Oregon Revised Statutes
As used in ORS 735.005 to 735.145, unless the context requires otherwise: “Association” means the Oregon FAIR Plan Association created by ORS 735.045. “Board” means the board of directors of the association. “Essential property insurance” means insurance against direct loss to property as defined and limited in standard fire policies and extended coverage…
The purpose of ORS 735.005 to 735.145 is: To assure stability in the property insurance market for certain property located in this state. To assure the availability of essential property insurance to the owners of insurable property. To encourage maximum use, in obtaining essential property insurance, of the normal insurance market provided by authorized…
ORS 735.005 to 735.145 shall be liberally construed to effect the purpose provided in ORS 735.015.
ORS 735.005 to 735.145 apply only to essential property insurance on domestic risks.
There is hereby created the Oregon FAIR Plan Association. Each insurer that is a member insurer shall become and remain a member of the association as a condition of its authority to transact insurance in this state. The association shall perform its functions in accordance with a plan of operation established pursuant to ORS 735.085, and shall exercise its …
The board of directors of the Oregon FAIR Plan Association shall consist of five members selected by the member insurers, subject to the approval of the Director of the Department of Consumer and Business Services, and four persons selected by the Governor, one of whom shall be an insurance producer holding an appointment as an Oregon insurance producer of a…
The Oregon FAIR Plan Association shall: Have authority on behalf of its members to arrange for the issuance of property insurance policies by service insurers and to reinsure any of those policies in whole or in part and to cede such reinsurance, subject to the plan. Assess member insurers the amounts necessary to pay the expenses incurred by the associati…
The Oregon FAIR Plan Association may: With the approval of the Director of the Department of Consumer and Business Services, employ or retain such persons and designate such inspection bureaus and service insurers as are necessary to handle applications, inspect and insure property and perform the other duties of the association. Borrow funds as necessary …
The Oregon FAIR Plan Association shall submit to the Director of the Department of Consumer and Business Services, not later than September 7, 1971, a plan of operation, and may thereafter submit such amendments thereto as will provide for the reasonable and equitable exercise of the duties and powers of the association. The plan of operation, and any amendm…
The plan shall: Establish procedures for the submission and processing of applications for insurance and the payment of claims for losses. Establish procedures for record keeping, payment of other expenses and administration of all other financial affairs of the Oregon FAIR Plan Association. Establish times and places for meetings of the board. Establish…
The Oregon FAIR Plan Association is subject to regulation by the Director of the Department of Consumer and Business Services in the same manner as an insurer, to the extent determined by the director to be necessary to carry out the purpose of ORS 735.005 to 735.145. Not later than March 30 of each year the board shall submit to the director, in a form appr…
Except for taxes levied on real or personal property, the Oregon FAIR Plan Association shall be exempt from the payment of all fees and taxes levied by this state or by any city, county, district or other political subdivision of this state.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No person shall have a cause of action against the Oregon FAIR Plan Association or its employees or servicing facilities, any member of the board, or the Director of the Department of Consumer and Business Services or the employees of the director for any action taken by them in carrying out ORS 735.005 to 735.145. CAPTIVE INSURERS
As used in ORS 735.150 to 735.190: “Affiliate” means a business entity that, because of common ownership, common control, common operation or common management, is in the same corporate system as a parent or a member organization. For purposes of this subsection, “common ownership, common control, common operation or common management” means that two or mo…
The provisions of the Insurance Code cited in ORS 735.150 to 735.190 apply to captive insurers. In addition, the provisions of the Insurance Code set forth in ORS chapter 731 relating to administration of the insurance laws apply to captive insurers to the extent not inconsistent with the express provisions of ORS 735.150 to 735.190. In addition to the prov…
The Director of the Department of Consumer and Business Services may adopt rules for the administration of ORS 735.150 to 735.190. Note: See note under 735.150.
All documents, materials and other information in the possession of the Department of Consumer and Business Services under ORS 735.150 to 735.190 are confidential and subject to public disclosure only as provided in ORS 705.137. Note: See note under 735.150.
When permitted by its articles of incorporation or its charter and bylaws, a captive insurer may apply to the Director of the Department of Consumer and Business Services for a certificate of authority to transact any class of insurance. Notwithstanding paragraph (a) of this subsection: A pure captive insurer may not insure a risk other than a risk of its …
A captive insurer may assume a business name only if consistent with the provisions of ORS 731.430. Note: See note under 735.150.
To qualify for authority to transact insurance in this state, a captive insurer shall possess and thereafter maintain capital or surplus, or any combination thereof, of not less than: $250,000 for a pure captive insurer. $750,000 for an association captive insurer incorporated as a stock insurer or as a mutual insurer. $300,000,000 for a captive reinsurer…
A pure captive insurer must be incorporated as a stock insurer with the capital of the pure captive insurer divided into shares and held by the shareholders of the pure captive insurer. An association captive insurer may be: Incorporated as a stock insurer with the capital of the association captive insurer divided into shares and held by the shareholders …
An association captive insurer must comply with the investment requirements of ORS 733.510 to 733.780. Notwithstanding paragraph (a) of this subsection, the Director of the Department of Consumer and Business Services may by rule approve the use of alternative reliable methods of valuation and rating for an association captive insurer. A pure captive insur…
A captive insurer may provide reinsurance on risks ceded by an affiliate of the insurer or a controlled unaffiliated business. A captive insurer may take credit for reserves on risks or portions of risks ceded to reinsurers if the credit is acceptable to the Director of the Department of Consumer and Business Services. Subject to the prior written approval…
A captive insurer is not required to join a rating organization. Note: See note under 735.150.
A captive insurer is not required to make a report except as specified in this section. Before March 1 of each year, or in accordance with rules adopted under subsection (6) of this section, a captive insurer shall submit to the Director of the Department of Consumer and Business Services a report of the financial condition of the captive insurer, verified …
The Director of the Department of Consumer and Business Services shall examine the affairs of each captive insurer once in each three-year period. The three-year period described in paragraph (a) of this subsection is determined on the basis of three full annual accounting periods of operation. The examination is to be made as of December 31 of the full th…
Notwithstanding the limits of risk set forth in ORS 731.504, any captive insurer for which the Director of the Department of Consumer and Business Services issues a certificate of authority under ORS 735.150 to 735.190 must comply with sound actuarial principles as determined by the director and must submit reports demonstrating such compliance to the direct…
The Director of the Department of Consumer and Business Services may suspend or revoke the certificate of authority issued to a captive insurer to transact insurance in this state if the captive insurer: Is insolvent or impaired as defined in ORS 734.014; Fails to meet the requirements of ORS 735.150 to 735.190; Refuses or fails to submit an annual report…
Except as otherwise provided in ORS 735.150 to 735.190, a branch captive insurer must be a pure captive insurer with respect to business operations in this state, unless otherwise permitted by rule of the Director of the Department of Consumer and Business Services. Note: See note under 735.150.
The Director of the Department of Consumer and Business Services shall examine only the branch operations of, and the insurance transacted by, a branch captive insurer in this state if the branch captive insurer: Provides annually to the director a certificate of compliance, or an equivalent, issued by or filed with the licensing authority of the jurisdicti…
Notwithstanding ORS 731.022, a foreign captive insurer may provide insurance in this state if the foreign captive insurer meets both of the following conditions: The foreign captive insurer is domiciled in a state that regulates the foreign captive insurer as a captive insurer and the captive insurer is in good standing in that state. All activities relate…
At least 35 percent of the assets of a captive reinsurer must be managed by an asset manager domiciled in this state. Note: See note under 735.150.
If permitted by its articles of incorporation or charter, and in accordance with ORS 735.158 and 735.190, a captive reinsurer may apply to the Director of the Department of Consumer and Business Services for a certificate of authority to transact reinsurance. Note: See note under 735.150.
A captive reinsurer must be incorporated as a stock insurer with its capital divided into shares and held by the captive reinsurer’s shareholders. In incorporating, a captive reinsurer must comply with the requirements of ORS 735.164. The capital stock of a captive reinsurer must be issued at par value or greater. At least one member of the board of direct…
The Legislative Assembly finds that: Some businesses and service providers in Oregon have experienced major problems in both the availability and affordability of commercial liability insurance. Premiums for such insurance policies have recently grown as much as 500 percent and the availability of such insurance in Oregon markets has greatly diminished. Th…
As used in ORS 735.200 to 735.260: “Joint underwriting association” means a mechanism requiring casualty insurers doing business in Oregon to provide commercial liability insurance to certain businesses and service providers on either an assigned risk basis or through a joint underwriting pool underwritten to standards adopted under the Insurance Code. “Ma…
After a public hearing, the Director of the Department of Consumer and Business Services may by rule require insurers authorized to write and writing commercial liability insurance in this state to form a market assistance plan to assist businesses and service providers unable to purchase specified classes of commercial liability insurance in adequate amount…
The Director of the Department of Consumer and Business Services may mandate the formation of a joint underwriting association under ORS 735.220 if after directing the formation of a market assistance plan and allowing it a reasonable time to alleviate insurance availability problems, the director finds that: There exist in Oregon certain businesses or serv…
After finding under ORS 735.215 that there is a need in Oregon for a joint underwriting association, the Director of the Department of Consumer and Business Services may form and put into operation a temporary, nonprofit, nonexclusive joint underwriting association constituting a legal entity separate and distinct from its members for commercial liability in…
The joint underwriting association established under ORS 735.220 shall be comprised of all insurers authorized to write and who are writing commercial liability insurance within this state on a direct basis, including the commercial liability portions of multiperil policies. Every such insurer shall remain a member of the association as a condition of its au…
The board of directors of the joint underwriting association shall engage the services of an independent actuarial firm to develop and recommend actuarially sound rates, rating plans, rating rules and classifications. The Director of the Department of Consumer and Business Services shall approve rates filed by the joint underwriting association in accordance…
The joint underwriting association formed under ORS 735.220 shall be under the administrative control of a seven person board of directors appointed by the Governor. Two directors shall represent insurance carriers participating in the association; one director shall represent insurance producers; three directors shall represent the affected classes of insur…
The joint underwriting association shall file an annual statement prepared by an independent certified public accountant containing a financial statement, a summary of its transactions and operations for the prior year and other information as prescribed by the Director of the Department of Consumer and Business Services by rule.
Upon a determination of the board of directors that the joint underwriting association will be unable to pay its outstanding lawful obligations as they mature, the board shall certify the existence of this condition to the Director of the Department of Consumer and Business Services. A schedule for policyholder surcharges shall be submitted by the board at t…
There shall be no liability or cause of action against any member insurer, self-insurer, or its agents or employees, the joint underwriting association or its agents or employees, members of the board of directors, the Department of Consumer and Business Services or its representatives for any action taken by or statement made by them in performance of their…
The state is not liable to pay any debts or obligations of any association formed under ORS 735.220 and no person may assert any claim against the state or any of its agencies for any act or omission of the association.
The Director of the Department of Consumer and Business Services may adopt all rules necessary to insure the efficient, equitable operation of the market assistance plan or the joint underwriting association, including but not limited to rules requiring or limiting certain policy provisions.
If a market assistance plan is formed under ORS 735.210, or a joint underwriting association is formed under ORS 735.220, the Director of the Department of Consumer and Business Services shall by rule establish such liquor liability insurance risk and rate classifications as may be necessary to facilitate the availability and affordability of this commercial…
The purpose of ORS 735.300 to 735.365 is to regulate the formation and operation of risk retention groups and purchasing groups in this state formed pursuant to the provisions of the federal Liability Risk Retention Act of 1986 (P.L. 99-563).
As used in ORS 735.300 to 735.365: “Director” means the Director of the Department of Consumer and Business Services of this state or the commissioner, director or superintendent of insurance in any other state. “Completed operations liability” means liability arising out of the installation, maintenance or repair of any product at a site that is not owned…
A risk retention group seeking to be organized in this state: Must be organized as a liability insurer in this state and authorized by a subsisting certificate of authority issued by the director to transact liability insurance in this state, as provided in ORS chapter 732; and Except as otherwise provided in ORS 735.300 to 735.365, must comply with all la…
Risk retention groups chartered in states other than this state and seeking to do business as a risk retention group in this state must observe and abide by the laws of this state as follows: Before transacting insurance in this state, a risk retention group shall submit to the director: A statement identifying the state or states in which the risk retenti…
No risk retention group shall be permitted to join or contribute financially to any insurance insolvency guaranty fund, or similar mechanism, in this state. No risk retention group, or its insureds, shall receive any benefit from any such fund for claims arising out of the operations of the risk retention group. A risk retention group shall participate in t…
Any purchasing group meeting the criteria established under the provisions of the federal Liability Risk Retention Act of 1986 (P.L. 99-563), shall be exempt from any law of this state relating to the creation of groups for the purchase of insurance or the prohibition of group purchasing, or any law that would discriminate against a purchasing group or its m…
A purchasing group that intends to do business in this state shall furnish notice to the director, which shall: Identify the state in which the group is domiciled; Specify the lines and classifications of liability insurance that the purchasing group intends to purchase; Identify the insurer from which the group intends to purchase its insurance and the d…
A purchasing group may not purchase insurance from a risk retention group that is not chartered in a state or from an insurer not admitted in the state in which the purchasing group is located, unless the purchase is effected through a licensed insurance producer acting pursuant to the surplus lines laws and regulations of that state.
The director is authorized to make use of any of the powers established under the Insurance Code to enforce the laws of this state so long as those powers are not specifically preempted by the federal Product Liability Risk Retention Act of 1981, as amended by the Risk Retention Amendments of 1986. This includes, but is not limited to, the director’s adminis…
A risk retention group that violates any provision of ORS 735.300 to 735.365 is subject to criminal and civil penalties applicable to insurers generally, and to suspension or revocation of its certificate of authority to transact insurance.
Any person acting or offering to act as an insurance producer for a risk retention group or purchasing group that solicits members, sells insurance coverage, purchases coverage for its members located within this state or otherwise does business in this state shall, before commencing any such activity, obtain a license as an insurance producer from the direc…
An order issued by any district court of the United States enjoining a risk retention group from soliciting or selling insurance or operating in any state or in all states or in any territory or possession of the United States, upon a finding that such a group is in a hazardous financial condition shall be enforceable in the courts of this state.
The director may adopt rules that the director determines are necessary for carrying out ORS 735.300 to 735.365.
ORS 735.300 to 735.365 shall be known and may be cited as the Oregon Liability Risk Retention Law. SURPLUS LINES LAW
ORS 735.400 to 735.495 shall be liberally construed and applied to promote its underlying purposes which include: Protecting persons seeking insurance in this state; Permitting surplus lines insurance to be placed with reputable and financially sound nonadmitted insurers and exported from this state pursuant to ORS 735.400 to 735.495; Establishing a syste…
As used in ORS 735.400 to 735.495: “Admitted insurer” means an insurer authorized to do an insurance business in this state. “Affiliated group” means any group of entities that, with respect to an insured, exercise control over the insured, are under the control of the insured, or are under common control with the insured. “Capital” means funds paid in fo…
Beginning on January 1, 2015, and each fifth January 1 occurring thereafter, the amounts in ORS 735.405 (6)(c)(A), (B) and (D) shall be adjusted to reflect the percentage change for such five-year period in the Consumer Price Index for All Urban Consumers, West Region (All Items), as published by the Bureau of Labor Statistics of the United States Department…
Insurance may be procured through a surplus lines licensee from a nonadmitted insurer if: The insurer is an eligible surplus lines insurer; A diligent search has first been made among the insurers who are authorized to transact and are actually writing the particular kind and class of insurance in this state, and it is determined that the full amount or ki…
A surplus lines licensee may not place any coverage with a nonadmitted insurer unless at the time of placement the nonadmitted insurer has done all of the following: Obtained authorization to write the kind of insurance to be placed by the surplus lines licensee by the insurance supervisory official in the insurer’s domiciliary jurisdiction. Qualified unde…
Each insured in this state who obtains independently procured insurance, or continues or renews independently procured insurance on Oregon home state risks, other than insurance procured through a surplus lines licensee, shall file, within 30 days after the date the insurance was procured, continued or renewed, a written report with the Director of the Depar…
For purposes of carrying out the Nonadmitted and Reinsurance Reform Act of 2010 (P.L. 111-203, Title V, Subtitle B), after receiving express legislative approval, the Director of the Department of Consumer and Business Services is authorized to enter into a compact or to otherwise establish procedures with other states to allocate among the states the premiu…
The Director of the Department of Consumer and Business Services may declare a surplus lines insurer described in ORS 735.415 (1) ineligible if the director has reason to believe that the surplus lines insurer: Is in unsound financial condition; Is no longer eligible under ORS 735.415; Has willfully violated the laws of this state; or Does not make reaso…
Within 90 days after the placing of any surplus lines insurance in this state on an Oregon home state risk, each surplus lines licensee shall file with the Director of the Department of Consumer and Business Services: A statement signed by the licensee regarding the insurance, which shall be kept confidential as provided in ORS 705.137, including the follow…
The Surplus Line Association of Oregon is the advisory organization of surplus lines licensees to: Facilitate and encourage compliance by resident and nonresident surplus lines licensees with the laws of this state and the rules of the Director of the Department of Consumer and Business Services relative to surplus lines insurance; Provide means for the ex…
Upon placing surplus lines insurance on an Oregon home state risk, the surplus lines licensee shall promptly deliver to the insured or the producing insurance producer the policy, or if such policy is not then available, a certificate as described in subsection (4) of this section, cover note or binder. The certificate, as described in subsection (4) of this…
Insurance contracts procured under ORS 735.400 to 735.495 shall be valid and enforceable as to all parties.
A payment of premium to a surplus lines licensee acting for a person other than the surplus lines licensee in negotiating, continuing or renewing any policy of insurance under ORS 735.400 to 735.495 shall be deemed to be payment to the insurer, whatever conditions or stipulations may be inserted in the policy or contract notwithstanding.
A person may not procure any contract of surplus lines insurance with any nonadmitted insurer for an Oregon home state risk unless the person is licensed under ORS chapter 744 to transact surplus lines insurance. A person may obtain a license to transact surplus lines insurance only if the person is licensed as an insurance producer under ORS chapter 744 to …
A surplus lines licensee may originate surplus lines insurance on an Oregon home state risk or accept such insurance from any other insurance producer duly licensed as to the kinds of insurance involved on an Oregon home state risk, and the surplus lines licensee may compensate the insurance producer therefor. A surplus lines licensee may charge a producing…
Each surplus lines licensee shall keep a full and true record of each surplus lines insurance contract placed on an Oregon home state risk by or through the licensee as required by ORS 744.068, including a copy of the policy, certificate, cover note or other evidence of insurance showing any of the following items that are applicable: Amount of the insuranc…
On or before the end of each month, each surplus lines licensee shall file with the Director of the Department of Consumer and Business Services, as prescribed by the director, a verified report of all surplus lines insurance transacted on Oregon home state risks during the preceding 90 days. The report need not show transacted surplus lines insurance that w…
The surplus lines licensee shall pay the Director of the Department of Consumer and Business Services a surplus lines premium tax equal to two percent of the gross amount of premiums received on Oregon home state risks as shown in the report required by ORS 735.465. Notwithstanding ORS 731.820, the surplus lines licensee shall also pay to the director a tax…
If the tax collectible by a surplus lines licensee under ORS 735.400 to 735.495 is not paid within the time prescribed, the same shall be recoverable in a suit brought by the Director of the Department of Consumer and Business Services against the surplus lines licensee.
The Director of the Department of Consumer and Business Services may suspend, revoke or refuse to renew the license of a surplus lines licensee after notice and hearing as provided under the applicable provision of this state’s laws upon any one or more of the following grounds: Removal of the surplus lines licensee’s office from this state, if the licensee…
A surplus lines insurer may be sued upon any cause of action arising in this state under any surplus lines insurance contract on an Oregon home state risk made by it or evidence of insurance issued or delivered by the surplus lines licensee pursuant to the procedure provided in ORS 735.490. Any surplus lines policy issued by the surplus lines licensee shall …
An insurer transacting insurance on an Oregon home state risk under the provisions of ORS 735.400 to 735.495 may be sued upon any cause of action, arising under any policy of insurance so issued and delivered by it, in the courts for the county where the insurance producer who registered or delivered the policy resides or transacts business, by the service o…
ORS 731.324, 731.328, 731.512 and 731.624 do not apply to surplus lines insurers.
ORS 735.400 to 735.495 shall be known and may be cited as “The Oregon Surplus Lines Law.” If any provisions of ORS 735.400 to 735.495, or the application of such provision to any person or circumstance, is held invalid, the remainder of ORS 735.400 to 735.495 and the application of such provision to persons or circumstances other than those as to which it i…
As used in this section and ORS 735.510: “Control” means the possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting stock, by contract or otherwise. A person who is the owner of 10 percent or more ownership interest in a retainer medical practice o…
A certified retainer medical practice shall: Notify the Department of Consumer and Business Services immediately whenever: The license of a provider who has provided services on behalf of the practice is denied, suspended, revoked or not renewed in this state or in any other jurisdiction; or The authority of the practice to operate in another jurisdiction…
As used in this section: “Dental services contract” means a contract between an insurer and a provider or a group of providers to provide dental health services for enrollees. “Dental services contract” does not include a contract of employment or a contract creating legal entities and ownership thereof that are authorized under ORS chapter 58, 60 or 70, or…
As used in this section: “Eligible employer” means an operator of a facility that: Is a participating provider in the state medical assistance program; Elects to participate in the Oregon Essential Workforce Health Care Program; and Meets other requirements prescribed by the Oregon Health Authority by rule. “Facility” includes: A long term care facilit…
As used in ORS 735.530 to 735.552: “Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or service. “Enrollee” means an individual who has enrolled for coverage in a health benefit plan for which a pharmacy benefit manager has contracted with …
A person may not transact business or purport to transact business in this state as a pharmacy benefit manager unless the person has a license to transact business as a pharmacy benefit manager issued by the Department of Consumer and Business Services. To obtain a license under this section, a person must: Submit an application to the department on a form…
In accordance with ORS chapter 183, the Department of Consumer and Business Services may deny an application for a license to transact business as a pharmacy benefit manager or deny an application for renewal of a license to transact business as a pharmacy benefit manager, and may suspend or revoke a license to transact business as a pharmacy benefit manager…
As used in this section: “Conflict of interest” means: Present employment, ownership or control by a covered entity, pharmaceutical manufacturer, pharmacy benefit manager or health benefit plan as defined in ORS 743B.005; or Third party employment, ownership or control by a covered entity, pharmaceutical manufacturer, pharmacy benefit manager or health be…
As used in this section, “out-of-pocket cost” means the amount paid by an enrollee under the enrollee’s coverage, including deductibles, copayments, coinsurance or other expenses as prescribed by the Department of Consumer and Business Services by rule. A pharmacy benefit manager licensed under ORS 735.532: May not require a prescription to be filled or re…
As used in this section: “Administrative fee” means the administrative and service fees charged by pharmacy benefit managers to manufacturers and carriers that are typically a percentage of the list price of a prescription drug. “Carrier” has the meaning given that term in ORS 743B.005. “Manufacturer” has the meaning given that term in ORS 646A.689. “Pre…
As used in this section, “pharmacy services administrative organization” means an entity that: Contracts with a pharmacy to act as the pharmacy’s agent with respect to matters involving a pharmacy benefit manager, third party payer or other entity, including by negotiating, executing or administering contracts with the pharmacy benefit manager, third party …
As used in ORS 735.540 to 735.552: “Audit” means an on-site or remote review of the records of a pharmacy, or a request for records from a pharmacy for the purpose of an audit, by or on behalf of an entity. “Clerical error” means a minor error: In the keeping, recording or transcribing of records or documents or in the handling of electronic or hard copie…
An entity that audits claims or an independent third party that contracts with an entity to audit claims: Must establish, in writing, a procedure for a pharmacy to appeal the entity’s findings with respect to a claim and must provide a pharmacy with a notice regarding the procedure, in writing or electronically, prior to conducting an audit of the pharmacy’…
An entity’s finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs. Note: See note under 735.53…
An entity that contracts with an independent third party to conduct audits may not: Agree to compensate the independent third party based on a percentage of the amount of overpayments recovered; or Disclose information obtained during an audit except to the contracting entity, the pharmacy subject to the audit or the holder of the policy or certificate of …
For purposes of ORS 735.540 to 735.552, an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim: An electronic or physical copy of a prescription that complies with ORS chapter 689 if the prescribed drug was, within 14 days of the dispensing date: Picked up by the patient or …
After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than 45 days after the date on which the audit was completed and must be sent: By mail or common carrier with a return receipt requested; or Electronically w…
ORS 735.540 to 735.552 do not: Preclude an entity from instituting an action for fraud against a pharmacy; Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is evidenced by physical review, review of claims data or statements or other investigative methods; or Apply to a state agency that is conducting aud…
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
As used in ORS 735.631 to 735.643: “Discount medical plan” means a contract, agreement or other business arrangement between a discount medical plan organization and a plan member in which the organization, in exchange for fees, service or subscription charges, dues or other consideration, offers or purports to offer the plan member access to providers and …
A person may not conduct business as or purport to conduct business as a discount medical plan organization unless the person first obtains a license to operate as a discount medical plan organization from the Director of the Department of Consumer and Business Services in accordance with ORS 735.634. The license requirement set forth in subsection (1) of t…
A discount medical plan organization shall have a written contract or other written agreement with all providers or provider networks that the organization includes or purports to include in a discount medical plan, or with an entity that contracts with or enters into an agreement with a provider network on the organization’s behalf. The contract or other a…
Each applicant for a license to operate as a discount medical plan organization shall apply to the Director of the Department of Consumer and Business Services in a form and manner that the director prescribes by rule. An application for a license under this section must contain all of the following: The applicant’s name, fictitious name, assumed business n…
No operative statutory text appears at this designation in the selected edition.
A licensee shall: Notify the Director of the Department of Consumer and Business Services immediately whenever the licensee’s license or other form of authority to operate as a discount medical plan organization in another jurisdiction is suspended, revoked or not renewed in that jurisdiction. Describe in a notice to the director any change in the name, ad…
A license obtained under ORS 735.634 is effective for one year, or for a longer period if the Director of the Department of Consumer and Business Services so prescribes by rule. The director shall prescribe by rule conditions and procedures under which a licensee may renew a license that has expired. Note: See note under 735.631.
A discount medical plan organization shall establish or provide, in connection with every discount medical plan: A 30-day period in which new plan members may review the discount medical plan and decide whether to continue or to cancel the plan for any reason. The discount medical plan organization shall provide to a member who cancels a discount medical pl…
A person may not use or disseminate in marketing, advertising, promotional, sales or plan documents or other informational materials for discount medical plans or in communications with plan members or prospective plan members: Misleading, deceptive or false statements; or The terms “health plan,” “coverage,” “copay,” “copayments,” “deductible,” “preexisti…
No operative statutory text appears at this designation in the selected edition.
The Director of the Department of Consumer and Business Services may investigate a person operating or purporting to operate as a discount medical plan organization and may require the person at any time to produce marketing, promotional and advertising materials, records, books, files or other information the person uses in conducting business as a discount…
The Director of the Department of Consumer and Business Services by order may suspend, revoke or refuse to renew a license issued under ORS 735.634 if the director finds in writing that: Any fact or condition exists that, if the fact or condition had existed at the time the licensee applied for a license to operate as a discount medical plan organization, w…
A person, a municipal or other public corporation or, at the request of the Director of the Department of Consumer and Business Services, the Attorney General may bring an action in a circuit court of this state against a person that operates or purports to operate as a discount medical plan organization but that has not obtained a license under ORS 735.634,…
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.
No operative statutory text appears at this designation in the selected edition.