reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0190 - Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies and Certificates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If a Medicare
			 supplement policy or certificate replaces another Medicare supplement policy or
			 certificate, the replacing issuer shall waive any time periods applicable to
			 preexisting conditions, waiting periods, elimination periods and probationary
			 periods in the new Medicare supplement policy to the extent such a time period
			 was spent under the original policy.
(2) If a Medicare supplement policy or
			 certificate replaces another Medicare supplement policy or certificate that has
			 been in effect for at least six months, the replacing policy shall not provide
			 any time period applicable to preexisting conditions, waiting periods,
			 elimination periods and probationary periods.
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(1)(c),
				  ORS 743.010(2), ORS
				  743.683(2)
				  & ORS 743.685(8)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0192 - Prohibition Against Use of Genetic Information and Requests for Genetic Testing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This section
			 applies to all policies with policy years beginning on or after May 21,
			 2009.
(2) An issuer of a Medicare
			 supplement policy or certificate shall not:
(a) Deny or condition the issuance or
			 effectiveness of the policy or certificate including the imposition of any
			 exclusion of benefits under the policy based on a pre-existing condition on the
			 basis of the genetic information with respect to the individual; or
(b) Discriminate in the pricing of the policy
			 or certificate including the adjustment of premium rates of an individual on
			 the basis of the genetic information with respect to the individual.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0194 - Separability

Current through Register Vol. 63, No. 7, July 1, 2024
If any provision of OAR 836-052-0103  to 836-052-0194  or the
				application thereof to any person or circumstance is held to be invalid for any
				reason, the remainder of 836-052-0103  to 836-052-0194  shall not be affected
				thereby.
Stat. Auth.: ORS
				  731.244,
				  743.010,
				  743.013,
				  743.680 -
				  743.689 &
				  746.240
Stats. Implemented: ORS
				  174.040 &
				  731.244
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0500 - Statutory Authority; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-052-0500  to 836-052-0786  are
			 adopted pursuant to the requirements and authority of ORS
			 731.244,
			 742.003,
			 742.005,
			 742.023,
			 743.013,
			 743.655,
			 743.656 and
			 746.240.
(2) Except as otherwise specifically
			 provided, OAR 836-052-0500  to 836-052-0786  apply to all long term care
			 insurance policies, including qualified long term care contracts and life
			 insurance policies that accelerate benefits for long term care delivered or
			 issued for delivery in this state by insurers, fraternal benefit societies,
			 nonprofit health, hospital and medical service corporations, prepaid health
			 plans, health maintenance organizations and all similar
			 organizations.
(3) OAR 836-052-0500  to 836-052-0786  do not apply to a provision in a life insurance policy, rider
			 or endorsement that provides accelerated death benefits in a single lump-sum
			 upon the occurrence of a single qualifying event as defined in ORS
			 743.154.
(4) OAR 836-052-0500  to 836-052-0786  apply to
			 policies having indemnity benefits that are triggered by activities of daily
			 living and sold as disability income insurance if:
(a) The benefits of the disability income
			 policy are dependent upon or vary in amount based on the receipt of long-term
			 care services;
(b) The disability
			 income policy is advertised, marketed or offered as insurance for long-term
			 care services; or
(c) Benefits
			 under the policy may commence after the policyholder has reached normal
			 retirement age for Social Security unless benefits are designed to replace lost
			 income or pay for specific expenses other than long-term care
			 services.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0508 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purpose of OAR 836-052-0500  to 836-052-0790:
(1) The following have the meanings given
			 those terms in ORS 743.652:
(a) "Applicant;"
(b) "Benefit trigger;"
(c) "Certificate;"
(d) "Group long term care
			 insurance;"
(e) "Long term care
			 insurance;"
(f) "Policy;"
			 and
(g) "Qualified long term care
			 insurance."
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0526 - Policy Practices and Provisions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Renewability. The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of OAR 836-052-0556. In addition:
(a) A policy issued to an individual shall not contain renewal provisions other than "guaranteed renewable" or "noncancellable."
(b) The term "guaranteed renewable" may be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums and when the insurer has no unilateral right to make any change in any provision of the policy or rider while the insurance is in force, and cannot decline to renew, except that rates may be revised by the insurer on a class basis.
(c) The term "noncancellable" may be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums and during which period the insurer has no right to unilaterally make any change in any provision of the insurance or in the premium rate.
(d) The term "level premium" may be used only when the insurer does not have the right to change the premium.
(e) In addition to the other requirements of this subsection, a qualified long-term care insurance contract shall be guaranteed renewable, within the meaning of Section  7702B(b)(1)(C) of the Internal Revenue Code of 1986, as amended.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0531 - Long Term Care Insurance Partnership Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) As used in this rule, "qualified long
			 term care insurance partnership policy" or "partnership policy" means a long
			 term care insurance policy that meets all of the following requirements:
(a) The policy was issued on or after January
			 1, 2008 or exchanged as provided in section (8) of this rule on or after
			 January 1, 2008, and covers an insured who was a resident of this state or of
			 another state that has entered into a reciprocal agreement with this state when
			 coverage first became effective under the policy.
(b) The policy is a qualified long term care
			 insurance policy.
(c) The policy
			 meets all of the applicable requirements of ORS
			 743.650 to
			 743.656 and OAR 836-052-500 to
			 836-052-0786  and the requirements of the National Association of Insurance
			 Commissioners long term care insurance model act and model regulation as those
			 requirements are set forth in sec. 1917(b)(5)(A) of the Social Security Act (42 USC sec. 1396p(b)(5)(A)).
(d) The
			 policy provides the following inflation protections:
(A) If the policy is sold to an individual
			 who has not attained age 61 as of the date of purchase, the policy shall
			 provide a compound annual inflation protection that is at least equivalent to
			 the option for inflation protection in OAR 836-052-0616(1)(a).
(B) If the policy is sold to an individual
			 who has attained age 61 but has not attained age 76 as of the date of purchase,
			 the policy shall provide an inflation protection that is at least equivalent to
			 an option for inflation protection in OAR 836-052-0616.
(C) If the policy is sold to an individual
			 who has attained age 76 as of the date of purchase, the policy may provide
			 inflation protection, but must at least comply with the provisions for
			 inflation protections in OAR 836-052-0616.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0536 - Repealed

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  731.244,
				  742.023,
				  743.013,
				  743.655,
				  743.656 &
				  746.240
Stats. Implemented: ORS
				  731.244,
				  742.003,
				  742.005,
				  742.009,
				  743.010(3),
				  743.013(3),
				  743.650,
				  743.653,
				  743.655 &
				  743.656,
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0546 - Required Policy Provisions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Renewability. Each individual long-term care insurance policy shall contain a renewability provision. The following requirements apply to such a provision:
(a) The provision shall be appropriately captioned, shall appear on the first page of the policy and shall clearly state that the coverage is guaranteed renewable or noncancellable. This provision does not apply to a policy that does not contain a renewability provision, and under which the right to nonrenew is reserved solely to the policyholder.
(b) A long-term care insurance policy or certificate, other than one in which the insurer does not have the right to change the premium, shall include a statement that premium rates may change.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0556 - Required Disclosure of Rating Practices to Consumers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule applies as follows:
(a) Except as provided in subsection (b) of
			 this section, this rule applies to any long term care policy or certificate
			 issued in this state on or after March 1, 2006.
(b) For certificates issued on or after March
			 1, 2005 under a group long-term care insurance policy as defined in ORS
			 743.652(3)(a),
			 which policy was in force on March 1, 2005, the provisions of this rule shall
			 apply on the policy anniversary following March 1, 2006.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0566 - Initial Rate Filing Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
(a)
			 Except as provided in subsection (b) of this section, this rule applies to any
			 long-term care insurance policy issued in this state on or after March 1, 2006.
(b) Sections (2)(b)(D) and (3) of
			 this rule apply to any long-term care policy issued in this state on or after
			 January 1, 2016.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0576 - Prohibition Against Post-Claims Underwriting, Applications

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Each application for a long-term care
			 insurance policy, rider or certificate, except those that are guaranteed issue,
			 shall contain clear and unambiguous questions designed to ascertain the health
			 condition of the applicant.
(2) If
			 an application for long-term care insurance contains a question asking whether
			 the applicant has had medication prescribed by a physician, it must also ask
			 the applicant to list the medication that has been prescribed;
(3) If the medications listed in the
			 application were known by the insurer, or should have been known by the insurer
			 at the time of application, to be directly related to a medical condition for
			 which coverage would otherwise be denied, the policy, rider or certificate
			 shall not be rescinded for that condition.
(4) Except for policies or certificates that
			 are guaranteed issue:
(a) The following
			 language shall be set out conspicuously and in close conjunction with the
			 applicant's signature block on an application for a long-term care insurance
			 policy, rider or certificate: Caution: If your answers on this application are
			 incorrect or untrue, (insurer) has the right to deny benefits or rescind your
			 policy.
(b) The following language,
			 or language substantially similar to the following, shall be set out
			 conspicuously on the long-term care insurance policy, rider or certificate at
			 the time of delivery: Caution: The issuance of this long-term care insurance
			 (policy) (rider) (certificate) is based upon your responses to the questions on
			 your application. A copy of your (application) (enrollment form) (is enclosed)
			 (was retained by you when your applied). If your answers are incorrect or
			 untrue, the insurer has the right to deny benefits or rescind your policy. The
			 best time to clear up any questions is now, before a claim arises! If, for any
			 reason, any of your answers are incorrect, contact the insurer at this address:
			 (insert address).
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0586 - Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 A long-term care insurance policy, certificate or rider that provides benefits
			 for home care services or community care services may not limit or exclude
			 those benefits:
(a) By requiring that the
			 insured or claimant would need care in a skilled nursing facility if home care
			 services were not provided;
(b) By
			 requiring that the insured or claimant first or simultaneously receive nursing
			 or therapeutic services, or either service or simultaneously receive both
			 services, in a home, community, or institutional setting before home care
			 services are covered;
(c) By
			 limiting eligible services to services provided by registered nurses or
			 licensed practical nurses;
(d) By
			 requiring that a nurse or therapist provide services covered by the policy when
			 the services can be provided by a home care aide or other licensed or certified
			 home care worker acting within the scope of the licensure or
			 certification;
(e) By requiring
			 that the insured or claimant have an acute condition before home care services
			 are covered;
(f) By excluding
			 coverage for personal care services provided by a home care aide;
(g) By requiring that the provision of home
			 care services be at a level of certification or licensure greater than that
			 required by the eligible service;
(h) By limiting benefits to services provided
			 by Medicare-certified agencies or providers; or
(i) By excluding coverage for adult day care
			 services.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0596 - Standards for Covered Services

Current through Register Vol. 63, No. 7, July 1, 2024
This rule establishes standards for covered services for the
				purpose of payment of benefits pursuant to ORS
				743.656. An insurer shall not
				define the covered services more restrictively than the following minimum
				standards, or similar standards found by the Director to be substantially as
				favorable to the consumer:
(1) Nursing
			 home services, when provided to the insured in this state, include services
			 provided in or by a nursing home licensed under ORS
			 678.710 to
			 678.840. When provided to the
			 insured outside this state, nursing home services include services provided in
			 or by a nursing home in the other state. The nursing home must be licensed by
			 the other state if so required by a similar licensing or other regulatory
			 program;
(2) Assisted living
			 services, when provided to the insured in this state, include those services
			 provided in a facility or by a person licensed or otherwise regulated by this
			 state to provide assisted living services as that term is defined in OAR
			 411-056-0005. When the services are provided to the insured outside this state,
			 the provider or providing facility must be licensed by the other state if so
			 required by a similar licensing or other regulatory program;
(3) Home care services, regardless of the
			 state in which they are provided, include service provided in the insured's own
			 home rather than a facility such as an assisted living facility or adult foster
			 care facility;
(4) Adult foster
			 care services, when provided to the insured in this state, include those
			 services that are provided in an adult foster home pursuant to a license issued
			 under ORS 443.705 to
			 443.825. When the services are
			 provided to the insured outside this state, the provider or providing facility
			 must be licensed by the other state if so required by a similar licensing or
			 other regulatory program; and
(5)
			 Services through a residential care facility, when provided to the insured in
			 this state, include those services provided in a facility or by a person
			 licensed or otherwise regulated by this state to provide services through a
			 residential care facility as that term is defined in ORS
			 443.400. When the services are
			 provided to the insured outside this state, the provider or providing facility
			 must be licensed by the other state if so required by a similar licensing or
			 other regulatory program.
Stat. Auth.: ORS
				  731.244 &
				  743.656
Stats. Implemented: ORS
				  743.656
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0606 - Use and Definition of "Home" or Similar Wording

Current through Register Vol. 63, No. 7, July 1, 2024
A long-term care insurance policy that defines "home" or uses
				similar wording to refer to the residence of the insured shall define or use
				wording that means or refers to the principal place of residence for the
				insured, whether a private home, a foster home, congregate care or assisted
				living facility or other place in a community setting, other than a licensed
				nursing facility.
Stat. Auth.: ORS 731, 742 & 743
Stats. Implemented: ORS
				  743.655(1)(a)
				  & 743.656
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0616 - Requirement to Offer Inflation Protection

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer may not offer a long-term care
			 insurance policy unless the insurer also offers to the policyholder, in
			 addition to any other inflation protection offered by the insurer, the option
			 to purchase a policy that provides for benefit levels to increase with benefit
			 maximums or reasonable durations that are meaningful to account for reasonably
			 anticipated increases in the costs of long-term care services covered by the
			 policy. An insurer must offer to each policyholder, at the time of purchase,
			 the option to purchase a policy with an inflation protection feature no less
			 favorable than a feature that does one of the following:
(a) Increases benefit levels annually in a
			 manner so that the increases are compounded annually at a rate not less than
			 three percent.
(b) Guarantees the
			 insured individual periodically increased benefit levels without having to
			 provide evidence of insurability or health status, unless the policyholder
			 declines a periodic increase. The amount of the additional benefit shall be no
			 less than the difference between the existing policy benefit and that benefit
			 compounded annually at a rate of at least three percent for the period
			 beginning with the purchase of the existing benefit and extending until the
			 year in which the offer is made. The insurer shall notify the policyholder, at
			 each periodic increase, that declining an inflation increase under this
			 subsection will imperil the policy's partnership status.
(c) Covers a specified percentage of actual
			 or reasonable charges and does not include a maximum specified indemnity amount
			 or limit.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0626 - Requirements for Application Forms and Replacement Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An application form for long-term care
			 insurance shall include the questions set forth in this section designed to
			 elicit information as to whether, as of the date of the application, the
			 applicant has another long-term care insurance policy, rider or certificate in
			 force or whether a long-term care insurance policy, rider or certificate is
			 intended to replace any other health or long term care insurance policy, rider
			 or certificate currently in force. A supplementary application or other form to
			 be signed by the applicant and insurance producer, except when the coverage is
			 sold without an insurance producer, containing the questions may be used. With
			 regard to a replacement policy issued to a group defined by ORS
			 743.652(3)(a),
			 the following questions may be modified only to the extent necessary to elicit
			 information about health or long-term care insurance policies other than the
			 group policy being replaced, but only if the certificate holder has been
			 notified of the replacement. The questions are as follows:
(a) Do you have another long-term care
			 insurance policy, rider or certificate in force (including health care service
			 contract, health maintenance organization contract)?
(b) Did you have another long-term care
			 insurance policy, rider or certificate in force during the last 12 months?
(A) If so, with which insurer?
(B) If that policy lapsed, when did it
			 lapse?
(C) Are you covered by a
			 state assistance program (Medicaid)?
(c) Do you intend to replace any of your
			 medical or health insurance coverage with this policy, rider or
			 certificate?
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0636 - Reporting Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Every
			 insurer shall maintain records for each insurance producer of that insurance
			 producer's amount of replacement sales as a percent of the insurance producer's
			 total annual sales and the amount of lapses of long-term care insurance
			 policies sold by the insurance producer as a percent of the insurance
			 producer's total annual sales.
(2)
			 Reported replacement and lapse rates do not alone constitute a violation of
			 insurance laws or necessarily imply wrongdoing. The reports are for the purpose
			 of reviewing more closely agent activities regarding the sale of long-term care
			 insurance.
(3) Every insurer shall
			 report to the Director annually by June 30 the ten percent of its insurance
			 producers with the greatest percentages of lapses and replacements as measured
			 by section (1) of this rule using the form provided by the director on the
			 Insurance Division website or a similar form and shall also include the
			 following information in the annual report:
(a) The number of lapsed policies as a
			 percent of its total annual sales and as a percent of its total number of
			 policies in force as of the end of the preceding calendar year.
(b) The number of replacement policies sold
			 as a percent of its total annual sales and as a percent of its total number of
			 policies in force as of the preceding calendar year.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0637 - Annual Rate Certification Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule applies to any long-term care
			 policy issued in this state on or after January 1, 2016.
(2) The following annual submission
			 requirements apply subsequent to initial rate filings for individual long-term
			 care insurance policies made under this rule:
(a) An actuarial certification prepared,
			 dated and signed by the member of the American Academy of Actuaries who
			 provides the information. The actuarial certification shall provide at least:
(A) A statement of the sufficiency of the
			 current premium rate schedule and the following:
(i) For the rate schedules currently
			 marketed:
(I) The premium rate schedule
			 continues to be sufficient to cover anticipated costs under moderately adverse
			 experience and that the premium rate schedule is reasonably expected to be
			 sustainable over the life of the form with no future premium increase
			 anticipated; or
(II) If the above
			 statement cannot be made, a statement that margins for moderately adverse
			 experience may no longer be sufficient. In this situation, the insurer shall
			 provide to the Director within 60 days of the date the actuarial certification
			 is submitted to the Director, a plan of action, including a time frame, for the
			 re-establishment of adequate margins for moderately adverse experience so that
			 the ultimate premium rate schedule would be reasonably expected to be
			 sustainable over the future life of the form with no future premium increases
			 anticipated. Failure to submit a plan of action to the Director within 60 days
			 or to comply with the time frame stated in the plan of action constitutes
			 grounds for the Director to withdraw or modify its approval of the form for
			 future sales pursuant to ORS
			 742.007.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0639 - Training for Insurance Producers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When the provider of a training course
			 notifies an insurance producer that the insurance producer has successfully
			 completed the training course and passed the examination, the insurance
			 producer shall send the notice of completion as verification of the training to
			 each insurer for which the insurance producer transacts or will transact long
			 term care insurance in this state. The insurer shall approve or disapprove the
			 verification as meeting the requirements of section 9, chapter 486, Oregon Laws
			 2007 and return the verification to the insurance producer.
(2) An insurance producer shall submit the
			 notice of completion of required training to the Director as approved by each
			 insurer under section (2) of this rule when the insurance producer reports to
			 the Director at license renewal regarding compliance with continuing education
			 requirements.
(3) A training course
			 taken online or through self-study in satisfaction of the requirements of
			 section 9, chapter 486, Oregon Laws 2007 (Enrolled SB 191) must include an
			 examination indicating understanding of the topics covered in the course. An
			 insurance producer does not satisfy the training requirement of section 9,
			 chapter 486, Oregon Laws 2007 unless the individual passes the examination for
			 the online or self-study training course with a score of not less than 70
			 percent.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: Sec. 9, Ch. 486, OL 2007 (Enrolled SB
				  191)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0646 - Benefits Provided Through Advancement of Life Insurance Proceeds

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When long term
			 care benefits are provided through early payment of a portion of a life
			 insurance policy death benefit, the insurer may make no more than a pro rata
			 reduction in the life insurance policy cash value, based on the percentage of
			 death benefits advanced. When the cash value is reduced in this manner, the
			 insurer may apply no more of the payment to the reduction of any outstanding
			 policy loans than this same pro rata percentage.
(2) For each month in which a long term care
			 benefit has been provided through early payment of a portion of a life
			 insurance death benefit, the insurer shall provide a report to the policyholder
			 showing the benefits paid during the month, the change in the life insurance
			 policy cash value, loan balance and death benefit, and the amount of benefits
			 remaining.
Stat. Auth.: ORS
				  731.244,
				  742.023,
				  743.013,
				  743.655,
				  743.656 &
				  746.240
Stats. Implemented: ORS
				  742.003,
				  742.005,
				  743.650,
				  743.655 &
				  743.656
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0656 - Reserve Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
(a) Each insurer shall use the following
			 standards for determining policy reserves for long-term care insurance: When
			 long-term care benefits are provided through the acceleration of benefits under
			 a group or individual life insurance policy or a rider to such a policy, policy
			 reserves for the benefits shall be determined in accordance with ORS
			 733.322. Claim reserves shall
			 also be established in the case when the policy or rider is in claim
			 status.
(b) Reserves for policies
			 and riders subject to this section shall be based on the multiple decrement
			 model using all relevant decrements except for voluntary termination rates.
			 Single decrement approximations are acceptable if the calculation produces
			 essentially similar reserves, if the reserve is clearly more conservative or if
			 the reserve is immaterial. The calculations may take into account the reduction
			 in life insurance benefits due to the payment of long-term care benefits.
			 However, in no event shall the reserves for the long-term care benefit and the
			 life insurance benefit be less than the reserves for the life insurance benefit
			 assuming no long-term care benefit.
(c) In the development and calculation of
			 reserves for long-term care insurance policies and riders subject to this
			 section, an insurer shall consider the applicable policy and rider provisions,
			 marketing methods, administrative procedures and all other considerations that
			 affect projected claim costs, including but not limited to the following:
(A) Definition of insured events;
(B) Covered long-term care
			 facilities;
(C) Existence of home
			 care and home care coverage. For purposes of this paragraph, "home" has the
			 meaning provided in OAR 836-052-0606;
(D) Definition of facilities;
(E) Existence or absence of barriers to
			 eligibility;
(F) Premium waiver
			 provisions;
(G)
			 Renewability;
(H) Ability to raise
			 premiums;
(I) Marketing
			 methods;
(J) Underwriting
			 procedures;
(K) Claims adjustment
			 procedures;
(L) Waiting
			 periods;
(M) Maximum
			 benefits;
(N) Availability of
			 eligible facilities;
(O) Margins in
			 claim costs;
(P) Optional nature of
			 benefit;
(Q) Delay in eligibility
			 for benefit;
(R) Inflation
			 protection provisions; and
(S)
			 Guaranteed insurability option.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0666 - Loss Ratio

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule
			 applies to all long-term care insurance policies, certificates and riders
			 except those that are subject to OAR 836-052-0566  and 836-052-0676.
(2) Benefits under long-term care insurance
			 policies and riders shall be deemed reasonable in relation to premiums only if
			 the expected loss ratio is at least 60 percent and is calculated in a manner
			 providing for adequate reserving of the long-term care insurance
			 risk.
(3) In evaluating the
			 expected loss ratio under section (2) of this rule, an insurer shall consider
			 all relevant factors, including:
(a)
			 Statistical credibility of incurred claims experience and earned
			 premiums;
(b) The period for which
			 rates are computed to provide coverage;
(c) Experienced and projected
			 trends;
(d) Concentration of
			 experience within early policy duration;
(e) Expected claim fluctuation;
(f) Experience refunds, adjustments or
			 dividends;
(g) Renewability
			 features;
(h) All appropriate
			 expense factors;
(i)
			 Interest;
(j) Experimental nature
			 of the coverage;
(k) Policy
			 reserves;
(l) The mix of business
			 by risk classification;
(m) Product
			 features, such as long elimination periods, high deductibles and high maximum
			 limits.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0676 - Premium Rate Schedule Increases

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule applies as follows:
(a) Except as provided in subsection (b) of
			 this section, this rule applies to any long-term care insurance policy or
			 certificate issued in this state on or after March 1, 2006 and prior to January
			 1, 2016.
(b) For certificates
			 issued on or after March 1, 2005 under a group long-term care insurance policy
			 as defined in ORS 743.652(3)(a)
			 that was in force on March 1, 2005, this rule applies on the policy anniversary
			 following March 1, 2006.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0680 - Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This
			 rule applies as follows:
(a) Except as
			 provided in section (1)(b) of this rule, this rule applies to any long-term
			 care policy or certificate issued in this state on or after January 1, 2016.
(b) For certificates issued on or
			 after January 1, 2016 under a group long-term care insurance policy as defined
			 in ORS 743.652(4),
			 which policy was in force at the time this amended rule became effective, the
			 provisions of this section shall apply on the policy anniversary following July
			 1, 2016.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0686 - Filing Requirements for Out-of-State Group Policies

Current through Register Vol. 63, No. 7, July 1, 2024
Each insurer providing group long-term care insurance benefits
				to a resident of this state under an exempt master group policy pursuant to ORS
				731.486 issued outside of this
				state shall file, for informational purposes, a copy of the policy form filed
				for approval with the state of domicile of the insurer and any rider or
				certificate used in this state in accordance with the filing requirements and
				procedures applicable to group entities filing in this state.
Stat. Auth.: ORS 731, 742 & 743
Stats. Implemented: ORS
				  731.244 &
				  743.653
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0696 - Filing Requirements for Advertising

Current through Register Vol. 63, No. 7, July 1, 2024
At the request of the Director, every insurer, health care
				service plan or other entity providing long-term care insurance or benefits in
				this state shall provide to the Director a copy of any long-term care insurance
				advertisement intended for use in this state, whether through the written,
				radio or television medium, for review or approval by the Director as
				authorized under ORS 742.009 and other state law. In
				addition, all advertisements shall be retained by the insurer, health care
				service plan or other entity for at least three years from the date the
				advertisement was first used. Each advertisement shall comply with all
				applicable laws and rules of this state.
Stat. Auth.: ORS
				  731.244 &
				  742.009
Stats. Implemented: ORS
				  742.009 &
				  743.655(1)(a)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0706 - Standards for Marketing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Every
			 insurer, health care service plan or other entity marketing long-term care
			 insurance coverage in this state, directly or through its insurance producers,
			 shall:
(a) Establish marketing procedures and
			 insurance producer training requirements to assure that:
(A) Any marketing activities, including any
			 comparison of policies by its insurance producers, will be fair and accurate;
			 and
(B) Excessive insurance is not
			 sold or issued.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0716 - Disclosure Statement

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 insurer offering long-term care insurance coverage in this state shall deliver
			 a disclosure statement as provided in this rule to the insured under a
			 long-term care insurance policy, rider or certificate or separately but at the
			 same time as delivery of the policy, rider or certificate.
(2) The disclosure statement must include the
			 following matters:
(a) A statement of the
			 premium. The statement must give the total annual premium for the policy, rider
			 or certificate and, if the premium varies with an applicant's choice among
			 benefits options, must indicate the portion of annual premium corresponding to
			 each benefit option;
(b) The terms
			 of renewability. The terms used to describe renewability must be used in
			 accordance with OAR 836-052-0526. The terms must be stated on the first page of
			 the policy and must be one of the following, defined as follows:
(A) A policy is "guaranteed renewable" when
			 renewal cannot be declined by the insurer for any reason, but the insurer can
			 revise rates on a class basis;
(B)
			 A policy is "noncancellable" if the insurer cannot decline renewal and cannot
			 revise rates.
(c)
			 Initial and subsequent conditions of eligibility;
(d) A statement of nonduplication of coverage
			 provisions;
(e) Coverage of
			 dependents;
(f) Preexisting
			 conditions;
(g) Termination of
			 insurance;
(h) Continuation or
			 conversion of coverage;
(i) Any
			 probationary periods;
(j)
			 Limitations, exceptions and reductions;
(k) Elimination periods;
(l) Requirements for replacement;
(m) Recurrent conditions;
(n) Definitions of terms;
(o) Option to apply for new
			 benefits
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0726 - Suitability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule does
			 not apply to life insurance policies that accelerate benefits for long-term
			 care.
(2) Each insurer, health care
			 service plan or other entity shall:
(a)
			 Develop and use suitability standards to determine whether the purchase or
			 replacement of long-term care insurance is appropriate for the needs of the
			 applicant;
(b) Train its insurance
			 producers in the use of its suitability standards; and
(c) Maintain a copy of its suitability
			 standards and make them available for inspection upon request by the
			 Director.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0736 - Prohibition Against Preexisting Conditions, Waiting Periods and Probationary Periods in Replacement Policies and Certificates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If a long-term care insurance policy
			 replaces another long-term care insurance policy, the replacing insurer shall
			 waive any time periods applicable to preexisting conditions, waiting periods
			 and probationary periods in the new long-term care insurance policy for similar
			 benefits to the extent that similar exclusions have been satisfied under the
			 original policy.
(2) If a group
			 long-term care policy is replaced by another group long-term care policy
			 purchased by the same policyholder, the succeeding insurer shall offer coverage
			 to all persons covered under the old group policy on its date of
			 termination.
Stat. Auth.: ORS 731, 742 & 743
Stats. Implemented: ORS
				  743.655(1)(a)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0738 - Availability of New Services or Providers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer shall notify policyholders of
			 the availability of a new long term policy series that provides coverage for
			 new long term care services or providers that are material in nature and not
			 previously available through the insurer to the general public. The notice
			 shall be provided within 12 months of the date that the new policy series is
			 made available for sale in this state.
(2) Notwithstanding section (1) of this rule,
			 notification is not required for any policy issued prior to the effective date
			 of this rule or to any policyholder or certificate holder who is currently
			 eligible for benefits, within an elimination period or on a claim, or who
			 previously had been in claim status, or who would not be eligible to apply for
			 coverage due to issue age limitations under the new policy. The insurer may
			 require that policyholders meet all eligibility requirements, including
			 underwriting and payment of the required premium, to add such new services or
			 providers.
(3) An insurer shall
			 make the new coverage available in one of the following ways:
(a) By adding a rider to the existing policy
			 and charging a separate premium for the new rider based on the insured's
			 attained age;
(b) By exchanging the
			 existing policy or certificate for one with an issue age based on the present
			 age of the insured and recognizing past insured status by granting premium
			 credits toward the premiums for the new policy or certificate. The premium
			 credits shall be based on premiums paid or reserves held for the prior policy
			 or certificate.
(c) By exchanging
			 the existing policy or certificate for a new policy or certificate in which
			 consideration for past insured status shall be recognized by setting the
			 premium for the new policy or certificate at the issue age of the policy or
			 certificate being exchanged. The cost for the new policy or certificate may
			 recognize the difference in reserves between the new policy or certificate and
			 the original policy or certificate.
(d) By an alternative program developed by
			 the insurer that meets the intent of this rule if the program is filed with and
			 approved by the Director.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0740 - Right to Reduce Coverage and Lower Premiums

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Every long term care insurance policy and
			 certificate must include a provision that allows the policyholder or
			 certificate holder to reduce coverage and lower the policy or certificate
			 premium in at least one of the following ways:
(a) Reducing the maximum benefit; or
(b) Reducing the daily, weekly, or
			 monthly benefit amount.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0746 - Nonforfeiture Benefit Requirement

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 This rule does not apply to life insurance policies or riders containing
			 accelerated long-term care benefits.
(2) To comply with the requirement to offer a
			 nonforfeiture benefit pursuant to the provisions of ORS
			 743.664:
(a) A long-term care policy, certificate or
			 rider offered with nonforfeiture benefits must have coverage elements,
			 eligibility, benefit triggers and benefit length that are the same as coverage
			 to be issued without nonforfeiture benefits. The nonforfeiture benefit included
			 in the offer must be the benefit described in section (6) of this rule.
(b) The offer must be in writing
			 if the nonforfeiture benefit is not otherwise described in the Outline of
			 Coverage or other materials given to the prospective policyholder.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0756 - Standards for Benefit Triggers

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 A long-term care insurance policy shall condition the payment of benefits on a
			 determination of the insured's ability to perform activities of daily living
			 and on cognitive impairment. Eligibility for the payment of benefits shall not
			 be more restrictive than requiring either a deficiency in the ability to
			 perform not more than three of the activities of daily living or the presence
			 of cognitive impairment.
(2)
(a) Activities of daily living shall include
			 at least the following as defined in OAR 836-052-0516  and in the policy:
(A) Bathing;
(B) Continence;
(C) Dressing;
(D) Eating;
(E) Toileting; and
(F) Transferring;