, may be asked, but only if questions related to other
			 high risk medical conditions are also asked. The questions must be presented
			 and asked, and the answers used, in the same manner as other questions and
			 their answers relating to other high risk medical conditions. Additional
			 questions may be asked in a supplement but the supplement must be used in
			 conjunction with medical questions on the application form.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0250 - Testing for HIV Infection

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 An insurer may not rate or deny coverage on the basis of test results unless
			 the rating or denial is based on a test protocol consisting of two positive
			 ELISA tests confirmed by a Western Blot test or another test or test series
			 that the state epidemiologist finds to be no less accurate. This testing series
			 may be performed on blood samples, or on oral specimens or urine obtained and
			 tested according to approval by the federal Food and Drug Administration. If
			 the result of a Western Blot test is indeterminate, the insurer may postpone
			 action on the application not longer than six months after the date of that
			 Western Blot test in order to retest the applicant for conclusive Western Blot
			 test results. The insurer may rate or deny coverage only if retesting produces
			 the positive testing result or if the applicant declines the retesting or fails
			 to respond to a request for retesting by the insurer.
(2) The following provisions apply to all
			 testing for HIV infection and consent therefor:
(a) Testing may be done only with the
			 informed consent of the applicant. Any test that helps an insurer determine the
			 presence of HIV infection and is performed in conjunction with an insurance
			 application shall have a signed consent by the applicant regarding the specific
			 types of tests involved. This consent shall require the applicant to designate
			 the person to whom final positive test results are to be reported. The
			 applicant may designate a named physician, the county health department or the
			 applicant directly. An insurer may obtain the consent of the applicant at any
			 time in the underwriting process prior to obtaining a sample or
			 specimen.
(b) The consent form must
			 be submitted to the Director for approval before use. A consent form may not be
			 used unless the Director has approved the form as complying with OAR
			 836-050-0230  to 836-050-0255.
(c)
			 An insurer shall disclose to the applicant when soliciting consent that the
			 test is used for determining insurability.
(d) A copy of an informational brochure
			 containing the information in
Exhibit 1
shall be given to the
			 applicant prior to or at the time of consent. [Exhibit not included. See ED.
			 NOTE.] The consent form and informational brochure may be combined in one
			 form.
(e) A consent form signed by
			 an applicant is valid for six months following the date that the consent form
			 was signed. The consent form must so state. If after six months the test is not
			 performed or retesting is needed, a new signed consent form must be
			 obtained.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0255 - Inquiries Regarding Past Test Results

Current through Register Vol. 63, No. 7, July 1, 2024
Insurers may ask whether an applicant has tested positive in
				any HIV antibody test, subject to the following restrictions:
(1) General questions asking only whether the
			 applicant has taken such a test, regardless of outcome, are
			 prohibited.
(2) Except as provided
			 in this section, an insurer may not rate or deny coverage based merely on an
			 affirmative response on the application to a questions about past test results.
			 Before rating or denying coverage, the insurer must confirm a positive result
			 to the full test protocol described in OAR 836-050-0250  through medical records
			 or current retesting unless:
(a) The applicant
			 fails to respond to a request by the insurer for the medical records or for
			 retesting; or
(b) The insurer is
			 informed that the applicant declines such further testing.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0275 - Credit Unions as Associations; Group Life Insurance

Current through Register Vol. 63, No. 7, July 1, 2024
A credit union organized under ORS Chapter 723, a credit union
				authorized to conduct business as a credit union in this state under
				723.042 or a federal credit
				union the principal office of which is located in Oregon is considered to be
				maintained primarily for purposes other than the procurement of insurance. Such
				a credit union may qualify as an association for the purposes of being the
				policyholder of a group life insurance policy if:
(1) The credit union is authorized to provide
			 insurance to its members under the laws under which the credit union is
			 organized; and
(2) The Director
			 determines that the credit union otherwise satisfies the requirements of ORS
			 743.351(1).
Stat. Auth.: ORS 731 & 743
Stats. Implemented: ORS
				  743.303 &
				  743.351
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0280 - Credit Unions as Association; Group Health Insurance

Current through Register Vol. 63, No. 7, July 1, 2024
A credit union organized under ORS chapter 723, a credit union
				authorized to conduct business as a credit union in this state under
				723.042 or a federal credit
				union the principal office of which is located in Oregon is considered to have
				a constitution and bylaws and to be maintained primarily for purposes other
				than the procurement of insurance. Such a credit union may qualify as an
				association for the purposes of being the policyholder of a group health
				insurance policy if:
(1) The credit
			 union is authorized to be such a policyholder under the laws under which the
			 credit union is organized; and
(2)
			 The Director determines that the credit union otherwise satisfies the
			 requirements of ORS 743.522(2).
Stat. Auth.: ORS 731 & 743
Stats. Implemented: ORS
				  743.522 &
				  743.524
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0300 - Purpose, Authority, Application

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-050-0300  and 836-050-0305  are
			 adopted to implement section 2, chapter 22, Oregon Laws 2008 (Enrolled HB
			 3605), which requires the Director to adopt rules establishing general criteria
			 for orders that the Director is authorized to issue when the Governor declares
			 a state of emergency under ORS
			 401.055.
(2) OAR 836-050-0300  and 836-050-0305  apply
			 to a state of emergency declared by the Governor when the conditions leading to
			 the declaration substantially interfere with the public's ability to carry on
			 its normal business affairs.
Stat. Auth.: ORS
				  731.244 &2008 OL Ch. 22,
				  Sec. 2
Stats. Implemented: 2008 OL Ch. 22, Sec.
				  2
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 50 - GENERAL PROVISIONS › Section 836-050-0305 - Criteria for orders

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 order issued pursuant to section 2, chapter 22, Oregon Laws 2008 (Enrolled HB
			 3605):
(a) Must include the items required in
			 that section to be specified by line of insurance; and
(b) Must make a statement of general findings
			 that refers to the specific declaration of a state of emergency upon which the
			 order is based, describes the need for the order and declares the harm to be
			 prevented or mitigated by the order.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0005 - Statutory Authority; Purpose; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-051-0005  to 836-051-0020  are
			 adopted by the Director pursuant to general rulemaking authority in ORS
			 731.244, and specific authority
			 in 742.009 to issue rules requiring
			 disclosures to prospective insurance purchasers.
(2) The purpose of OAR 836-051-0005  to
			 836-051-0020  is to require insurers that are not electing to illustrate life
			 insurance policies under 836-051-0500  to 836-051-0600  to deliver to prospective
			 buyers of life insurance guaranteed policy information that will improve the
			 buyer's ability to select the most appropriate plan of life insurance for the
			 buyer's needs, improve the buyer's understanding of the basic features of the
			 policy that has been purchased or that is under consideration and improve the
			 buyer's ability to evaluate the relative costs of similar plans of life
			 insurance. OAR 836-051-0005  to 836-051-0020  do not prohibit the use of
			 additional material that is not in violation of these or other rules of the
			 Director or provisions of the Insurance Code.
(3) OAR 836-051-0005  to 836-051-0020  apply to
			 all transactions of life insurance in this state except with respect to:
(a) Annuities;
(b) Credit life insurance;
(c) Group life insurance;
(d) Life insurance policies issued in
			 connection with employee benefit plans as defined by Section 3(3) of the
			 federal Employee Retirement Income Security Act of 1974 (ERISA) as amended from
			 time to time; and
(e) Life
			 insurance policies that comply with OAR 836-051-0500  to 836-051-0600.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-051-0005  to 836-051-0020:
(1) "Buyer's Guide" means a document that
			 contains, and is limited to, the wording contained in Exhibit 1 or other
			 wording approved by the Director.
(2) "Cash Dividend" means the currently
			 illustrated dividend that can be applied toward payment of the gross
			 premium.
(3) "Equivalent Level
			 Annual Dividend" means the amount calculated by the following steps:
(a) Accumulate the annual cash dividends at
			 five percent interest, compounded annually, to the ends of the 10th and 20th
			 policy years;
(b) Divide each
			 accumulation of step (a) by an interest factor that converts it into the
			 equivalent level annual amount that, if paid at the beginning of each year,
			 would accumulate to the value in step (a) over the respective period. If the
			 period is 10 years, the factor is 13.207 and if the period is 20 years, the
			 factor is 34.719;
(c) Divide the
			 results of step (b) by the number of thousands of the Equivalent Level Death
			 Benefit to arrive at the Equivalent Level Annual Dividend for each of the
			 respective periods.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0015 - Disclosure Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 insurer shall provide to each prospective buyer of life insurance a Buyer's
			 Guide and a Policy Summary prior to accepting the applicant's initial premium
			 or premium deposit, except that if the policy for which application is made
			 contains an unconditional refund provision effective for at least ten days or
			 if the Policy Summary contains such an unconditional refund provision, the
			 Buyer's Guide and Policy Summary must be delivered with the policy or prior to
			 delivery of the policy.
(2) An
			 insurer shall provide a Buyer's Guide and a Policy Summary to any prospective
			 buyer upon request of the prospective buyer.
(3) In the case of policies for which the
			 Equivalent Level Death Benefit does not exceed $5,000, the Policy Summary need
			 include only the information described in the items in OAR 836-051-0010(8)(b),
			 (c), (d), (e)(A), (e)(B), (e)(C), (f), (g), (j), and (k).
Stat. Auth.: ORS 731 & 743
Stats. Implemented: ORS
				  742.009(2)