reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0700 - Authorization, Genetic Testing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 person who asks an applicant for insurance to take a genetic test in connection
			 with an application for insurance shall obtain the specific authorization of
			 the applicant by use of the form in Exhibit 1 to this rule, or a form that is
			 substantively similar.
(2) This
			 rule implements ORS 746.135.
Stat. Auth.: ORS
				  746.135
Stats. Implemented: ORS
				  746.135
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0750 - Purpose; Authority; Applicability; and Effective Date

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-051-0750  to 836-051-0775  are
			 adopted pursuant to the general rulemaking authority of the Director in ORS
			 731.244, and specific authority
			 of ORS 733.306 and
			 743.215 for approving mortality
			 tables adopted by the National Association of Insurance Commissioners for use
			 in determining minimum valuation and nonforfeiture standards.
(2) OAR 836-051-0750  to 836-051-0775  apply to
			 preneed insurance and to similar policies and certificates used to fund funeral
			 services and expenses as determined by the Director, issued on or after January
			 1, 2009.
(3) The purpose of OAR
			 836-051-0750  to 836-051-0775  is to establish for preneed insurance products
			 minimum mortality standards for reserves and nonforfeiture values, and to
			 require the use of the 1980 Commissioners Standard Ordinary (CSO) Life
			 Valuation Mortality Table for use in determining the minimum standard of
			 valuation of reserves and the minimum standard nonforfeiture values for preneed
			 insurance products.
Stat. Authority: ORS
				  731.244,
				  733.306, 743.205
Stats. Implemented: ORS
				  733.306,
				  733.310,
				  743.215,
				  743.216,
				  743.221
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0755 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-051-0750  to 836-051-0775:
(1) "Preneed insurance" is any life insurance
			 policy that is issued in combination with, in support of, with an assignment
			 to, or as a guarantee for a prearrangement agreement for goods and services to
			 be provided at the time of and immediately following the death of the insured.
			 Goods and services may include, but are not limited to embalming, cremation,
			 body preparation, viewing or visitation, coffin or urn, memorial stone, and
			 transportation of the deceased. The status of the policy as preneed insurance
			 is determined at the time of issue in accordance with the policy form
			 filing.
(2) "Ultimate 1980 CSO"
			 means the 1980 Commissioners' Standard Ordinary Life Valuation Mortality Tables
			 (1980 CSO) without ten-year (10-year) selection factors, incorporated into the
			 1980 amendments to the NAIC Standard Valuation Law approved in December
			 1983.
Stat. Authority: ORS
				  731.244,
				  733.306, 743.205
Stats. Implemented: ORS
				  733.306,
				  733.310,
				  743.215,
				  743.216,
				  743.221
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0760 - Minimum Valuation Mortality Standards

Current through Register Vol. 63, No. 7, July 1, 2024
For preneed insurance and to similar policies and certificates
				used to fund funeral services and expenses, the minimum mortality standard for
				determining reserve liabilities and nonforfeiture values for both male and
				female insureds shall be the Ultimate 1980 CSO.
Stat. Authority: ORS
				  731.244,
				  733.306, 743.205
Stats. Implemented: ORS
				  733.306,
				  733.310,
				  743.215,
				  743.216,
				  743.221
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0765 - Minimum Valuation Interest Rate Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The interest rates used in determining
			 the minimum standard for valuation of preneed insurance shall be the calendar
			 year statutory valuation interest rates as defined in ORS
			 733.306 and
			 733.310.
(2) The interest rates used in determining
			 the minimum standard for nonforfeiture values for preneed insurance shall be
			 the calendar year statutory nonforfeiture interest rates as defined in ORS
			 743.215,
			 743.216 and
			 743.221.
Stat. Authority: ORS
				  731.244,
				  733.306, 743.205
Stats. Implemented: ORS
				  733.306,
				  733.310,
				  743.215,
				  743.216,
				  743.221
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0770 - Minimum Valuation Method Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The method used in determining the
			 standard for the minimum valuation of reserves of preneed insurance shall be
			 the method defined in ORS
			 733.306 and
			 733.310.
(2) The method used in determining the
			 standard for the minimum nonforfeiture values for preneed insurance shall be
			 the method defined in ORS
			 743.215,
			 743.216 and
			 743.221.
Stat. Authority: ORS
				  731.244,
				  733.306, 743.205
Stats. Implemented: ORS
				  733.306,
				  733.310,
				  743.215,
				  743.216,
				  743.221
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0775 - Transition Rules

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For preneed
			 insurance policies issued on or after the effective date of this rule and
			 before January 1, 2012, the 2001 CSO may be used as the minimum standard for
			 reserves and minimum standard for nonforfeiture benefits for both male and
			 female insureds.
(2) If an insurer
			 elects to use the 2001 CSO as a minimum standard for any preneed insurance
			 policy issued on or after the effective date of this rule and before January 1,
			 2012, the insurer shall provide, as a part of the actuarial opinion memorandum
			 submitted in support of the company's asset adequacy testing, an annual written
			 notification to the Director. The notification shall include:
(a) A complete list of all preneed insurance
			 policy forms that use the 2001 CSO as a minimum standard;
(b) A certification signed by the appointed
			 actuary stating that the reserve methodology employed by the company in
			 determining reserves for the preneed insurance policies issued after the
			 effective date and using the 2001 CSO as a minimum standard, develops adequate
			 reserves (For the purposes of this certification, the preneed insurance
			 policies using the 2001 CSO as a minimum standard cannot be aggregated with any
			 other policies.); and
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0900 - Purpose; Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR
			 836-051-0900  to 836-051-0925  establish standards for disclosure of minimum
			 information relating to annuity contracts, to protect consumers and foster
			 consumer education. OAR836-051-0900  to 836-051-0925  prescribe the minimum
			 information that must be disclosed and the method for disclosing it in
			 connection with the sale of annuity contracts. The goal of 836-051-0900  to
			 836-051-0925  is to ensure that purchasers of annuity contracts understand
			 certain basic features of annuity contracts.
(2) OAR 836-051-0900  to 836-051-0925  are
			 adopted pursuant to ORS
			 731.244 for the purpose of
			 implementing 746.075,
			 746.085,
			 746.110 &
			 746.240.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  742.009,
				  746.075,
				  746.085,
				  746.110, &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0905 - Applicability and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-051-0900  to 836-051-0925  apply to all group and individual annuity contracts and certificates except:
(a) Registered or non-registered variable annuities or other registered products;
(b) Immediate and deferred annuities that contain no nonguaranteed elements except as provided in OAR 836-051-0920(2);
(c) Annuities used to fund:
(A) An employee pension plan that is covered by the Employee Retirement Income Security Act (ERISA);
(B) A plan described by Sections  401(a),  401(k) or  403(b) of the Internal Revenue Code, when the plan, for purposes of ERISA, is established or maintained by an employer;
(C) A governmental or church plan defined in Section 414 or a deferred compensation plan of a state or local government or a tax exempt organization under Section  457 of the Internal Revenue Code; or
(D) A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor.
(d) Structured settlement annuities; and
(e) Funding agreements.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0910 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-051-0900  to 836-051-0925:
(1) "Contract owner" means the owner named in the annuity contract or a certificate holder in the case of a group annuity contract.
(2) "Determinable elements" means elements that are derived from processes or methods that are guaranteed at issue and not subject to insurer discretion, but in which the values or amounts cannot be determined until some point after issue. These elements include the premiums, credited interest rates (including any bonus), benefits, values, non-interest based credits, charges or elements of formulas used to determine any of these. These elements may be described as guaranteed but not determined at issue. An element is considered determinable if it was calculated from underlying determinable elements only, or from both determinable and guaranteed elements.
(3) "Free look" means the number of days immediately after delivery of the contract in which the contract owner has to examine the contract and decide to return it to get the purchase payment returned penalty free. May also be referred to as "Right to Examine."
(4) "Funding agreement" means an agreement for an insurer to accept and accumulate funds and to make one or more payments at future dates in amounts that are not based on mortality or morbidity contingencies.
(5) "Generic name" means a short title descriptive of the annuity contract being applied for or illustrated, such as "single premium deferred annuity."
(6) "Guaranteed elements" means the premiums, credited interest rates (including any bonus), benefits, values, non-interest based credits, charges or elements of formulas used to determine any of these, that are guaranteed and determined at issue. An element is considered guaranteed if all of the underlying elements that go into its calculation are guaranteed.
(7) "Non-guaranteed elements" means the premiums, credited interest rates (including any bonus), benefits, values, non-interest based credits, charges or elements of formulas used to determine any of these, that are subject to company discretion and are not guaranteed at issue. An element is considered non-guaranteed if any of the underlying non-guaranteed elements are used in its calculation.
(8) "Structured settlement annuity" means a "qualified funding asset" as defined in section  130(d) of the Internal Revenue Code or an annuity that, by its issue, would be a qualified funding asset under section 130(d) but for the fact that it is not owned by an assignee under a qualified assignment.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  742.009,
				  746.075,
				  746.085,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0915 - Standards for the Disclosure Document and Buyer's Guide

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When the application for an annuity
			 contract is taken in a face-to-face meeting, the applicant shall be given, at
			 or before the time of application, both the disclosure document described in
			 section (6) of this rule and the Buyer's Guide contained in Exhibit 1 to this
			 rule.
(2) When the application for
			 an annuity contract is taken by means other than in a face-to-face meeting, the
			 applicant shall be sent both the disclosure document and the Buyer's Guide no
			 later than five business days after the completed application is received by
			 the insurer. The following provisions apply to the requirement in this section:
(a) With respect to an application received
			 as a result of a direct solicitation through the mail:
(A) Providing a Buyer's Guide in a mailing
			 inviting prospective applicants to apply for an annuity contract satisfies the
			 requirement that the Buyer's Guide be provided no later than five business days
			 after receipt of the application.
(B) Providing a disclosure document in a
			 mailing inviting a prospective applicant to apply for an annuity contract
			 satisfies the requirement that the disclosure document be provided no later
			 than five business days after receipt of the application.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0920 - Report to Contract Owners

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For
			 an annuity in the payout period with changes in non-guaranteed elements and for
			 the accumulation period of a deferred annuity, the insurer shall provide each
			 contract owner with a report, at least annually, on the status of the contract
			 that contains at least the following information:
(a) The beginning and end date of the current
			 report period.
(b) The accumulation
			 and cash surrender value, if any, at the end of the previous report period and
			 at the end of the current report period.
(c) The total amounts, if any, that have been
			 credited, charged to the contract value or paid during the current report
			 period; and
(d) The amount of
			 outstanding loans, if any, as of the end of the current report
			 period.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 51 - LIFE, INDIVIDUAL AND GROUP; ANNUITIES › Section 836-051-0925 - Trade Practice Regulation

Current through Register Vol. 63, No. 7, July 1, 2024
Violation of any provision of OAR 836-051-0900  to 836-051-0925 is an unfair trade practice under ORS
				746.240.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  742.009,
				  746.075,
				  746.085,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0103 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR
			 836-052-0103  to 836-052-0194  are adopted in order to:
(a) Provide for the standardization of
			 coverage and simplification of terms and benefits of Medicare supplement
			 policies;
(b) Facilitate public
			 understanding and comparison of such policies;
(c) Eliminate provisions contained in such
			 policies that may be misleading or confusing in connection with the purchase of
			 such policies or with the settlement of claims; and
(d) Provide for full disclosures in the sale
			 of accident and sickness insurance coverage to persons eligible for
			 Medicare.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0107 - Authority

Current through Register Vol. 63, No. 7, July 1, 2024
OAR 836-052-0103  to 836-052-0194  are adopted pursuant to the
				general rulemaking authority of the Director under ORS
				731.244 and the specific
				authority in ORS 742.009,
				743.013,
				743.680 to
				743.689, and
				746.240.
Stat. Auth.: ORS
				  731.244, ORS
				  743.010, ORS
				  743.013, ORS
				  743.680 - ORS
				  743.689 & ORS
				  746.240
Stats. Implemented: ORS
				  743.010(2)
				  & ORS 743.683
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0114 - Applicability and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Except
			 as otherwise specifically provided in OAR 836-052-0134, 836-052-0140,
			 836-052-0144, 836-052-0145, 836-052-0160  and 836-052-0185, 836-052-0103  to
			 836-052-0194  apply to the following Medicare supplement policies and
			 certificates issued under group Medicare supplement policies, as follows:
(a) All Medicare supplement policies
			 delivered or issued for delivery in this state on or after July 1, 1992;
			 and
(b) All certificates issued
			 under group Medicare supplement policies and delivered or issued for delivery
			 in this state on or after July 1, 1992.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0119 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-052-0103  to 836-052-0194:
(1) "Applicant" means:
(a) In the case of an individual Medicare
			 supplement policy, the person who seeks to contract for insurance
			 benefits;
(b) In the case of a
			 group Medicare supplement policy, the proposed certificate holder.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0124 - Policy Definitions and Terms

Current through Register Vol. 63, No. 7, July 1, 2024
A policy or certificate may not be advertised, solicited or
				issued for delivering in this state as a Medicare supplement policy or
				certificate unless the policy or certificate contains definitions or terms that
				conform to the following requirements:
(1) "Accident," "accidental injury" or
			 "accidental means" shall be defined to employ "result" language and shall not
			 include words that establish an accidental means test or use words such as
			 "external, violent, visible wounds" or similar words of description or
			 characterization. The following provisions also apply to definition of the
			 terms under this section:
(a) The definition
			 shall not be more restrictive than the following: "'Injury or injuries for
			 which benefits are provided' means accidental bodily injury sustained by the
			 insured person that is the direct result of an accident, independent of disease
			 or bodily infirmity or any other cause, and occurs while insurance coverage is
			 in force";
(b) The definition may
			 provide that injuries shall not include injuries for which benefits are
			 provided or available under any worker's compensation, employer's liability or
			 similar law or motor vehicle no-fault plan, unless prohibited by law.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0129 - Policy Provisions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Except
			 for permitted preexisting condition clauses as described in OAR
			 836-052-0133(2)(a), 836-052-0134(2)(a)  and 836-052-0132(1)(a), no policy or
			 certificate may be advertised, solicited or issued for delivery in this state
			 as a Medicare supplement policy if the policy or certificate contains
			 limitations or exclusions on coverage that are more restrictive than those of
			 Medicare.
(2) No Medicare
			 supplement policy or certificate may use waivers to exclude, limit or reduce
			 coverage or benefits for specifically named or described preexisting diseases
			 or physical conditions.
(3) No
			 Medicare supplement policy or certificate in force in the state shall contain
			 benefits that duplicate benefits provided by Medicare.
(4)
(a)
			 Subject to OAR 836-052-0133(2)(d) and (e), 836-052-0134(2)(d), (e) and (g)  and
			 836-052-0133(1)(d) and (e), a Medicare supplement policy with benefits for
			 outpatient prescription drugs in existence prior to January 1, 2006 may be
			 renewed for current policyholders who do not enroll in Part D at the option of
			 the policyholder.
(b) A Medicare
			 supplement policy with benefits for outpatient prescription drugs may not be
			 issued after December 31, 2005.
(c)
			 After December 31, 2005, a Medicare supplement policy with benefits for
			 outpatient prescription drugs may not be renewed after the policyholder enrolls
			 in Medicare Part D unless:
(A) The policy is
			 modified to eliminate outpatient prescription coverage for expenses of
			 outpatient prescription drugs incurred after the effective date of the
			 individual's coverage under a Part D plan; and
(B) Premiums are adjusted to reflect the
			 elimination of outpatient prescription drug coverage at the time of Medicare
			 Part D enrollment, accounting for any claims paid, if applicable.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0132 - Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date of Coverage on or After June 1, 2010

Current through Register Vol. 63, No. 7, July 1, 2024
The following standards are applicable to all Medicare
				supplement policies or certificates delivered or issued for delivery in this
				state with an effective date of coverage on or after June 1, 2010. A policy or
				certificate may not be advertised, solicited, delivered, or issued for delivery
				in this state as a Medicare supplement policy or certificate unless it complies
				with or exceeds the benefit standards set forth in this rule. No issuer may
				offer a 1990 Standardized Medicare supplement benefit plan for sale on or after
				June 1, 2010. Benefit standards applicable to Medicare supplement policies and
				certificates issued with an effective date of coverage before June 1, 2010
				remain subject to the requirements of OAR 836-052-0133, 836-052-0134  and
				836-052-0136.
(1) The following
			 standards apply to Medicare supplement policies and certificates and are in
			 addition to all other requirements of OAR 836-052-0103  to 836-052-0194:
(a) Regarding preexisting conditions, a
			 Medicare supplement policy or certificate shall not:
(A) Exclude or limit benefits for loss
			 incurred more than six months after the effective date of coverage because the
			 loss involved a preexisting condition; or
(B) Define a preexisting condition more
			 restrictively than a condition for which medical advice was given or treatment
			 was recommended by or received from a physician within six months before the
			 effective date of coverage.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0133 - Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The following standards in this rule are
			 applicable to all Medicare supplement policies or certificates delivered or
			 issued for delivery in this state on or after July 1, 1992 and with an
			 effective date of coverage prior to June 1, 2010. A policy or certificate may
			 not be advertised, solicited, delivered or issued for delivery in this state as
			 a Medicare supplement policy or certificate unless it complies with or exceeds
			 the benefit standards set forth in this rule.
(2) The following standards apply to Medicare
			 supplement policies and certificates and are in addition to all other
			 requirements of OAR 836-052-0103  to 836-052-0194.
(a) Regarding preexisting conditions, a
			 Medicare supplement policy or certificate shall not:
(A) Exclude or limit benefits for a loss
			 incurred more than six months after the effective date of coverage because the
			 loss involved a preexisting condition. The benefits shall be available after
			 the period of exclusion or limitation permitted under this subsection whether
			 or not a claim concerning the condition was made during the period and whether
			 or not a physician gave medical advice or recommended or gave treatment
			 concerning the condition during the period;
(B) Define a preexisting condition more
			 restrictively than a condition for which medical advice was given or treatment
			 was recommended by or received from a physician within six months before the
			 effective date of coverage.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0138 - Open Enrollment

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
(a) An issuer may not deny or condition the
			 issuance or effectiveness of any Medicare supplement policy or certificate
			 available for sale in this state, nor discriminate in the pricing of a policy
			 or certificate because of the health status, claims experience, receipt of
			 health care, or medical condition of an applicant in the case of an application
			 for a Medicare supplement policy or certificate that is submitted to the issuer
			 prior to or during the six month period beginning with the first day of the
			 first month in which an individual is enrolled for benefits under Medicare Part
			 B. Each Medicare supplement policy and certificate currently available from an
			 issuer shall be made available on a guaranteed issue basis to all applicants
			 who qualify under this section without regard to age.
(b) If a person under the age of 65 applies
			 for enrollment under Medicare Part B due to disability and is initially denied
			 as ineligible, but upon conclusion of the person's appeals process the person
			 is awarded retroactive enrollment, the six month period described in this
			 section begins on the first day of the first month after the person receives
			 written notice of retroactive enrollment.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0139 - Medicare Select Policies and Certificates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This section applies to Medicare Select
			 policies and certificates, as defined in this rule.
(2) No policy or certificate may be
			 advertised as a Medicare Select policy or certificate unless it meets the
			 requirements of this rule.
(3) For
			 the purposes of this rule:
(a) "Complaint"
			 means any dissatisfaction expressed by an individual concerning a Medicare
			 Select issuer or its network providers;
(b) "Grievance" means dissatisfaction
			 expressed in writing by an individual insured under a Medicare Select policy or
			 certificate with the administration, claims practices, or provision of services
			 concerning a Medicare Select issuer or its network providers;
(c) "Medicare Select issuer" means an issuer
			 offering, or seeking to offer, a Medicare Select policy or
			 certificate;
(d) "Medicare Select
			 policy" or "Medicare Select certificate" means respectively a Medicare
			 supplement policy or certificate that contains restricted network
			 provisions;
(e) "Network provider"
			 means a provider of health care, or a group of providers of health care, that
			 has entered into a written agreement with the issuer to provide benefits
			 insured under a Medicare Select policy;
(f) "Restricted network provision" means any
			 provision that conditions the payment of benefits, in whole or in part, on the
			 use of network providers; and
(g)
			 "Service area" means the geographic area approved by the Director of the
			 Department of Consumer and Business Services within which an issuer is
			 authorized to offer a Medicare Select policy.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0140 - Standards for Claims Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 An issuer must comply with Section 1882(c)(3) of the Social Security Act, as
			 enacted by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of
			 1987 (OBRA) 1987, Public Law No. 100-203, by:
(a) Accepting a notice from a Medicare
			 carrier on dually assigned claims submitted by participating physicians and
			 suppliers as a claim for benefits in place of any other claim form otherwise
			 required and making a payment determination on the basis of the information
			 contained in that notice;
(b)
			 Notifying the participating physician or supplier and the beneficiary of the
			 payment determination;
(c) Paying
			 the participating physician or supplier directly;
(d) Furnishing each enrollee, at the time of
			 enrollment, with a card listing the policy name, number and a central mailing
			 address to which notices from a Medicare carrier may be sent;
(e) Paying user fees for claim notices that
			 are transmitted electronically or otherwise; and
(f) Providing to the Secretary of Health and
			 Human Services, at least annually, a central mailing address to which all
			 claims may be sent by Medicare carriers.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0141 - Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates with an Effective Date of Coverage on or After June 1, 2010

Current through Register Vol. 63, No. 7, July 1, 2024
The following standards are applicable to all Medicare
				supplement policies or certificates delivered or issued for delivery in this
				state with an effective date for coverage on or after June 1, 2010. No policy
				or certificate may be advertised, solicited, delivered, or issued for delivery
				in this state as a Medicare supplement policy or certificate unless it complies
				with these benefit standards. No issuer may offer any 1990 Standardized
				Medicare supplement benefit plan for sale with an effective date for coverage
				on or after June 1, 2010. Benefit standards applicable to Medicare supplement
				policies and certificates with an effective date for coverage before June 1,
				2010 remain subject to the requirements of OAR 836-052-0133.
(1)
(a) An
			 issuer shall make available to each prospective policyholder and certificate
			 holder a policy form or certificate form containing only the basic core
			 benefits, as defined in OAR 836-052-0132(2).
(b) If an issuer makes available any of the
			 additional benefits described in OAR 836-052-0132(3)  or offers standardized
			 benefit Plans K or L as described subsections (5)(h) and (i) of this rule, then
			 the issuer shall make available to each prospective policyholder and
			 certificate holder, in addition to a policy form or certificate form with only
			 the basic core benefits as described in subsection (a) of this section, a
			 policy form or certificate form containing either standardized benefit Plan C
			 as described in subsection (5)(c) of this rule or standardized benefit Plan F
			 as described in subsection (5)(e) of this.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0142 - Guaranteed Issue for Eligible Persons

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Guaranteed issue:
(a) Eligible persons are those individuals
			 described in section (2) of this rule who seek to enroll under the policy
			 during the period specified in section (3) of this rule and who submit evidence
			 of the date of termination, disenrollment or Medicare Part D enrollment with
			 the application for a Medicare supplement policy.
(b) With respect to eligible persons, an
			 issuer shall not deny or condition the issuance or effectiveness of a Medicare
			 supplement policy described in section (5) of this rule that is offered and is
			 available for issuance to new enrollees by the issuer, shall not discriminate
			 in the pricing of such a Medicare supplement policy because of health status,
			 claims experience, receipt of health care or medical condition, and shall not
			 impose an exclusion of benefits based on a preexisting condition under such a
			 Medicare supplement policy.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0143 - Annual Opportunity to Select Another Medicare Supplement Policy or Certificate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For
			 the purposes of this rule, for 1990, 2010, and 2020 Medicare Supplement Plans,
			 "same or lesser benefits" means a policy or certificate of the same or lower
			 benefit level as indicated on a chart available on the website of the Division
			 of Financial Regulation of the Department of Consumer and Business
			 Services.
(2) Beginning 30 days
			 prior to a person's birthday and for 30 days after the person's birthday, a
			 person enrolled in a Medicare supplement policy may cancel the person's
			 existing Medicare supplement policy or certificate and purchase or select
			 another Medicare supplement policy or certificate with the same or lesser
			 benefits to replace the existing Medicare supplement policy or certificate. An
			 issuer may not deny or condition the issuance or effectiveness, nor
			 discriminate in the pricing of the replacement policy or certificate on the
			 basis of health status, claims experience, receipt of health care or medical
			 condition of the applicant.
(3)
			 This rule does not apply to Medicare supplement policies or certificates issued
			 or delivered before January 1, 1990.
Statutory/Other Authority: ORS
				  743.010, ORS
				  743.680 - 743.689 &
				  731.244
Statutes/Other Implemented: ORS
				  743.010 & ORS
				  743.683 -
				  743.684
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0144 - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or after January 1, 2020.

Current through Register Vol. 63, No. 7, July 1, 2024
The Medicare Access and CHIP Reauthorization Act of 2015
				(MACRA) requires the following standards to be applicable to all Medicare
				supplement policies delivered or issued for delivery in this state to
				individuals newly eligible for Medicare on or after January 1, 2020. No policy
				or certificate that provides coverage of the Medicare Part B deductible may be
				advertised, solicited, delivered or issued for delivery in this state as a
				Medicare supplement policy or certificate to individuals newly eligible for
				Medicare on or after January 1, 2020. All policies must comply with the
				following benefit standards. Benefit plan standards applicable to Medicare
				supplement policies and certificates issued to individuals eligible for
				Medicare before January 1, 2020 remain subject to the requirements of OAR
				836-052-0103  to 836-052-0194.
(1)
			 Benefit Requirements. The standards and requirements of OAR 836-052-0141  shall
			 apply to all Medicare supplement policies or certificates delivered or issued
			 for delivery to individuals newly eligible for Medicare on or after January 1,
			 2020 with the following exceptions:
(a)
			 Standardized Medicare supplement benefit Plan C is redesignated as Plan D and
			 shall provide the benefits contained in OAR 836-052-0141(5)(c)  but shall not
			 provide coverage for one hundred percent (100%) or any portion of the Medicare
			 Part B deductible.
(b) Standardized
			 Medicare supplement benefit Plan F is redesignated as Plan G and shall provide
			 the benefits contained in OAR 836-052-0141(5)(e)  but shall not provide coverage
			 for one hundred percent (100%) or any portion of the Medicare Part B
			 deductible.
(c) Standardized
			 Medicare supplement benefit plans C, F and F With High Deductible may not be
			 offered to individuals newly eligible for Medicare on or after January 1,
			 2020.
(d) Standardized Medicare
			 supplement benefit Plan F With High Deductible is redesignated as Plan G With
			 High Deductible and shall provide the benefits contained in OAR
			 836-052-0141(5)(f)  but shall not provide coverage for one hundred percent
			 (100%) or any portion of the Medicare Part B deductible; provided further that
			 the Medicare Part B deductible paid by the beneficiary shall be considered an
			 out-of-pocket expense in meeting the annual high deductible.
(e) The reference to Plans C or F contained
			 in OAR 836-052-0141(1)(b)  is deemed a reference to Plans D or G for purposes of
			 this section.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0145 - Loss Ratio Standards and Refund or Credit of Premium

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The following
			 provisions of this section establish loss ratio standards:
(a) A Medicare supplement policy form or
			 certificate form shall not be delivered or issued for delivery unless the
			 policy form or certificate form can be expected, as estimated for the entire
			 period for which rates are computed to provide coverage, to return the
			 applicable percentage specified in this section to the policyholder and
			 certificate holder in the form of aggregate benefits, not including anticipated
			 refunds or credits, provided under the policy form or certificate form:
(A) At least 75 percent of the aggregate
			 amount of premiums earned, in the case of group policies; or
(B) At least 65 percent of the aggregate
			 amount of premiums earned, in the case of individual policies.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0151 - Filing and Approval of Policies and Certificates and Premium Rates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An issuer shall
			 not deliver or issue for delivery a policy or certificate to a resident of this
			 state unless the policy form or certificate form has been filed with and
			 approved by the Director in accordance with filing requirements and procedures
			 prescribed by the Director.
(2) An
			 issuer shall file any riders or amendments to policy or certificate forms to
			 delete outpatient prescription drug benefits as required by the Medicare
			 Prescription Drug, Improvement, and Modernization Act of 2003 only with the
			 Insurance Commissioner in the state in which the policy or certificate was
			 issued.
(3)
(a) An issuer shall not use or change premium
			 rates for a Medicare supplement policy or certificate unless the rates, rating
			 schedule and supporting documentation have been filed with and approved by the
			 Director in accordance with filing requirements and procedures prescribed by
			 the Director.
(b) Except for an
			 adjustment of premium on the basis of attained age under OAR 836-052-0138, an
			 issuer may not increase the rates for a Medicare supplement policy or
			 certificate issued in this state more than once in a 12-month period. Annual
			 rate increases shall be effective on the policy or certificate anniversary date
			 or renewal date. If an issuer intends to exercise the right to adjust a premium
			 for age attainment under OAR 836-052-0138, and such adjustment results in more
			 than one increase in a 12-month period, the issuer must provide written
			 disclosure to the consumer prior to the issuance of the policy or certificate.
			 The limitation on premium adjustments under this subsection does not apply to a
			 premium adjustment that results from a change in the policy or premium payment
			 terms requested by an insured including but not limited to changes in the
			 method of payment such as discontinuing payment by a preauthorized electronic
			 funds transfer.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0156 - Permitted Compensation Arrangements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An issuer or other entity may provide
			 commission or other compensation to an insurance producer or other
			 representative for the sale of a Medicare supplement policy or certificate only
			 if the first year commission or other first year compensation, including
			 overrides and other sales-connected remuneration to field supervisory
			 personnel, does not exceed 200 percent of the commission or the compensation
			 paid for selling or servicing the policy or certificate in the second year or
			 period.
(2) The commission or other
			 compensation to an insurance producer or other representative for the sale or
			 renewal of a guaranteed issue Medicare supplement policy or certificate must be
			 made on the same basis as for any other Medicare supplement policy or
			 certificate.
(3) The commission or
			 other compensation provided in subsequent renewal years must be the same as
			 that provided in the second year or period and must be provided for a
			 reasonable number of renewal years. The total number of renewal years shall not
			 be fewer than five renewal years.
(4) An issuer or entity shall not provide
			 compensation to its insurance producers and an insurance producer shall not
			 receive compensation greater than the renewal compensation payable by the
			 replacing issuer if an existing policy or certificate is replaced.
(5) For purposes of this rule, "compensation"
			 includes pecuniary or non-pecuniary remuneration of any kind relating to the
			 sale or renewal of the policy or certificate, including but not limited to
			 bonuses, gifts, prizes, awards and finder's fees.
(6) Violation of this rule is an unfair trade
			 practice under ORS 746.240.
Statutory/Other Authority: ORS
				  743.010,
				  743.013,
				  743.680 - 743.689, 746.240 &
				  731.244
Statutes/Other Implemented: ORS
				  743.684(3)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0170 - Filing Requirements for Advertising

Current through Register Vol. 63, No. 7, July 1, 2024
An issuer shall provide to the Director a copy of any Medicare
				supplement advertisement intended for use in this state, whether through the
				written, radio or television medium, for review or approval by the Director to
				the extent it may be required under ORS
				742.009 and other state law.
				Each advertisement shall comply with all applicable laws and rules of this
				state.
Stat. Auth.: ORS
				  731.244, ORS
				  743.010, ORS
				  743.013, ORS
				  743.680 - ORS
				  743.689 & ORS
				  746.240
Stats. Implemented: ORS
				  743.687
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0175 - Standards for Marketing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 issuer, directly or through its producers, shall:
(a) Establish marketing procedures to assure
			 that any comparison of policies by its insurance producers will be fair and
			 accurate;
(b) Establish marketing
			 procedures to assure excessive insurance is not sold or issued;
(c) Display prominently by type, stamp or
			 other appropriate means, on the first page of the policy, the following:
			 "
Notice to Buyer
: This policy may not cover all of your medical
			 expenses";
(d) Inquire and
			 otherwise make every reasonable effort to identify whether a prospective
			 applicant or enrollee for Medicare supplement insurance already has health
			 insurance and the types and amounts of any such insurance;
(e) Establish auditable procedures for
			 verifying compliance with this section.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0180 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In recommending
			 the purchase or replacement of any Medicare supplement policy or certificate,
			 an agent shall make reasonable efforts to determine the appropriateness of a
			 recommended purchase or replacement.
(2) Any sale of Medicare supplement coverage
			 that will provide an individual more than one Medicare supplement policy or
			 certificate is prohibited.
(3) An
			 issuer shall not issue a Medicare supplement policy or certificate to an
			 individual enrolled in Medicare Part C unless the effective date of the
			 coverage is after the termination date of the individual's Part C
			 coverage.
Stat. Auth.: ORS
				  731.244,
				  743.010,
				  743.013,
				  743.680 -
				  743.689 &
				  746.240
Stats. Implemented: ORS
				  743.010(1)(c),
				  743.010(2),
				  743.683(2)
				  & 743.685(8)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0185 - Reporting of Multiple Policies

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 On or before March 1 of each year, each issuer shall report to the Director the
			 following information for every individual resident of this state for which the
			 issuer has in force more than one Medicare supplement insurance policy or
			 certificate:
(a) Policy and certificate
			 number; and
(b) Date of
			 issuance.