Oregon Administrative Rules › Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS › Division 65 - SUSTAINABLE HEALTH CARE COST GROWTH TARGET PROGRAM › Section 409-065-0005 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply to OAR 409-065-0000  to
				409-065-0030:
(1) "Accident policy"
			 means an insurance policy that provides benefits only for a loss due to
			 accidental bodily injury.
(2)
			 "Authority" means the Oregon Health Authority.
(3) "DCBS" means the Oregon Department of
			 Consumer and Business Services.
(4)
			 "Dental-only insurance" means an insurance policy that provides benefits only
			 for dental services.
(5)
			 "Disability policy" means an insurance policy that provides benefits for losses
			 due to a covered illness or disability.
(6) "Health benefit plan" has the meaning
			 provided in ORS
			 743B.005.
(7) "Health care" has the meaning provided in
			 ORS 442.385.
(8) "Health insurance"
			 has the meaning provided in ORS
			 731.162.
(9) "Hospital indemnity policy" means an
			 insurance policy that provides benefits only for covered hospital
			 stays.
(10) "Long-term care
			 insurance" has the meaning provided in ORS
			 743.652.
(11) "Mandatory Reporter" means any payer or
			 licensed third party administrator with a mean total lives of 1,000 or more
			 across all lines of business, as calculated by the Authority.
(12) "Medicare supplemental insurance" means
			 a group or individual insurance policy or a subscriber contract, other than a
			 policy issued pursuant to a contract under Section 1876 of the federal Social
			 Security Act (42 U.S.C. section
			 1395 et seq.) or an issued policy under a
			 demonstration project specified in
			 42
			 U.S.C. section 1395ss(g)(1)
			 that is advertised, marketed or designed primarily as a supplement to
			 reimbursements under Medicare for the hospital, medical or surgical expenses of
			 persons eligible for Medicare.
(13)
			 "Payer" has the meaning provided in ORS 442.385.
(14) "Specific disease policy" means an
			 insurance policy that provides benefits only for a loss due to a covered
			 disease.
(15) "Stand-alone
			 prescription drug plan" means an insurance policy that provides benefits only
			 for prescription drugs.
(16)
			 "Stop-loss plan" means insurance against the risk of economic loss assumed
			 under a less than fully-insured employee health benefit plan as provided in ORS
			 742.065.
(17) "Third-party administrator (TPA)" means
			 any person who directly or indirectly solicits or effects coverage of,
			 underwrites, collects charges or premiums from, or adjusts or settles claims
			 on, residents of Oregon or residents of another state from offices in Oregon,
			 in connection with life insurance or health insurance coverage; or any person
			 or entity who must otherwise be licensed under ORS
			 744.702.
(18) "Vision policy" means a health benefits
			 plan covering only vision health care.
(19) "Voluntary reporter" means a payer or
			 third-party administrator that does not meet the requirements to be considered
			 a Mandatory Reporter and elects to submit cost growth target data on a
			 voluntary basis.
Statutory/Other Authority: ORS 442.386
Statutes/Other Implemented: ORS 442.386 & ORS
				  442.385