Chapter 743 — Health and Life Insurance and Annuities

743.003 [1967 c.359 §335; renumbered 742.001 in 1989]

GENERAL PROVISIONS (Reporting and Data Submission Requirements)

743.004 Submission of information by carriers offering health benefit plans

Each carrier offering a health benefit plan shall submit to the Director of the Department of Consumer and Business Services on or before April 1 of each year a report that contains: The following information for the preceding year that is derived from the exhibit of premiums, enrollment and utilization included in the carrier’s annual report: The total nu…

743.005 Protection of health information report

As used in this section: “Covered entity” has the meaning given that term in ORS 192.556 but excludes state agencies. “Protected health information” has the meaning given that term in ORS 192.556. A covered entity that is required to file an annual financial statement under ORS 731.574 shall file with the Department of Consumer and Business Services, alon…

743.006 [Formerly 736.300; renumbered 742.003 in 1989]

743.007 Data reporting

A carrier offering a health benefit plan, an insurer offering insurance against the risk of economic loss assumed under a less than fully insured employee health plan described in ORS 742.065 and a third party administrator licensed under ORS 744.702 shall annually submit to the Department of Consumer and Business Services, in a form and manner prescribed by…

743.008 Reporting requirements; rules

The Department of Consumer and Business Services shall develop by rule reporting requirements as necessary for the consistent and efficient implementation of ORS 743B.200, 743B.202, 743B.250 and 743B.423. In order to minimize duplicative reporting requirements, the department shall accept copies of reports prepared for national accreditation organizations as…

743.009 [1967 c.359 §337; 1969 c.336 §11; 1973 c.608 §1; renumbered 742.005 in 1989]

(Filing and Approval of Rates, Schedules and Forms)

743.010 Health insurance policy and health benefit plan forms; expenditures on primary care; rules

In addition to all other powers of the Director of the Department of Consumer and Business Services with respect thereto, the director may issue rules with respect to policy forms and health benefit plan forms described in ORS 742.005 (6)(a) and (b): Establishing minimum benefit standards; Requiring the ratio of benefits to premiums to be not less than a s…

743.011 [1985 c.827 §2; repealed by 1989 c.255 §15]

743.012 [1967 c.359 §338; 1989 c.700 §13; renumbered 742.007 in 1989]

743.013 [1989 c.474 §2; 2003 c.364 §106; renumbered 743B.300 in 2015]

743.015 Filing and approval of credit life and credit health insurance forms; filing of rates

All credit life and credit health insurance policies subject to ORS 743.371 to 743.380, and all certificates of insurance, notices of proposed insurance, applications for insurance, indorsements and riders used in connection with such kinds of policies, delivered or issued for delivery in this state and the schedules of premium rates pertaining thereto shall…

743.018 Filing of rates for life and health insurance; rules

Except for group life and health insurance, and except as provided in ORS 743.015, every insurer shall file with the Director of the Department of Consumer and Business Services all schedules and tables of premium rates for life and health insurance to be used on risks in this state, and shall file any amendments to or corrections of such schedules and table…

743.019 Procedure for review of proposed rates for health benefit plans; rules

When an insurer files a schedule or table of premium rates for individual or small employer health benefit plans under ORS 743.018, the Department of Consumer and Business Services shall open a 30-day public comment period on the rate filing that begins on the date the insurer files the schedule or table of premium rates. The department shall post all of the…

743.020 Rate filing to include statement of administrative expenses; rules

An insurer licensed by the Department of Consumer and Business Services shall include in any rate filing under ORS 743.018 with respect to individual and small employer health benefit plans, as defined in ORS 743B.005, a statement of administrative expenses in the form and manner prescribed by the department by rule. The statement must include, but is not li…

743.021 [1967 c.359 §341; 1971 c.231 §21; 1973 c.525 §1; renumbered 742.009 in 1989]

743.022 Premium rates for individual health benefit plans

Premium rates for individual health benefit plans shall be subject to the following provisions: Each carrier must file the carrier’s initial geographic average rate and any changes to the geographic average rate for its individual health benefit plans with the Director of the Department of Consumer and Business Services. The premium rates charged during a …

743.023 Electronic administration; discounted rates; requirements

As used in this section: “Explanation of benefits” means claim processing advice or notification of action on claims. “Payment, remittance and reconciliation information” means all information required for premium billing or invoicing, facilitating timely electronic payment of premiums due, delinquency notification, final billing notification or terminatio…

743.024 [1967 c.359 §342; renumbered 743.040 in 2015]

743.025 Annual report of information related to prescription drugs covered by health benefit plans; reports to Legislative Assembly

As used in this section, “health benefit plan” has the meaning given that term in ORS 743B.005. An insurer shall annually report the following information to the Department of Consumer and Business Services, in the form and manner prescribed by the department, regarding drugs reimbursed by the insurer under health benefit plans issued by the insurer in this…

743.027 [1967 c.359 §342a; 1991 c.182 §2; 2009 c.331 §1; 2015 c.629 §60; renumbered 743.038 in 2015]

(Forms and Standards)

743.028 Uniform health insurance claim forms

The Director of the Department of Consumer and Business Services shall prescribe uniform health insurance claim forms which shall be used by all insurers transacting health insurance in this state and by all state agencies that require health insurance claim forms for their records.

743.029 Uniform standards for health care financial and administrative transactions; rules

The Department of Consumer and Business Services may adopt by rule uniform standards applicable to persons listed in subsection (2) of this section for health care financial and administrative transactions, including uniform standards for: Eligibility inquiry and response; Claim submission; Payment remittance advice; Claims payment or electronic funds tr…

743.030 [Formerly 739.420; renumbered 743.044 in 2015]

743.031 Stakeholder work group to recommend uniform standards

The Oregon Health Authority shall convene a stakeholder work group to recommend uniform standards for health care financial and administrative transactions, including, to the extent allowed by law, standards applicable to commercial health insurance plans, self-funded plans and state governmental health plans and programs. The authority shall report uniform…

743.033 [1967 c.359 §344; renumbered 742.011 in 1989]

743.034 Coordination with Oregon Health Authority concerning uniform standards; Department of Human Services to be subject to standards

The Department of Consumer and Business Services and the Oregon Health Authority shall confer before the department finalizes rules implementing uniform standards under ORS 743.029, for the purpose of reconciling any differences between the department’s and the authority’s requirements for health care financial and administrative transactions described in OR…

743.035 Uniform prior authorization form for prescription drug benefits; consultation with Oregon Health Authority; rules

The Department of Consumer and Business Services, in consultation with the Oregon Health Authority, shall develop by rule a form that providers in this state shall use to request prior authorization for prescription drug benefits. The form must: Be uniform for all providers; Not exceed two pages; Be electronically available and transmissible; and Include…

743.036 [Formerly 736.330; 1973 c.823 §149; repealed by 1973 c.827 §83]

743.037 [1973 c.521 §2; renumbered 743.721 in 1989]

HEALTH AND LIFE INSURANCE

743.038 Consent of individual required for life and health insurance; exceptions

A life or health insurance policy upon an individual, except a policy of group life insurance or of group or blanket health insurance, may not be made or effectuated unless at the time of the making of the policy the individual insured, being of competent legal capacity to contract, applies therefor or has consented thereto in writing, except in the followin…

743.039 Alteration of application for life or health insurance

An application for a life insurance policy may not provide for alterations by any person other than the applicant in either the application or the policy to be issued thereon with respect to the amount of insurance, classification of risk, plan of insurance or the benefits unless the application contains a statement that no such changes are effective until a…

743.040 Personal insurance, insurable interest and beneficiaries

Any individual of competent legal capacity may procure or effect an insurance policy on the individual’s own life or body for the benefit of any person. However, except as provided in ORS 743.044, no person shall procure or cause to be procured any insurance policy upon the life or body of another unless the benefits under such policy are payable to the indi…

743.041 Payment discharges insurer

Whenever the proceeds of or payments under a life or health insurance policy become payable in accordance with the terms of such policy, or the exercise of any right or privilege under such policy, and the insurer makes payment in accordance with the terms of the policy or in accordance with any written assignment of the policy, the person so designated as b…

743.042 [1967 c.359 §347; 1985 c.465 §1; renumbered 742.013 in 1989]

743.043 Assignment of policies

A policy may be assignable or not assignable, as provided by its terms. Subject to its terms relating to assignability, any life or health insurance policy, under the terms of which the beneficiary may be changed upon the sole request of the insured or owner, may be assigned either by pledge or transfer of title, by an assignment executed by the insured or o…

743.044 Life insurance for benefit of charity

Life insurance policies may be effected although the person paying the consideration has no insurable interest in the life of the person insured if a charitable, benevolent, educational or religious institution is designated irrevocably as the beneficiary. In making such policies the person paying the premium shall make and sign the application therefor as …

743.045 [Formerly 736.305; 1971 c.231 §22; 1985 c.465 §2; renumbered 742.016 in 1989]

743.046 Exemption of proceeds of individual life insurance other than annuities

When a policy of insurance is effected by any person on any person’s own life or on another life in favor of some person other than that person having an insurable interest in the life insured, the lawful beneficiary thereof, other than that person or that person’s legal representative, is entitled to its proceeds against the creditors or representatives of …

743.047 Exemption of proceeds of group life insurance

A policy of group life insurance or the proceeds thereof payable to a person or persons other than the individual insured or the individual’s estate shall be exempt from debts and claims of creditors or representatives of the individual insured and, in the event of bankruptcy of the individual insured, from all demands in legal proceedings under such bankrup…

743.048 [Formerly 736.315; renumbered 742.018]

743.049 Exemption of proceeds of annuity policies; assignability of rights

The benefits, rights, privileges and options which are due or prospectively due an annuitant under any annuity policy issued before, on or after June 8, 1967, shall not be subject to execution, nor shall the annuitant be compelled to exercise any such rights, powers or options, nor shall creditors be allowed to interfere with or terminate the policy, except:…

743.050 Exemption of proceeds of health insurance

Except as may otherwise be expressly provided by the policy, the proceeds or avails of all health insurance policies and of provisions providing benefits on account of the insured’s disability which are supplemental to life insurance policies, issued before, on or after June 8, 1967, shall be exempt from all liability for any debt of the insured, and from an…

743.051 [1967 c.359 §350; renumbered 742.021 in 1989]

743.052 [1971 c.372 §2; renumbered 743.719 in 1989]

743.053 Prohibition on requirement that death or dismemberment occur in less than 180 days after accident

A life insurance policy or health insurance policy, whether group or individual, that contains provisions providing benefits in case of death or dismemberment by accident shall not require that the death or dismemberment occur less than 180 days after the date of the accident in order for benefits to be paid under the policy.

743.054 [1967 c.359 §351; renumbered 742.023 in 1989]

743.055 [1991 c.875 §2; repealed by 1995 c.506 §11]

743.056 [2011 c.30 §2; 2013 c.5 §§15,16; renumbered 742.407 in 2015]

743.057 [1967 c.359 §352; renumbered 742.026 in 1989]

743.060 [1967 c.359 §353; renumbered 742.028 in 1989]

743.061 [2011 c.130 §2; 2015 c.792 §12; renumbered 743.029 in 2015]

743.062 [2011 c.130 §3; renumbered 743.031 in 2015]

743.063 [1967 c.359 §354; renumbered 742.033 in 1989]

743.064 [2011 c.130 §5; renumbered 743.034 in 2015]

743.065 [2013 c.596 §2; renumbered 743.035 in 2015]

743.066 [1967 c.359 §355; 1971 c.231 §23; renumbered 742.036 in 1989]

743.069 [1967 c.359 §356; renumbered 742.038 in 1989]

743.072 [Formerly 736.310; 1971 c.231 §24; 1973 c.149 §1; renumbered 742.041 in 1989]

743.075 [1967 c.359 §358; 1975 c.391 §1; 1977 c.742 §8; renumbered 742.043 in 1989]

743.078 [1967 c.359 §359; renumbered 742.046 in 1989]

743.080 [1971 c.231 §5; 1983 c.249 §1; renumbered 742.048 in 1989]

743.081 [1967 c.359 §360; renumbered 742.051 in 1989]

743.082 [2011 c.561 §1; renumbered 743B.500 in 2015]

743.083 [2011 c.561 §3; renumbered 743B.501 in 2015]

743.084 [1967 c.359 §361; renumbered 743.041 in 1989]

743.085 [2011 c.561 §4; renumbered 743B.502 in 2015]

743.086 [2011 c.561 §5; renumbered 743B.503 in 2015]

743.087 [1967 c.359 §362; renumbered 743.043 in 1989]

743.090 [Formerly 736.335; repealed by 1973 c.827 §83]

743.093 [1967 c.359 §364; renumbered 742.053 in 1989]

743.096 [1967 c.359 §365; renumbered 742.056 in 1989]

743.099 [Formerly 739.405; renumbered 743.046 in 1989]

POLICY LANGUAGE SIMPLIFICATION

743.100 Short title

ORS 743.100 to 743.109 may be cited as the Life and Health Insurance Policy Language Simplification Act.

743.101 Purpose

The purpose of the Life and Health Insurance Policy Language Simplification Act is to establish minimum standards for language used in policies and certificates of life insurance and health insurance delivered or issued for delivery in this state in order to facilitate ease of reading. ORS 743.100 to 743.109 is not intended to increase the risk assumed by i…

743.102 [1967 c.359 §367; renumbered 743.047 in 1989]

743.103 Definitions for ORS 743.100 to 743.109

As used in ORS 743.100 to 743.109, “policy” has the meaning given in ORS 731.122 and, in addition, includes a certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state.

743.104 Scope of ORS 743.100 to 743.109

ORS 743.100 to 743.109 apply to all policies delivered or issued for delivery in this state, except: Any policy that is a security subject to federal jurisdiction. Any group policy covering a group of 1,000 or more lives at date of issue, other than a group credit life insurance policy or a group credit health insurance policy. However, this paragraph shal…

743.105 [1967 c.359 §368; renumbered 743.049 in 1989]

743.106 Reading ease standards for life and health insurance policies

No policy form shall be delivered or issued for delivery in this state unless: The policy text achieves a score of 40 or more on the Flesch reading ease test, or an equivalent score on any comparable test as provided in subsection (3) of this section; The policy, except for specification pages, schedules and tables is printed in not less than 12-point type…

743.107 When director may authorize lower standards

The Director of the Department of Consumer and Business Services may authorize a lower score than the Flesch reading ease test score required by ORS 743.106 when, in the director’s sole discretion, the director finds that a lower required score: Will provide a more accurate reflection of the readability of a policy form; Is warranted by the nature of a par…

743.108 [1967 c.359 §369; renumbered 743.050 in 1989]

743.109 Approval of certain policy forms containing specified provisions; conditions for approval

A policy form meeting the requirements of ORS 743.106 shall not be disapproved because of other provisions of the Insurance Code that specify the content of policies, if the policy form provides the policyholders and claimants protection not less favorable than they would be entitled to under such provisions.

743.111 [Formerly 744.090; renumbered 742.058 in 1989]

743.114 [Formerly 736.325; 1971 c.123 §1; 1981 c.667 §1; renumbered 742.061 in 1989]

743.115 [1987 c.774 §46; 1989 c.376 §1; renumbered 742.063 in 1989]

743.116 [1971 c.603 §2; 1981 c.422 §1; 1981 c.891 §2; renumbered 743.701 in 1989]

743.117 [1967 c.271 §§2,3; renumbered 743.703 in 1989]

743.118 [1987 c.720 §2; renumbered 743.704 in 1989]

743.119 [1981 c.254 §2; renumbered 743.706 in 1989]

743.120 [1975 c.135 §2; renumbered 743.707 in 1989]

743.123 [1975 c.338 §2; renumbered 743.709 in 1989]

743.125 [1979 c.268 §6; renumbered 743.710 in 1989]

743.128 [1979 c.785 §20; renumbered 743.712 in 1989]

743.132 [1979 c.1 §15; renumbered 743.713 in 1989]

743.135 [1981 c.422 §5; 1989 c.721 §54; 1989 c.1080 §1; renumbered 743.714 in 1989]

743.138 [1987 c.739 §§2,4b; renumbered 743.715 in 1989]

743.140 [1985 c.536 §1; renumbered 743.716 in 1989]

743.143 [1985 c.312 §2; renumbered 743.717 in 1989]

743.145 [1985 c.747 §59; renumbered 743.700 in 1989]

743.147 [1987 c.530 §2; renumbered 743.718 in 1989]

INDIVIDUAL LIFE INSURANCE AND ANNUITIES (Generally)

743.150 Scope of ORS 743.150, 743.153 and 743.156

This section and ORS 743.153 and 743.156 apply only to policies of life insurance, other than group life insurance.

743.153 Statement of benefits

A life insurance policy shall contain a provision stating the amount of benefits payable or the method to be used or procedure to be followed in determining such amount, the manner of payment and the consideration therefor.

743.154 Acceleration of death benefits; rules

A life insurance policy or a rider to a life insurance policy may provide for the acceleration of death benefits as part of the life insurance coverage. For purposes of this section, accelerated death benefits are benefits that: Are payable to the policy owner or certificate holder during the lifetime of the insured, in anticipation of death or upon the occ…

743.156 Statement of premium

A life insurance policy shall contain a provision separately stating the premium for each benefit provision of the policy for which such separate statement is necessary, as determined by the Director of the Department of Consumer and Business Services, to give adequate disclosure of the terms of the policy. (Individual Life Insurance Policies)

743.159 Scope of ORS 743.162 to 743.243

ORS 743.162 to 743.243 apply only to policies of life insurance other than group life insurance, and do not apply to annuity or pure endowment policies. Such sections apply to such policies that are policies of variable life insurance, except to the extent the provisions of such sections are obviously inapplicable to variable life insurance or are in conflic…

743.162 Payment of premium

A life insurance policy shall contain a provision relating to the time and place of payment of premium.

743.165 Grace period

A life insurance policy shall contain a provision that a grace period of 30 days, or, at the option of the insurer, of one month of not less than 30 days, or of four weeks in the case of industrial life insurance policies the premiums for which are payable more frequently than monthly, shall be allowed within which the payment of any premium after the first …

743.168 Incontestability

A life insurance policy shall contain a provision that the policy shall be incontestable after it has been in force for two years from its date of issue during the lifetime of the insured, except for nonpayment of premiums. At the option of the insurer the two-year limit within which the policy may be contested shall not apply to the provisions for benefits …

743.171 Incontestability and limitation of liability after reinstatement

A reinstated policy of life insurance may be contested on account of fraud or misrepresentation of facts material to the reinstatement only for the same period following reinstatement, and with the same conditions and exceptions, as the policy provides with respect to contestability after original issuance. When any policy of life insurance is reinstated, s…

743.174 Entire contract

A life insurance policy shall contain a provision that the policy constitutes the entire contract between the parties.

743.177 Statements of insured

A life insurance policy shall contain a provision that all statements made by or on behalf of the insured shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense of a claim under the policy unless contained in a written application and unless a copy of such application is indorsed upon…

743.180 Misstatement of age

A life insurance policy shall contain a provision that if it is found at any time before final settlement under the policy that the age of the insured or of any other person whose age is considered in determining the premium or benefit accruing under the policy has been misstated, the amount payable or benefit accruing under the policy shall be such as the p…

743.183 Dividends

A life insurance policy other than a nonparticipating policy shall contain a provision that the policy shall participate in the divisible surplus of the insurer annually, beginning not later than the end of the third policy year. Any policy containing provision for participation beginning at the end of the first or the second policy year may provide that div…

743.186 Policy loan

A life insurance policy shall contain a provision that after three full years’ premiums have been paid and after the policy has a cash surrender value and while no premium is in default beyond the grace period for payment, the insurer will advance, on proper assignment or pledge of the policy and on the sole security thereof, an amount equal to or, at the op…

743.187 Maximum interest rate on policy loan; adjustable interest rate

Except as provided otherwise in this section, the maximum interest rate in the policy loan provision required by ORS 743.186 shall be eight percent per year. The insurer may include in the policy loan provision, in lieu of a fixed maximum interest rate, a provision for an adjustable interest rate. The adjustable interest rate provision must comply with this …

743.189 Reinstatement

A life insurance policy shall contain a provision that if in the event of a default in premium payments the value of the policy has been applied to provide a paid-up nonforfeiture benefit, and if this benefit is currently in force and the original policy has not been surrendered to the insurer and canceled, and if a period of not more than three years has el…

743.192 Payment of claim; payment of interest upon failure to pay proceeds

A life insurance policy shall contain a provision that when the policy becomes a claim by the death of the insured, settlement shall be made upon receipt of due proof of death and of the interest of the claimant. If the insurer fails to pay the proceeds of or make payment under the policy within 30 days after receipt of due proof of death and of the interes…

743.195 Installment payments

A life insurance policy shall contain a table showing the amounts of installments, if any, by which its proceeds may be payable.

743.198 Title

A life insurance policy shall contain a title briefly and correctly describing the policy. If an industrial life insurance policy, it shall have the words “industrial policy” imprinted on the face thereof as part of the descriptive matter.

743.201 Beneficiary of industrial policies

An industrial life insurance policy shall have the name of the beneficiary designated thereon, or in the application or other form if attached to the policy, with a reservation of the right to designate or change the beneficiary after the issuance of the policy unless such beneficiary has been irrevocably designated. The policy may also provide that no desig…

743.204 Standard Nonforfeiture Law for Life Insurance; applicability

ORS 743.204 to 743.222 may be cited as the Standard Nonforfeiture Law for Life Insurance. The operative date of the Standard Nonforfeiture Law for Life Insurance as to any policy is the earlier of: January 1, 1948; or The date specified in a written notice, filed with the Director of the Department of Consumer and Business Services by the insurer, of elec…

743.207 Required provisions relating to nonforfeiture

A life insurance policy shall contain in substance the following provisions, or corresponding provisions which in the opinion of the Director of the Department of Consumer and Business Services are at least as favorable to the defaulting or surrendering policyholder as are the minimum requirements specified in this section, and which are essentially in compl…

743.210 Determination of cash surrender values; applicability to certain policies

Except as otherwise provided in subsections (2) and (3) of this section, any cash surrender value available under a life insurance policy in the event of default in a premium payment due on any policy anniversary, whether or not required by ORS 743.207, shall be an amount not less than the excess, if any, of the present value, on such anniversary, of the fut…

743.213 Determination of paid-up nonforfeiture benefits

Any paid-up nonforfeiture benefit available under a life insurance policy in the event of default in a premium payment due on any policy anniversary shall be such that its present value as of such anniversary shall be at least equal to the cash surrender value then provided for by the policy or, if none is provided for, that cash surrender value which would …

743.215 Calculation of adjusted premiums

This section applies to all life insurance policies issued on or after the operative date defined in this subsection for the issuing insurer. After January 1, 1982, any insurer may file with the Director of the Department of Consumer and Business Services a written notice of its election to comply with the provisions of this section with regard to any number…

743.216 Adjusted premiums; applicability

This section applies only to life insurance policies issued before the operative date defined in ORS 743.215. For such policies: Except as provided in subsection (3) of this section, the adjusted premiums referred to in ORS 743.210 shall be calculated on an annual basis and shall be such uniform percentage of the respective premiums specified in the policy …

743.218 Requirements for determination of future premium amounts or minimum values

In the case of policies of life insurance which provide for determination of future premium amounts by the insurer on the basis of current estimates of future experience, or policies of life insurance which are of such a nature that minimum values cannot in the judgment of the Director of the Department of Consumer and Business Services be determined by the …

743.219 Supplemental rules for calculating nonforfeiture benefits

Any cash surrender value and any paid-up nonforfeiture benefit available under a life insurance policy in the event of default in a premium payment due at any time other than on the policy anniversary date shall be calculated with allowance for the lapse of time and the payment of fractional premiums beyond the last preceding policy anniversary. All values …

743.221 Cash surrender values upon default in premium payment

This section shall apply to all life insurance policies issued on or after January 1, 1986. Any cash surrender value available in the event of default in a premium payment due on any policy anniversary under a life insurance policy to which this section applies shall be in an amount which does not differ, by more than two-tenths of one percent of the amount…

743.222 Policy benefits and premiums that shall be disregarded in calculating cash surrender values and paid-up nonforfeiture benefits

Notwithstanding ORS 743.210, in ascertaining minimum cash surrender values and paid-up nonforfeiture benefits required by the Standard Nonforfeiture Law for Life Insurance, benefits and their respective premiums provided for in a life insurance policy shall be disregarded where the benefits are payable: In the event of death or dismemberment by accident or …

743.225 Prohibited provisions

A life insurance policy may not: Limit the time within which any action at law or suit in equity may be commenced to less than three years after the cause of action or suit accrues; Purport to be issued or to take effect more than six months before the original application for the insurance was made; Require forfeiture of the policy for failure to repay a…

743.228 Acts of corporate insured or beneficiary with respect to policy

Whenever a corporation organized under the laws of this state or qualified to do business in this state has caused to be insured the life of any director, officer, agent or employee, or whenever such corporation is named as a beneficiary in or assignee of any life insurance policy, due authority to effect, assign, release, relinquish, convert, surrender, cha…

743.230 Variable life policy provisions

A variable life insurance policy shall contain in substance the following provisions: A provision that there will be a period of grace of 30 days within which payment of any premium after the first may be made, during which period of grace the policy will continue in full force. If a claim arises under the policy during such period of grace, the amount of a…

743.231 “Profit-sharing policy” defined

“Profit-sharing policy” means: A life insurance policy which by its terms expressly provides that the policyholder will participate in the distribution of earnings or surplus other than earnings or surplus attributable, by reasonable and nondiscriminatory standards, to the participating policies of the insurer and allocated to the policyholder on reasonable…

743.234 “Charter policy” or “founders policy” defined

“Charter policy” or “founders policy” means: A life insurance policy which by its terms expressly provides that the policyholder will receive some preferential or discriminatory advantage or benefit not available to persons who purchase insurance from the insurer at future dates or under other circumstances; or A life insurance policy the provisions of whi…

743.237 “Coupon policy” defined

“Coupon policy” means a life insurance policy which provides a series of pure endowments maturing periodically in amounts not exceeding the gross annual policy premiums. The term “pure endowment” or “endowment” is used in its accepted actuarial sense, meaning a benefit becoming payable at a specific future date if the insured person is then living.

743.240 Profit-sharing, charter or founders policies prohibited

No profit-sharing, charter or founders policy shall be issued or delivered in this state.

743.243 Restrictions on form of coupon policy

Coupon policies issued or delivered in this state shall be subject to the following provisions: No detachable coupons or certificates or passbooks may be used. No other device may be used which tends to emphasize the periodic endowment benefits or which tends to create the impression that the endowments represent interest earnings or anything other than ben…

743.245 Variable life insurance policy provisions

A variable life insurance policy shall contain a provision stating the essential features of the procedures to be followed by the insurer in determining benefits thereunder. Such a policy, and any certificate evidencing such a policy, shall contain on its first page a clear and prominent statement to the effect that benefits thereunder are variable.

743.247 Notice to variable life insurance policyholders

An insurer issuing individual variable life insurance policies shall mail to each policyholder at least once in each policy year after the first, at the last address of the policyholder known to the insurer: A statement reporting the investments held in the applicable separate account. A statement reporting as of a date not more than four months preceding …

743.252 Scope of ORS 743.255 to 743.273

ORS 743.255 to 743.273 apply only to annuity and pure endowment policies, other than reversionary annuity policies except as provided in ORS 743.273, and other than group annuity policies, and shall not apply to reversionary or deferred annuity benefits included in life insurance policies. Such sections apply to such policies that are variable annuity polici…

743.255 Grace period for annuities

An annuity or pure endowment policy shall contain a provision that there shall be a period of grace of one month, but not less than 30 days, within which any stipulated payment to the insurer falling due after the first such payment may be made, subject at the option of the insurer to an interest charge thereon at the rate specified in the policy but not exc…

743.258 Incontestability

If any statement other than those relating to age, sex and identity are required as a condition to issuing an annuity or pure endowment policy, the policy shall contain a provision that the policy shall be incontestable after it has been in force during the lifetime of the person or of each of the persons as to whom such statements are required, for a period…

743.261 Entire contract

An annuity or pure endowment policy shall contain a provision that the policy, including a copy of the application if indorsed upon or attached to the policy when issued, shall constitute the entire contract between the parties.

743.262 Obligations of producers and insurers in sale or recommendation of annuity; penalties; rules

As used in this section: “Annuity” means: An agreement to make periodic payments, whether fixed or variable, in an amount: That is individually solicited, whether the agreement is classified as an individual annuity or a group annuity; and In which the obligation to make all or some of the periodic payments, or the amount of any periodic payment, depends…

743.264 Misstatement of age or sex

An annuity or pure endowment policy shall contain a provision that if the age or sex of the person or persons upon whose life or lives the policy is made, or of any of them, has been misstated, the amount payable or benefits accruing under the policy shall be such as the stipulated payment or payments to the insurer would have purchased according to the corr…

743.267 Dividends

If an annuity or pure endowment policy is participating, it shall contain a provision that the insurer shall annually ascertain and apportion any divisible surplus accruing on the policy.

743.268 Advancement of policy loans

An insurer may advance a policy loan equal to or less than the loan value of an annuity policy or a pure endowment policy if: The policy premium is not in default beyond the grace period for payment; The insured has properly assigned or pledged the policy on the sole security thereof; and The interest rate provision complies with ORS 743.187 and does not …

743.269 Periodic payments for period certain

An annuity policy meeting the requirements of this section may provide that periodic payments shall be made under the policy for a period certain. Payments under such a policy shall begin on a date less than 13 months after the date on which the insurer issues the policy. The policy shall provide that payments will be made for a period of five years or more.…

743.270 Reinstatement

An annuity or pure endowment policy shall contain a provision that the policy may be reinstated at any time within one year from a default in making stipulated payments to the insurer, unless the cash surrender value has been paid, but all overdue stipulated payments and any indebtedness to the insurer on the policy shall be paid or reinstated with interest …

743.271 Periodic stipulated payments on variable annuities

A variable annuity policy requiring periodic stipulated payments to the insurer shall contain in substance the following provisions: A provision that there will be a period of grace of 30 days within which any stipulated payment to the insurer after the first may be made, during which period of grace the policy will continue in full force. The policy may in…

743.272 Computing benefits

A variable annuity policy shall specify the investment increment factors to be used in computing the dollar amount of variable benefits or other variable payments or values under the policy, and may guarantee that expense or mortality results or both will not adversely affect such dollar amounts. In the case of an individual variable annuity policy under whi…

743.273 Standard provisions of reversionary annuities

A policy of reversionary annuity shall contain in substance the following provisions: The provisions specified in ORS 743.255 to 743.267, except that under ORS 743.255 the insurer may at its option provide for an equitable reduction of the amount of the annuity payments in settlement of an overdue payment in lieu of providing for deduction of the overdue pa…

743.275 Standard Nonforfeiture Law for Individual Deferred Annuities; application

ORS 743.275 to 743.295 may be cited as the Standard Nonforfeiture Law for Individual Deferred Annuities. The Standard Nonforfeiture Law for Individual Deferred Annuities does not apply to: Reinsurance. A group annuity policy purchased under a retirement or deferred compensation plan established or maintained by an employer, including a partnership or sole…

743.278 Required provisions in annuity policies; exception

An annuity policy shall contain in substance the following provisions, or corresponding provisions that in the opinion of the Director of the Department of Consumer and Business Services are at least as favorable to the policyholder: That upon the termination of considerations under the policy, or upon the written request of the policyholder, the insurer sh…

743.281 [1977 c.320 §4; repealed by 2003 c.370 §9]

743.284 Computation of benefits

Any paid-up annuity benefit available under an annuity policy shall be such that its present value on the date annuity payments are to commence is at least equal to the minimum nonforfeiture amount on that date. The present value shall be computed using the mortality table, if any, and the interest rate specified in the policy for determining the minimum pai…

743.287 Commencement of annuity payments at optional maturity dates; calculation of benefits

For the purpose of determining the benefits calculated under ORS 743.284 (2) and (3) in the case of annuity policies under which an election may be made to have annuity payments commence at optional maturity dates, the maturity date shall be considered to be the latest date for which such election is permitted by the policy, but not later than the policy ann…

743.290 Notice of nonpayment of certain benefits to be included in annuity policy

An annuity policy that does not provide cash surrender benefits or does not provide death benefits at least equal to the minimum nonforfeiture amount prior to the start of annuity payments shall include a statement in a prominent place in the policy that the benefits are not provided.

743.293 Minimum forfeiture amounts for annuity policies; rules

The minimum values as specified in ORS 743.284 and 743.287 of any paid-up annuity, cash surrender or death benefits available under an annuity policy shall be based on minimum nonforfeiture amounts as described in this section. The minimum nonforfeiture amount at or prior to the commencement of any annuity payments shall be equal to an accumulation up to th…

743.295 Effect of certain life insurance and disability benefits on minimum nonforfeiture amounts

For an annuity policy that includes, by rider or supplemental contract provision, both annuity benefits and life insurance benefits that exceed the greater of cash surrender benefits or a return of the gross considerations with interest, the minimum nonforfeiture benefits shall equal the sum of the minimum nonforfeiture benefits for the annuity portion and t…

743.298 Penalties, fees or charges; rules

Notwithstanding the provisions of ORS 743.275 to 743.295, the Department of Consumer and Business Services may adopt rules to regulate the penalties, fees or other charges that an insurer imposes for a withdrawal, before maturity or after the owner or annuitant dies, from an individual deferred annuity policy. In adopting rules under subsection (1) of this …

743.303 Requirements for issuance of group life insurance policies

Policies of group life insurance are subject to the following requirements: The policy shall be issued upon the lives of persons who are associated in a common group formed for purposes other than the obtaining of insurance, except that either of the following kinds of policies may be issued to persons other than those in a common group: Group policies of …

743.306 Required provisions in group life insurance policies

Except as provided in subsection (2) of this section a group life insurance policy shall contain in substance the provisions described in ORS 743.309 to 743.342. The provisions described in ORS 743.327 to 743.339 shall not apply to policies of group credit life insurance.

743.309 Nonforfeiture provisions

If a group life insurance policy is on a plan of insurance other than the term plan, it shall contain nonforfeiture provision or provisions which in the opinion of the Director of the Department of Consumer and Business Services are equitable to the insured persons and to the policyholder, but nothing in this section shall be construed to require that group …

743.312 Grace period

A group life insurance policy shall contain a provision that the policyholder is entitled to a grace period of 31 days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date o…

743.315 Incontestability

A group life insurance policy shall contain a provision that the validity of the policy shall not be contested, except for nonpayment of premiums, after it has been in force for two years from its date of issue; and that no statement made by any person insured under the policy relating to the insurability of the person shall be used in contesting the validit…

743.318 Application; representations by policyholders and insureds

A group life insurance policy shall contain a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contes…

743.321 Evidence of insurability

A group life insurance policy shall contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the coverage.

743.324 Misstatement of age

A group life insurance policy shall contain a provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, such provision to contain a clear statement of the method of adjustment to be used.

743.327 Payments under policy; payment of interest upon failure to pay proceeds

A group life insurance policy shall contain a provision that any sum becoming due by reason of the death of a person insured shall be payable to the beneficiary designated by the person insured, subject to the provisions of the policy in the event there is no designated beneficiary, as to all or any part of such sum, living at the death of the person insured…

743.330 Issuance of certificates

A group life insurance policy shall contain a provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which the person is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in ORS 743.333, 743.…

743.333 Termination of individual coverage

A group life insurance policy shall contain a provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, such person shall be entitled to have issued by the insurer, without evidence of insurability, an…

743.336 Termination of policy or class of insured persons

A group life insurance policy shall contain a provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured thereunder at the date of such termination whose insurance terminates and who has been so insured for at least five years prior to such termination date shall be entit…

743.339 Death during period for conversion to individual policy

A group life insurance policy shall contain a provision that if a person insured under the group policy dies during the period within which the person would have been entitled to have an individual policy issued in accordance with ORS 743.333 or 743.336 and before such an individual policy shall have become effective, the amount of life insurance which the p…

743.342 Statement furnished to insured under credit life insurance policy

A group credit life insurance policy shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form which will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid thereunder by reason of death shall be applied to reduce or extingui…

743.345 Assignability of group life policies

Nothing in the Insurance Code or in any other law shall be construed to prohibit any person insured under a group life insurance policy from making an assignment of all or any part of the incidents of ownership under such policy, including but not limited to the privilege to have issued an individual policy of life insurance pursuant to the provisions of ORS…

743.348 Certain sales practices prohibited

No person selling group life insurance is authorized to sell membership in a common group for the purpose of qualifying an applicant who is an individual for group life insurance. No person selling membership in a common group is authorized to offer group life insurance for the purpose of selling membership in the common group.

743.350 [1979 c.708 §2; renumbered 743.100 in 1989]

743.351 Eligibility of association to be group life policyholder; rules

An insurer shall not offer a policy of group life insurance in this state to an association as the policyholder or offer coverage under such a policy, whether the policy is issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the association satisfies the following requirements: The associa…

743.353 [1979 c.708 §3; renumbered 743.101 in 1989]

743.354 Requirements for certain group life policies issued to trustees of certain funds; rules

An insurer shall not offer in this state a policy of group life insurance that is described in this section and insures persons in this state, or shall not offer coverage under such a policy, whether the policy is to be issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the requirements of…

743.356 Continuing coverage upon replacement of group life policy

When coverage under a group life insurance policy is replaced by coverage under another group life insurance policy, the insurer offering the policy that is replaced shall continue to provide coverage for each certificate holder under the replaced policy whose premium payments are suspended because the certificate holder is disabled. Note: 743.356 was enact…

743.357 [1979 c.708 §4; renumbered 743.103 in 1989]

743.358 Borrowing by certificate holders under group life policy

An insurer of a group life insurance policy may authorize certificate holders under the policy to borrow upon the policy, subject to the following provisions: The insurer may require a certificate holder, in order to borrow on the policy, to have been a certificate holder under the policy for a minimum period specified by the insurer. The insurer may requi…

743.360 Alternative group life insurance coverage

Group life insurance coverage offered to a resident in this state under a group life insurance policy issued to a group other than one described in ORS 743.351 or 743.354 may be delivered if: The Director of the Department of Consumer and Business Services finds that: The issuance of the policy is in the best interest of the public; The issuance of the po…

743.362 [1979 c.708 §5; renumbered 743.104 in 1989]

743.365 [1979 c.708 §6; renumbered 743.106 in 1989]

743.368 [1979 c.708 §7; renumbered 743.107 in 1989]

743.370 [1979 c.708 §8; renumbered 743.109 in 1989]

CREDIT LIFE AND CREDIT HEALTH INSURANCE

743.371 Definitions for credit life and credit health insurance provisions

“Credit life insurance” means insurance on the life of a debtor pursuant to or in connection with a specific loan or other credit transaction. “Credit health insurance” means insurance on a debtor to provide indemnity for payments becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy. “Creditor” m…

743.372 Applicability of credit life and credit health insurance provisions

All life or health insurance in connection with loans or other credit transactions shall be subject to ORS 743.371 to 743.380, except: Insurance in connection with a loan or other credit transaction of more than 10 years’ duration; or Insurance, the issuance of which is an isolated transaction on the part of the insurer not related to an agreement or a pla…

743.373 Forms of credit life and credit health insurance

Credit life and credit health insurance shall be issued only in the following forms: Individual policies of life insurance issued to debtors on the term plan. Individual policies of health insurance issued to debtors on a term plan, or disability benefit provisions in individual policies of credit life insurance. Group policies of life insurance issued to…

743.374 Limits on amount of credit life insurance

The initial amount of credit life insurance shall not exceed the total amount repayable under the contract of indebtedness and, where an indebtedness is repayable in substantially equal installments, the amount of insurance shall at no time exceed the scheduled or actual amount of unpaid indebtedness, whichever is greater. Notwithstanding the provisions of …

743.375 Limit on amount of credit health insurance

The total amount of periodic indemnity payable by credit health insurance in the event of disability, as defined in the policy, shall not exceed the aggregate of the periodic scheduled unpaid installments of the indebtedness; and the amount of each periodic indemnity payment shall not exceed the original indebtedness divided by the number of periodic install…

743.376 Duration of credit life and credit health insurance

The term of any credit life or credit health insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor, except that, where a group policy provides coverage with respect to existing obligations, the insurance on a debtor with respect to such indebtedness shall commence on the effective date o…

743.377 Credit life and credit health insurance policy or group certificate; contents; delivery of policy, certificate or copy of application

All credit life or credit health insurance shall be evidenced by an individual policy or, in the case of group insurance, by a certificate of insurance, which individual policy or group certificate of insurance shall be delivered to the debtor. Each individual policy or group certificate of credit life or credit health insurance, or both shall, in addition …

743.378 Charges and refunds to debtor

Each individual policy or group certificate of credit life or credit health insurance, or both, shall provide that in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of an amount paid by the debtor for insurance shall be paid or credited promptly to the person entitled thereto. However, the Direc…

743.379 Status of remuneration to creditor

Notwithstanding the provisions of any other law of this state which may expressly or by construction provide otherwise, any commission or service fee or other benefit or return to any creditor arising out of the sale or provision of credit life and credit health insurance shall not be deemed interest or charges in connection with loans or credit transactions…

743.380 Claim report and payment

All claims under policies of credit life or credit health insurance, or both, shall be promptly reported to the insurer or its designated claim representative and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the policy. All claims shall be paid either by draft drawn upon…

743.402 Exceptions to individual health insurance policy requirements

ORS 743.405 to 743.498 and 743A.160 do not apply to or affect: Any workers’ compensation insurance policy or any liability insurance policy with or without supplementary expense coverage therein; Any policy of reinsurance; Any blanket or group policy of insurance, except as expressly provided in ORS 750.055; or Any life insurance policy, or policy supple…

743.405 General requirements for health insurance policies

An individual health insurance policy must meet the following requirements: The policy must include a statement of the entire money and other considerations due. The policy must state the time at which the insurance takes effect and terminates. The policy may purport to insure only one person, unless an adult member of a family applies for coverage of fam…

743.406 Required provisions in group health insurance policies

A group health insurance policy shall contain in substance the following provisions: A provision that, in the absence of fraud, all statements made by applicants, the policyholder or an insured person shall be deemed representations and not warranties, and that no statement made for the purpose of effecting insurance shall avoid the insurance or reduce bene…

743.408 Mandatory provisions

Except as provided in ORS 742.021, a health insurance policy shall contain the provisions set forth in ORS 743.411 to 743.444. The provisions shall be preceded individually by the caption appearing in the sections or, at the option of the insurer, by the appropriate individual or group captions or subcaptions as the Director of the Department of Consumer and…

743.411 Entire contract; changes

A health insurance policy shall contain a provision as follows: “ENTIRE CONTRACT; CHANGES: This policy, including the indorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be indorsed hereon or attached …

743.412 [1977 c.632 §2; 1981 c.319 §1; 2001 c.900 §230; renumbered 743A.160 in 2007]

743.414 Time limit on certain defenses; incontestability

A health insurance policy shall contain a provision as follows: “TIME LIMIT ON CERTAIN DEFENSES: After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in th…

743.416 Due date for first premium payment

An insurer offering an individual health benefit plan may establish a due date for payment of the first premium for the plan no earlier than 15 days after the date that the coverage begins or 15 days after the insurer sends the initial invoice to the insured, whichever is later. Note: Definitions for 743.416 may be found in 743B.005. Note: 743.416 was adde…

743.417 Grace period for subsequent premium payments; cancellation and nonrenewal

A policy of health insurance issued to an individual residing in this state shall specify a minimum grace period following the premium due date for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force. Unless a longer grace period is provided by federal law, the grace period must be at …

743.420 Reinstatement

A health insurance policy, other than a health benefit plan as defined in ORS 743B.005, shall contain a provision as follows: “REINSTATEMENT: If any renewal premium is not paid within the grace period, a subsequent acceptance of premium by the insurer or by any insurance producer duly authorized by the insurer to accept such premium, without requiring in con…

743.423 Notice of claim

A health insurance policy shall contain a provision as follows: “NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at ___ (ins…

743.426 Claim forms

A health insurance policy shall contain a provision as follows: “CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished within 15 days after the giving of such notice, the claimant shall be deemed to have complied with the re…

743.429 Proofs of loss

A health insurance policy shall contain a provision as follows: “PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within 90 days after the termination of the period for which the insurer is liable and in case of cl…

743.432 Time of payment of claims

A health insurance policy shall contain a provision as follows: “TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for w…

743.435 Payment of claims

A health insurance policy shall contain a provision as follows: “PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shal…

743.438 Physical examinations and autopsy

A health insurance policy shall contain a provision as follows: “PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden b…

743.441 Legal actions

A health insurance policy shall contain a provision as follows: “LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after…

743.444 Change of beneficiary

A health insurance policy shall contain a provision as follows: “CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of benef…

743.447 Optional provisions

Except as provided in ORS 742.021, provisions in a health insurance policy respecting the matters set forth in ORS 743.450 to 743.477 shall be in the words that appear in such sections. Any such provision contained in the policy shall be preceded individually by the appropriate caption appearing in such sections or, at the option of the insurer, by such appr…

743.450 Change of occupation

A health insurance policy may contain a provision as follows: “CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having changed occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer will pay only suc…

743.453 Misstatement of age

A health insurance policy may contain a provision as follows: “MISSTATEMENT OF AGE: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.”

743.456 Other insurance in same insurer

A health insurance policy may contain a provision as follows: “OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for _____ (insert type of coverage or coverages) in excess of $___ (insert maxi…

743.459 Insurance with other insurers; expense incurred benefits

A health insurance policy may contain a provision as follows: “INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss,…

743.462 Insurance with other insurers; other than expense incurred benefits

A health insurance policy may contain a provision as follows: “INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for …

743.465 Relation of earnings to insurance

A health insurance policy may contain a provision as follows: “RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commence…

743.468 Unpaid premium

A health insurance policy may contain a provision as follows: “UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.”

743.471 Cancellation

A health insurance policy may contain a provision as follows: “CANCELLATION: The insurer may cancel this policy by written notice delivered to the insured, or mailed to the last address of the insured as shown by the records of the insurer. The notice must state the reason for cancellation and the date on which the cancellation shall be effective. Except as …

743.472 Permissible reasons for cancellation or refusal to renew

An insurer selling individual health insurance policies may cancel or refuse to renew an individual health insurance policy only if the insurer makes a determination to cancel or not to renew all policies of the same type and form as the individual policy, or if the ground for cancellation or nonrenewal is any of the following and is stated as a provision of…

743.474 Conformity with state statutes

A health insurance policy may contain a provision as follows: “CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date hereby is amended to conform to the minimum requirements of such statutes.”

743.477 Illegal occupation

A health insurance policy may contain a provision as follows: “ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the insured’s commission of or attempt to commit a felony or to which a contributing cause was the insured’s being engaged in an illegal occupation.”

743.480 [1967 c.359 §452; 1979 c.744 §64; 2007 c.128 §1; renumbered 743A.164 in 2007]

743.483 Arrangement of provisions

The provisions of a health insurance policy that are the subject of ORS 743.408 to 743.477, or any corresponding provisions that are used in lieu thereof in accordance with the Insurance Code, shall be printed in the consecutive order of such sections or, at the option of the insurer, any such provision may appear as a unit in any part of the policy, with ot…

743.486 Scope of term “insured” in statutory policy provisions

As used in ORS 743.402 to 743.498, the word “insured” shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein.

743.489 Extension of coverage beyond policy period; effect of misstatement of age

If any health insurance policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy shall continu…

743.492 Policy return and premium refund provision

Every health insurance policy except single premium nonrenewable policies shall have printed on its face or attached thereto a notice stating in substance that the person to whom the policy is issued shall be permitted to return the policy within 10 days of its delivery to the purchaser and to have the premium paid refunded if, after examination of the polic…

743.495 Use of terms “noncancelable” or “guaranteed renewable”; synonymous terms

No health insurance policy shall contain the following unqualified terms except as provided in this subsection: The unqualified terms “noncancelable” or “noncancelable and guaranteed renewable” may be used only in a policy which the insured has the right to continue in force for life by the timely payment of premiums set forth in the policy, during which pe…

743.498 Statement in policy of cancelability or renewability

A health insurance policy which is noncancelable or guaranteed renewable as those terms are used in ORS 743.495, except that the insured’s right is for a limited period of more than one year rather than for life, shall contain the applicable one of the following statements, or such other statement which, in the opinion of the Director of the Department of Co…

743.499 [2011 c.500 §4a; 2012 c.24 §1; renumbered 743B.330 in 2015]

743.516 [1967 c.359 §459; repealed by 1999 c.987 §28]

743.519 [1967 c.359 §460; 1971 c.231 §25; repealed by 1999 c.987 §28]

743.520 [1971 c.231 §4; repealed by 1999 c.987 §28]

GROUP HEALTH INSURANCE (Plans for Leased Workers)

743.521 Leased workers; offering group health insurance

A leasing company may offer group health insurance to its leased workers. If the leasing company does not offer group health insurance to its leased workers, the client employer may offer group health insurance to the leased workers. If a leasing company offers group health insurance to its leased workers, the leasing company shall offer group health insura…

743.522 Additional groups designated by director

As used in this section and ORS 743.521: “Client employer” means an employer to whom workers are provided under contract and for a fee on a leased basis by a worker leasing company licensed under ORS 656.850. “Employee” may include a retired employee. “Leased worker” means a worker provided by a worker leasing company licensed under ORS 656.850. Group he…

743.523 Certain sales practices prohibited

No person selling group health insurance is authorized to sell membership in an association, including a labor union, for the purpose of qualifying an applicant who is an individual for group health insurance. No person selling membership in an association, including a labor union, is authorized to offer group health insurance for the purpose of selling mem…

743.524 Eligibility of association to be group health policyholder; rules

An insurer may not offer a policy of group health insurance to an association as the policyholder or offer coverage under such a policy, whether issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the association satisfies the requirements of an association under ORS 731.098 (2). An insure…

743.525 [1967 c.359 §462; repealed by 1981 c.752 §17]

743.526 Determination of whether trustees are policyholders; consequences; rules

An insurer may not offer a policy of group health insurance described in ORS 731.098 (3) that insures persons in this state or offer coverage under such a policy, whether the policy is to be issued in this or another state, unless the Director of the Department of Consumer and Business Services determines that the requirements of this section and ORS 731.098…

743.527 [1979 c.797 §2; 1981 c.395 §1; renumbered 743B.340 in 2015]

743.528 [1967 c.359 §463; 1981 c.752 §13; 1997 c.716 §23; 2013 c.681 §57; renumbered 743.406 in 2015]

743.529 [1977 c.402 §5; 1991 c.182 §6; renumbered 743B.341 in 2015]

743.530 [1985 c.634 §2; renumbered 743B.342 in 2015]

743.531 [1967 c.359 §464; 1985 c.747 §71; 1989 c.784 §23; 2015 c.588 §3; renumbered 743B.460 in 2015]

743.532 [1987 c.782 §2; repealed by 1989 c.1044 §7]

743.533 [2001 c.943 §5; renumbered 743.521 in 2015]

743.534 [1967 c.359 §465; renumbered 743.536 in 2015]

743.535 Health benefit coverage for guaranteed association

As used in this section, “guaranteed association” means an association that: The Director of the Department of Consumer and Business Services has determined under ORS 743.524 meets the requirements described in ORS 731.098 (2); and Is a statewide nonprofit organization representing the interests of individuals licensed under ORS chapter 696. A carrier may…

743.536 “Blanket health insurance” defined

“Blanket health insurance” means that form of a health insurance covering groups of persons defined in this section and issued on one of the following bases: Under a policy issued to a common carrier or to an operator, owner or lessee of a means of transportation, who shall be deemed the policyholder, insuring a group of persons who may become passengers an…

743.537 Required provisions for blanket health insurance policies

A blanket health insurance policy shall contain provisions which in the opinion of the Director of the Department of Consumer and Business Services are not less favorable to the policyholder and the individual insureds than the provisions described in ORS 743.411, 743.423, 743.426, 743.429, 743.432, 743.438 and 743.441.

743.540 Application and certificates not required for blanket health insurance policies

An individual application need not be required from a person insured under a blanket health insurance policy, nor shall it be necessary for the insurer to furnish each person a certificate.

743.543 Payment of benefits under blanket health insurance policies

All benefits under a blanket health insurance policy shall be payable to the person insured, or to the designated beneficiary or beneficiaries of the person, or to the estate of the person, except that if the person insured is a minor or otherwise not competent to give a valid release, such benefits may be made payable to the parent, guardian or other person…

743.546 Exemption of policy form approval for blanket health insurance policies

The Director of the Department of Consumer and Business Services may exempt from the policy form filing and approval requirements of ORS 742.003, for so long as the director deems proper, any blanket health insurance policy to which in the opinion of the director such requirements may not practicably be applied, or may dispense with such filing and approval …

743.549 [1973 c.143 §2; 1989 c.1080 §2; repealed by 2013 c.681 §65 and 2013 c.640 §21]

(Student Health Insurance)

743.550 Student health insurance

Student health insurance is subject to ORS 743.537, 743.540, 743.543, 743.546 and 743B.475, except as provided in this section. Coverage under a student health insurance policy may be mandatory for all students at the institution, voluntary for all students at the institution, or mandatory for defined classes of students and voluntary for other classes of s…

743.551 Student health benefit plans; rules

As used in this section, “student health benefit plan” means a plan that is subject to rules adopted by the United States Department of Health and Human Services under 42 U.S.C. 18118(c). Notwithstanding any other provision of law, the Department of Consumer and Business Services shall by rule and in a manner consistent with federal law in effect on January…

743.552 [1973 c.143 §3; 2013 c.681 §15a; 2015 c.515 §6; renumbered 743B.475 in 2015]

743.555 [1973 c.143 §4; repealed by 2005 c.22 §495]

743.556 [1987 c.411 §2; 1989 c.721 §55; 1991 c.67 §198; 1991 c.470 §19; 1991 c.654 §2; 1999 c.1086 §1; 2001 c.900 §217; 2003 c.33 §5; 2005 c.705 §1; 2007 c.71 §240; renumbered 743A.168 in 2007]

743.557 [1975 c.698 §2; 1977 c.632 §3; 1981 c.319 §2; 1983 c.601 §5; repealed by 1987 c.411 §9]

743.558 [1973 c.613 §2; 1983 c.601 §6; repealed by 1987 c.411 §9]

743.559 [1983 c.601 §12; repealed by 1991 c.182 §20]

743.560 [1991 c.673 §§3,4; 1993 c.454 §1; 1997 c.716 §24; 2001 c.943 §11; 2013 c.681 §58; renumbered 743B.320 in 2015]

743.561 [Formerly 739.565; renumbered 743.371 in 1989]

743.562 [1991 c.673 §5; renumbered 743B.321 in 2015]

743.564 [Formerly 739.570; 1969 c.336 §13; 1989 c.1073 §1; renumbered 743.372 in 1989]

743.565 [2001 c.943 §8; renumbered 743B.323 in 2015]

743.566 [2001 c.943 §16; renumbered 743B.324 in 2015]

743.567 [Formerly 739.575; renumbered 743.373 in 1989]

743.570 [1967 c.359 §473; renumbered 743.374 in 1989]

743.573 [Formerly 741.425; renumbered 743.375 in 1989]

743.576 [Formerly 739.585; renumbered 743.376 in 1989]

743.579 [Formerly 739.590; renumbered 743.377 in 1989]

743.582 [Formerly 739.600; renumbered 743.378 in 1989]

743.585 [Formerly 739.603; renumbered 743.379 in 1989]

743.588 [Formerly 739.610; renumbered 743.380 in 1989]

743.600 [Formerly 743.851; renumbered 743B.343 in 2015]

743.601 [Formerly 743.852; 2003 c.576 §557; 2011 c.500 §6a; 2012 c.24 §2; renumbered 743B.344 in 2015]

743.602 [Formerly 743.853; 2015 c.515 §7; renumbered 743B.345 in 2015]

743.603 [Formerly 744.070; renumbered 742.200 in 1989]

743.606 [1967 c.359 §481; 1967 c.453 §3; renumbered 742.202 in 1989]

743.607 [1967 c.453 §2; renumbered 742.204 in 1989]

743.609 [1967 c.359 §482; 1971 c.231 §26; renumbered 742.206 in 1989]

743.610 [Formerly 743.850; 2009 c.73 §§3,4; 2011 c.500 §§6b,6c; 2012 c.24 §3; 2013 c.681 §16; renumbered 743B.347 in 2015]

743.611 [Formerly 743.855; 1991 c.673 §6; repealed by 1995 c.603 §42]

743.612 [1967 c.359 §483; 1985 c.465 §3; renumbered 742.208 in 1989]

743.613 [Formerly 743.860; repealed by 1995 c.603 §42]

743.614 [Formerly 743.865; repealed by 1995 c.603 §42]

743.615 [1967 c.359 §484; renumbered 742.210 in 1989]

743.616 [Formerly 743.870; repealed by 1995 c.603 §42]

743.617 [Formerly 743.875; repealed by 1995 c.603 §42]

743.618 [1967 c.359 §485; renumbered 742.212 in 1989]

743.619 [Formerly 743.880; repealed by 1995 c.603 §42]

743.620 [Formerly 743.885; repealed by 1995 c.603 §42]

743.621 [1967 c.359 §486; renumbered 742.214 in 1989]

743.622 [Formerly 743.890; repealed by 1995 c.603 §42]

743.624 [1967 c.359 §487; renumbered 742.216 in 1989]

743.627 [1967 c.359 §488; renumbered 742.218 in 1989]

743.630 [1967 c.359 §489; renumbered 742.220 in 1989]

743.633 [1967 c.359 §490; renumbered 742.222 in 1989]

743.636 [1967 c.359 §491; 1989 c.426 §2; renumbered 742.224 in 1989]

743.639 [1967 c.359 §492; renumbered 742.226 in 1989]

743.642 [1967 c.359 §493; renumbered 742.228 in 1989]

743.645 [1967 c.359 §494; 1989 c.426 §1; renumbered 742.230 in 1989]

743.648 [1967 c.359 §495; renumbered 742.232 in 1989]

(Long Term Care Insurance)

743.650 Long Term Care Insurance Act; purpose; application

ORS 743.650 to 743.665 may be known and cited as the “Long Term Care Insurance Act.” The purpose of ORS 743.650 to 743.665 is to: Promote the public interest in long term care insurance; Promote the availability of long term care insurance policies; Protect applicants for long term care insurance from unfair or deceptive sales or enrollment practices; E…

743.651 [1967 c.359 §496; renumbered 742.234 in 1989]

743.652 Definitions for ORS 743.650 to 743.665

As used in ORS 743.650 to 743.665, unless the context requires otherwise: “Applicant” means: In the case of an individual long term care insurance policy, the person who seeks to contract for benefits; and In the case of a group long term care insurance policy, the proposed certificate holder. “Benefit trigger” means a contractual provision in a long ter…

743.653 Prohibition on certain policies

Group long term care insurance coverage may not be offered to a resident of this state under a group policy issued in another state to a group described in ORS 743.652 (4)(d), unless this state or another state having statutory and regulatory long term care insurance requirements substantially similar to those adopted in this state has made a determination t…

743.654 [1967 c.359 §497; renumbered 742.236 in 1989]

743.655 Rules; disclosure; contents of policy

The Director of the Department of Consumer and Business Services shall adopt rules that include standards for full and fair disclosure setting forth the manner, content and required disclosures for the sale of long term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, cov…

743.656 Eligibility for benefits; providers required to be covered

No long term care insurance policy shall be delivered or issued for delivery in this state unless the policy determines eligibility for benefits through a determination that is not more restrictive than requiring that: The policyholder be functionally impaired and needing assistance in any three or more activities of daily living as defined by the Director …

743.657 [1967 c.359 §498; renumbered 742.238 in 1989]

743.658 Notice of lapse or termination; rules

An insurer may not issue an individual long term care insurance policy until the insurer receives from an applicant for the policy: A written designation of the full name and residential address of at least one person, in addition to the applicant, to whom the insurer can send notice of a lapse or termination of the policy because of a failure to pay a prem…

743.660 [1967 c.359 §499; renumbered 742.240 in 1989]

743.662 Rescission of policy and denial of claims

For a policy or certificate that has been in force for less than six months, an insurer may rescind a long term care insurance policy or certificate or deny an otherwise valid long term care insurance claim upon a showing of a misrepresentation that is material to the acceptance for coverage. For a policy or certificate that has been in force for at least s…

743.663 [1967 c.359 §500; renumbered 742.242 in 1989]

743.664 Offer of nonforfeiture benefit; rules

Except as provided in subsection (2) of this section, a long term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider …

743.665 Prompt pay requirements; rules

The Director of the Department of Consumer and Business Services shall adopt by rule prompt payment requirements for long term care insurance. The rules shall include a definition of “claim” and a definition of “clean claim.” In adopting the rules, the director shall consider the prompt payment requirements in long term care insurance model acts developed by…

743.666 [Formerly 744.125; renumbered 742.244 in 1989]

743.669 [Formerly 744.130; renumbered 742.246 in 1989]

743.672 [Formerly 744.430; renumbered 742.248 in 1989]

743.675 [Formerly 744.440; renumbered 742.250 in 1989]

743.678 [Formerly 744.450; renumbered 742.252 in 1989]

(Medicare Supplement Policies)

743.680 Definitions for ORS 743.680 to 743.689

As used in ORS 743.680 to 743.689, unless the context requires otherwise: “Applicant” means: In the case of an individual Medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits. In the case of a group Medicare supplement policy or subscriber contract, the proposed certificate holder. “Certificate” means…

743.681 [Formerly 744.460; renumbered 742.254 in 1989]

743.682 Application of ORS 743.680 to 743.689

Except as otherwise specifically provided, ORS 743.680 to 743.689 apply to: All Medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after May 31, 1989; and All certificates issued under group Medicare supplement policies or subscriber contracts, which certificates have been delivered or issued for deli…

743.683 Policy contents; standards for benefit and claims payments; rules

A Medicare supplement insurance policy, contract or certificate in force in the state may not contain benefits which duplicate benefits provided by Medicare. The Director of the Department of Consumer and Business Services shall adopt by rule specific standards for policy provisions of Medicare supplement policies and certificates. The standards shall be in…

743.684 Filing of policy; loss ratio standards; insurance producer compensation

Every insurer providing group Medicare supplement insurance benefits to a resident of this state pursuant to ORS 743.682 shall file a copy of the master policy and any certificate used in this state in accordance with the filing requirements and procedures applicable to group Medicare supplement policies issued in this state. However, no insurer shall be req…

743.685 Outline of coverage; information brochure; rules

In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made. The Director of the Department of Consumer and Business Services shall prescribe the format an…

743.686 Right to return of policy; premium refund

Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certific…

743.687 Advertising

Every insurer, health care service plan or other entity providing Medicare supplement insurance or benefits in this state shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medium to the Director of the Department of Consumer and Business Services of this state for review …

743.688 Rules

Rules adopted pursuant to ORS 743.680 to 743.689 shall be subject to the provisions of ORS chapter 183.

743.689 Director’s authority upon violation of ORS 743.680 to 743.689

In addition to any other applicable penalties for violations of the Insurance Code, the Director of the Department of Consumer and Business Services may require insurers violating any provision of ORS 743.680 to 743.689 or rules adopted pursuant to ORS 743.680 to 743.689 to cease marketing any Medicare supplement policy or certificate in this state which is …

743.690 [1981 c.247 §17; renumbered 742.280 in 1989]

743.691 [2003 c.748 §2; renumbered 743A.110 in 2007]

743.693 [1999 c.428 §2; 2001 c.104 §289; renumbered 743A.080 in 2007]

743.694 [2001 c.742 §2; renumbered 743A.184 in 2007]

743.695 [1997 c.573 §2; renumbered 743A.060 in 2007]

743.697 [1997 c.573 §3; renumbered 743A.062 in 2007]

743.699 [1997 c.651 §2; 2003 c.137 §1; renumbered 743A.012 in 2007]

743.700 [Formerly 743.145; 2005 c.69 §1; 2005 c.482 §3; 2007 c.313 §4; renumbered 743A.001 in 2007]

743.701 [Formerly 743.116; renumbered 743A.010 in 2007]

743.702 [Formerly 746.010; repealed by 1969 c.692 §11]

743.703 [Formerly 743.117; 2005 c.442 §4; renumbered 743A.040 in 2007]

743.704 [Formerly 743.118; repealed by 2001 c.742 §3]

743.705 [Formerly 746.030; 1969 c.692 §9; 1973 c.179 §1; 1982 s.s.1 c.5 §1; 1987 c.846 §13; renumbered 742.282 in 1989]

743.706 [Formerly 743.119; renumbered 743A.148 in 2007]

743.707 [Formerly 743.120; 1991 c.674 §2; 1995 c.506 §10; renumbered 743A.090 in 2007]

743.708 [Formerly 746.080; 1969 c.692 §10; 1973 c.823 §150; renumbered 742.284 in 1989]

743.709 [Formerly 743.123; renumbered 743A.048 in 2007]

743.710 [Formerly 743.125; renumbered 743A.088 in 2007]

743.711 [1987 c.846 §15; renumbered 742.286 in 1989]

743.712 [Formerly 743.128; renumbered 743A.036 in 2007]

743.713 [Formerly 743.132; 1993 c.142 §15; 2005 c.22 §496; renumbered 743A.028 in 2007]

743.714 [Formerly 743.135; renumbered 743A.024 in 2007]

743.715 [Formerly 743.138; repealed by 1991 c.182 §21]

743.716 [Formerly 743.140; repealed by 1995 c.506 §11]

743.717 [Formerly 743.143; renumbered 743A.180 in 2007]

743.718 [Formerly 743.147; renumbered 743A.014 in 2007]

743.719 [Formerly 743.052; renumbered 743A.032 in 2007]

743.720 [1979 c.866 §4; 1987 c.774 §56; renumbered 742.300 in 1989]

743.721 [Formerly 743.037; renumbered 743A.084 in 2007]

743.722 [1989 c.832 §2; 1991 c.314 §3; 1995 c.79 §365; repealed by 2007 c.313 §3]

743.723 [1979 c.866 §5; 1981 c.525 §1; 1987 c.774 §57; renumbered 742.302 in 1989]

743.724 [Formerly 746.307; repealed by 1997 c.695 §2 (743.725 enacted in lieu of 743.724)]

743.725 [1997 c.695 §3 (enacted in lieu of 743.724); 2003 c.446 §1; 2007 c.346 §1; renumbered 743A.044 in 2007]

743.726 [1997 c.496 §2; 2003 c.263 §1; renumbered 743A.188 in 2007]

743.727 [1993 c.575 §2; 1999 c.429 §1; renumbered 743A.100 in 2007]

743.728 [1993 c.576 §2; 1999 c.429 §2; renumbered 743A.104 in 2007]

743.729 [1993 c.407 §2; renumbered 743A.070 in 2007]

743.730 [1991 c.916 §3; 1993 c.18 §157; 1993 c.615 §25; 1993 c.649 §8; 1993 c.744 §31; 1995 c.603 §§1,36; 1997 c.716 §§1,2; 1999 c.547 §8; 1999 c.987 §6; 2001 c.943 §6; 2003 c.364 §112; 2005 c.744 §38; 2007 c.389 §1; 2009 c.595 §1135; 2011 c.500 §§7,49; 2012 c.38 §20; 2013 c.681 §§17,59; 2013 c.698 §20; 2015 c.3 §§50,51; 2015 c.515 §§8,9; renumbered 743B.005 in 2015]

743.731 [1991 c.916 §2; 1993 c.18 §158; 1993 c.649 §11; 1995 c.603 §2; 1997 c.716 §4; 2011 c.500 §8; 2013 c.681 §18; 2015 c.515 §11; renumbered 743B.003 in 2015]

743.732 [Formerly 747.080; renumbered 742.350 in 1989]

743.733 [1991 c.916 §4; 1993 c.18 §159; 1995 c.603 §3; 1999 c.987 §7; 2007 c.389 §4; subsection (3) of 2007 Edition enacted as 2007 c.389 §3; 2011 c.500 §9; 2013 c.681 §19; 2015 c.3 §52; renumbered 743B.010 in 2015]

743.734 [1991 c.916 §5; 1993 c.18 §160; 1995 c.603 §4; 1997 c.716 §5; 1999 c.987 §8; 2007 c.389 §5; 2007 c.752 §§4,9; 2010 c.81 §§1,2,3; 2011 c.500 §§12,13; 2013 c.681 §20; 2015 c.515 §12; renumbered 743B.011 in 2015]

743.735 [Formerly 747.100; 1973 c.823 §151; renumbered 742.352 in 1989]

743.736 [1991 c.916 §6; 1993 c.649 §12; 1995 c.603 §5; 1997 c.716 §6; 1999 c.987 §9; 2011 c.500 §14; 2013 c.681 §21; 2015 c.515 §13; renumbered 743B.012 in 2015]

743.737 [1991 c.916 §7; 1993 c.18 §161; 1993 c.649 §10; 1995 c.603 §§6,37; 1997 c.716 §§7,8; 1999 c.987 §10; 2001 c.943 §12; 2003 c.364 §113; 2003 c.599 §§4,6; 2003 c.748 §5; 2007 c.389 §§6,7; 2007 c.391 §2; 2009 c.595 §1136; 2011 c.500 §15; 2013 c.681 §22; 2015 c.515 §14; renumbered 743B.013 in 2015]

743.738 [Formerly 747.110; renumbered 742.354 in 1989]

743.739 [1991 c.916 §8; repealed by 1995 c.603 §32]

743.740 [1991 c.916 §9; 1993 c.18 §162; repealed by 1995 c.603 §32]

743.741 [Formerly 747.130; renumbered 742.356 in 1989]

743.742 [1991 c.916 §10; repealed by 1995 c.603 §32]

743.743 [1991 c.916 §11; 1993 c.18 §163; 1993 c.649 §13; repealed by 1995 c.603 §32]

743.744 [Formerly 747.140; renumbered 742.358 in 1989]

743.745 [1991 c.916 §12; 1993 c.18 §164; 1995 c.603 §§10,38; 1999 c.987 §11; 2003 c.364 §114; 2011 c.500 §16; 2013 c.681 §23; 2015 c.515 §15; renumbered 743B.100 in 2015]

743.746 [1997 c.716 §9c; repealed by 1999 c.987 §28]

743.747 [Formerly 747.150; renumbered 742.360 in 1989]

743.748 [2005 c.765 §2; 2007 c.752 §§5,10; 2011 c.500 §§17,18; 2013 c.681 §24; 2013 c.698 §§21,38; renumbered 743.004 in 2015]

743.749 [1997 c.716 §20; renumbered 743B.102 in 2015]

743.750 [1967 c.359 §516; renumbered 742.362 in 1989]

743.751 [1995 c.603 §15; 1997 c.716 §10; 2011 c.500 §19; 2013 c.681 §25; 2015 c.515 §18; renumbered 743B.103 in 2015]

743.752 [1995 c.603 §16; 1997 c.716 §11; 1999 c.987 §12; 2013 c.681 §26; renumbered 743B.104 in 2015]

743.753 [Formerly 747.170; 1969 c.526 §2; renumbered 742.364 in 1989]

743.754 [1995 c.603 §17; 1995 c.603 §40; 1997 c.716 §§12,13; 1999 c.987 §13; 2001 c.943 §13; 2003 c.748 §6; 2011 c.500 §20; 2013 c.681 §27; 2015 c.515 §19; renumbered 743B.105 in 2015]

743.755 [1969 c.526 §1; renumbered 742.366 in 1989]

743.756 [Formerly 747.180; renumbered 742.368 in 1989]

743.757 [2005 c.571 §2; 2013 c.681 §60; renumbered 743.535 in 2015]

743.758 [1997 c.716 §21; 2011 c.500 §21; renumbered 743B.110 in 2015]

743.759 [Formerly 747.190; renumbered 742.370 in 1989]

743.760 [1995 c.603 §18; 1997 c.716 §25; 1999 c.987 §14; 2003 c.364 §115; 2007 c.391 §3; 2011 c.500 §22; repealed by 2013 c.681 §65 and 2013 c.640 §21]

743.761 [1995 c.603 §19; 2011 c.500 §23; repealed by 2013 c.681 §65 and 2013 c.640 §21]

743.762 [Formerly 747.082; 1989 c.634 §1; renumbered 742.372 in 1989]

743.763 [1995 c.603 §20; 1997 c.716 §26; renumbered 735.616 in 1997]

743.764 [2011 c.500 §2; renumbered 743B.120 in 2015]

743.765 [Formerly 747.084; 1989 c.634 §2; renumbered 742.374 in 1989]

743.766 [1995 c.603 §§22,41; 1997 c.716 §§15,16; 1999 c.987 §15; 2001 c.943 §14; 2003 c.748 §7; 2011 c.500 §24; 2012 c.24 §4; 2013 c.681 §28; 2013 c.698 §22; 2015 c.515 §§20,21; renumbered 743B.125 in 2015]

743.767 [1995 c.603 §23; 1999 c.987 §16; 2011 c.500 §25; 2013 c.681 §29; 2013 c.698 §23; renumbered 743.022 in 2015]

743.768 [Formerly 747.086; 1983 c.338 §964; 1989 c.634 §3; renumbered 742.376 in 1989]

743.769 [1995 c.603 §24; 1999 c.987 §17; 2003 c.364 §116; 2003 c.590 §§1,3; 2013 c.681 §61; 2013 c.698 §39; 2015 c.515 §§22,22a; renumbered 743B.126 in 2015]

743.770 [Formerly 743.780; 1987 c.774 §60; renumbered 742.400 in 1989]

743.771 [1987 c.774 §151; renumbered 742.405 in 1989]

743.772 [Formerly 743.783; renumbered 742.031 in 1989]

743.773 [1995 c.603 §25; renumbered 743B.127 in 2015]

743.774 [Formerly 486.097; renumbered 806.190 in 1987]

743.775 [2003 c.590 §8; repealed by 2015 c.70 §17 and 2015 c.515 §31]

743.776 [Formerly 486.541; renumbered 742.450 in 1989]

743.777 [2010 c.75 §§2 to 5; 2011 c.500 §45; 2013 c.1 §93; 2013 c.160 §1; 2013 c.681 §30; renumbered 743.023 in 2015]

743.778 [Formerly 486.546; renumbered 742.454 in 1989]

743.779 [Formerly 486.551; 1989 c.700 §14; renumbered 742.456 in 1989]

743.780 [1975 c.796 §10; 1977 c.448 §12; 1985 c.103 §14; 1985 c.323 §10; 1985 c.624 §17a; renumbered 743.770; renumbered 742.400 in 1989]

743.781 [Formerly 486.556; 1989 c.700 §15; renumbered 742.458 in 1989]

743.782 [Formerly 486.561; 1989 c.700 §16; renumbered 742.460 in 1989]

743.783 [Formerly 736.320; renumbered 743.772; renumbered 742.031 in 1989]

743.784 [Formerly 486.564; 1989 c.700 §17; renumbered 742.462 in 1989]

743.785 [Formerly 486.566; renumbered 742.464 in 1989]

743.786 [1967 c.482 §1; 1971 c.523 §11; 1979 c.842 §7; 1983 c.338 §965; renumbered 742.500 in 1989]

(Prescription Drug Programs)

743.787 Definitions for ORS 743.788

As used in ORS 743.788: “Carrier” has the meaning given that term in ORS 743B.005. “Enrollee” has the meaning given that term in ORS 743B.005. “Health benefit plan” has the meaning given that term in ORS 743B.005.

743.788 Prescription drug identification card

A carrier that provides coverage for prescription drugs provided on an outpatient basis and issues a card or other technology for claims processing, or an administrator of a health benefit plan including, but not limited to, a third party administrator for a self-insured plan, a pharmacy benefits manager and an administrator of a state administered plan, sha…

743.789 [1967 c.482 §2; 1975 c.390 §1; 1981 c.586 §1; 1983 c.338 §966; 1987 c.632 §1; renumbered 742.502 in 1989]

743.790 Rules for prescription drug identification cards

The Director of the Department of Consumer and Business Services may adopt rules to implement ORS 743.788 and may consider any relevant standards developed by a standards development organization accredited by the American National Standards Institute that represents organizations interested in electronic standardization with the pharmacy services sector of …

743.791 [2005 c.482 §2; renumbered 743A.108 in 2007]

743.792 [1967 c.482 §3; 1977 c.600 §3; 1979 c.842 §8; 1983 c.338 §967; renumbered 742.504 in 1989]

743.793 [2003 c.91 §4; renumbered 743A.064 in 2007]

743.794 [2005 c.477 §2; renumbered 743A.120 in 2007]

743.795 [1979 c.842 §10; renumbered 742.506 in 1989]

743.796 [1987 c.742 §3; renumbered 742.508 in 1989]

743.797 [1987 c.742 §2; renumbered 742.510 in 1989]

743.798 [2005 c.628 §2; renumbered 743A.050 in 2007]

743.799 [2005 c.765 §6; renumbered 743A.124 in 2007]

743.800 [1971 c.523 §2; 1973 c.551 §1; 1975 c.784 §1; 1979 c.871 §45; 1981 c.414 §1; 1983 c.338 §968; 1987 c.588 §1; renumbered 742.520 in 1989]

743.801 [1995 c.672 §1; 1997 c.343 §18; 2001 c.266 §1; 2001 c.747 §5; 2003 c.87 §21; 2003 c.137 §§3,4; 2005 c.418 §2; 2009 c.806 §3; 2009 c.807 §4; 2011 c.500 §26; 2012 c.24 §5; 2013 c.596 §3; 2013 c.681 §61a; 2015 c.59 §§3,4; 2015 c.218 §§2,3; 2015 c.470 §§4,5; renumbered 743B.001 in 2015]

743.802 [1987 c.588 §5; renumbered 742.522 in 1989]

743.803 [1995 c.672 §2; 1997 c.343 §19; 1997 c.759 §4; 1999 c.271 §1; 2001 c.266 §4; 2013 c.129 §19; renumbered 743B.405 in 2015]

743.804 [1997 c.343 §3; 2001 c.266 §15; 2003 c.87 §22; 2011 c.500 §27; 2012 c.24 §6; 2013 c.681 §37; 2015 c.59 §5; 2015 c.218 §4; 2015 c.470 §6; renumbered 743B.250 in 2015]

743.805 [1971 c.523 §3; 1973 c.551 §2; 1975 c.784 §2; 1981 c.414 §2; 1987 c.588 §2; 1989 c.775 §1; renumbered 742.524 in 1989]

743.806 [1995 c.672 §6; 1997 c.343 §20; 2011 c.500 §28; 2012 c.24 §7; renumbered 743B.422 in 2015]

743.807 [1997 c.343 §4; 2011 c.500 §29; renumbered 743B.423 in 2015]

743.808 [1995 c.672 §4; 1997 c.343 §1; 1999 c.987 §19; renumbered 743B.220 in 2015]

743.809 [1995 c.672 §5; repealed by 2003 c.87 §26]

743.810 [1971 c.523 §4; 1973 c.551 §4; 1975 c.784 §3; renumbered 742.526 in 1989]

743.811 [1995 c.672 §7a; 2001 c.104 §290; 2003 c.87 §23; renumbered 743B.424 in 2015]

743.812 [1987 c.588 §4; renumbered 742.528 in 1989]

743.813 [1995 c.669 §2; renumbered 743.845 in 1997]

743.814 [1997 c.343 §5; 2003 c.14 §450; renumbered 743B.200 in 2015]

743.815 [1971 c.523 §5; 1973 c.551 §3; 1975 c.784 §4; 1981 c.414 §3; renumbered 742.530 in 1989]

743.816 [1995 c.506 §2; renumbered 743.847 in 1997]

743.817 [1997 c.343 §6; 2001 c.266 §6; renumbered 743B.202 in 2015]

743.818 [2009 c.595 §1195; 2015 c.515 §23; renumbered 743.007 in 2015]

743.819 [1997 c.343 §11; renumbered 743.008 in 2015]

743.820 [1971 c.523 §6; 1975 c.784 §5; 1981 c.414 §4; renumbered 742.532 in 1989]

743.821 [1997 c.343 §7; renumbered 743B.204 in 2015]

743.822 [2011 c.322 §§2,3; 2012 c.24 §8; 2012 c.38 §21; 2013 c.681 §31; 2015 c.3 §53; renumbered 743B.130 in 2015]

743.823 [1997 c.343 §8; renumbered 743B.195 in 2015]

(Wellness Programs)

743.824 Cash dividends for healthy behaviors

As used in this section, “healthy behaviors” means participating in constructive behaviors that encourage fitness, healthy eating and other activities that are beneficial to good health. An insurer offering a health benefit plan, as defined in ORS 743B.005, may pay cash dividends to enrollees in the plan who participate in a program approved by the insurer …

743.825 [1971 c.523 §7; 1975 c.784 §6; 1987 c.569 §4; 1987 c.632 §2; renumbered 742.534 in 1989]

(Catastrophic Coverage)

743.826 Requirements for catastrophic plans

As used in this section: “Catastrophic plan” means a health benefit plan that meets the requirements for a catastrophic plan under 42 U.S.C. 18022(e). “Minimum essential coverage” has the meaning given that term in section 5000A(f) of the Internal Revenue Code. A carrier may offer a catastrophic plan only to an individual who: Is under 30 years of age at…

743.827 [1997 c.343 §10; 2003 c.87 §24; 2003 c.137 §5; 2005 c.418 §3; renumbered 743B.197 in 2015]

743.828 [1975 c.784 §8; renumbered 742.536 in 1989]

743.829 [1997 c.343 §12; renumbered 743B.400 in 2015]

743.830 [1971 c.523 §8; 1975 c.784 §9; renumbered 742.538 in 1989]

743.831 [1997 c.343 §13; 2009 c.595 §1137; 2015 c.318 §46; renumbered 743B.206 in 2015]

743.833 [1975 c.784 §12; renumbered 742.540 in 1989]

743.834 [1997 c.343 §15; renumbered 743B.403 in 2015]

743.835 [1971 c.523 §9; 1975 c.784 §10; 1987 c.632 §3; renumbered 742.542 in 1989]

743.837 [1997 c.343 §16; renumbered 743B.420 in 2015]

743.839 [1997 c.343 §17; 2003 c.137 §6; 2005 c.418 §4; renumbered 743B.550 in 2015]

743.840 [1985 c.527 §2; renumbered 742.466 in 1989]

743.842 [1999 c.749 §2; renumbered 743A.250 in 2013]

743.845 [Formerly 743.813; 1999 c.607 §1; 2001 c.104 §291; 2011 c.500 §30; renumbered 743B.222 in 2015]

743.847 [Formerly 743.816; 2007 c.484 §2; 2011 c.602 §58; 2015 c.792 §13; renumbered 743B.470 in 2015]

743.850 [1981 c.752 §1; 1983 c.817 §1; 1987 c.505 §1; renumbered 743.610 in 1989]

743.851 [1987 c.505 §3; renumbered 743.600 in 1989]

743.852 [1987 c.505 §§3a,4; 1989 c.784 §22; renumbered 743.601 in 1989]

743.853 [1987 c.505 §5; renumbered 743.602 in 1989]

743.854 [2001 c.266 §3; renumbered 743B.225 in 2015]

743.855 [1981 c.752 §2; renumbered 743.611 in 1989]

743.856 [2001 c.266 §5; renumbered 743B.227 in 2015]

743.857 [2001 c.266 §8; 2011 c.500 §31; renumbered 743B.252 in 2015]

743.858 [2001 c.266 §9; renumbered 743B.253 in 2015]

743.859 [2001 c.266 §10; 2011 c.500 §32; renumbered 743B.254 in 2015]

743.860 [1981 c.752 §3; renumbered 743.613 in 1989]

743.861 [2001 c.266 §11; 2011 c.500 §33; renumbered 743B.255 in 2015]

743.862 [2001 c.266 §12; 2011 c.500 §34; renumbered 743B.256 in 2015]

743.863 [2001 c.266 §13; 2011 c.500 §35; renumbered 743B.257 in 2015]

743.864 [2001 c.266 §14; 2011 c.500 §36; renumbered 743B.258 in 2015]

743.865 [1981 c.752 §4; renumbered 743.614 in 1989]

743.866 [2001 c.747 §2; renumbered 743.911 in 2007]

743.868 [2001 c.747 §3; renumbered 743.913 in 2007]

743.870 [1981 c.752 §5; renumbered 743.616 in 1989]

743.871 [2007 c.390 §1; renumbered 743B.280 in 2015]

743.874 [2007 c.390 §2; renumbered 743B.281 in 2015]

743.875 [1981 c.752 §6; renumbered 743.617 in 1989]

743.876 [2007 c.390 §3; renumbered 743B.282 in 2015]

743.878 [2007 c.390 §4; 2011 c.500 §37; renumbered 743B.283 in 2015]

743.880 [1981 c.752 §7; renumbered 743.619 in 1989]

743.883 [2007 c.390 §5; renumbered 743B.284 in 2015]

743.885 [1981 c.752 §8; renumbered 743.620 in 1989]

743.890 [1981 c.752 §9; renumbered 743.622 in 1989]

743.893 [2007 c.390 §6; renumbered 743B.285 in 2015]

743.894 [2011 c.500 §4; 2013 c.681 §32; renumbered 743B.310 in 2015]

743.900 [1971 c.476 §2; 1975 c.570 §1; renumbered 742.560 in 1989]

743.905 [1971 c.476 §3; renumbered 742.562 in 1989]

743.910 [1971 c.476 §4; 1977 c.600 §7; 1989 c.426 §3; renumbered 742.564 in 1989]

743.911 [Formerly 743.866; 2015 c.218 §1; 2015 c.515 §25; renumbered 743B.450 in 2015]

743.912 [2009 c.807 §2; 2011 c.660 §21; renumbered 743B.451 in 2015]

743.913 [Formerly 743.868; renumbered 743B.452 in 2015]

743.915 [1971 c.476 §5; repealed by 1975 c.570 §2 (743.916 enacted in lieu of 743.915)]

743.916 [1975 c.570 §3 (enacted in lieu of 743.915); 1977 c.600 §8; 1989 c.426 §4; renumbered 742.566 in 1989]

743.917 [2009 c.807 §3; 2011 c.660 §22; renumbered 743B.453 in 2015]

743.918 [2009 c.806 §2; renumbered 743B.454 in 2015]

743.920 [1971 c.476 §6; renumbered 742.568 in 1989]

743.921 [2013 c.534 §6; repealed by 2015 c.588 §5]

743.923 [2013 c.681 §3; renumbered 743B.800 in 2015]

743.925 [1971 c.476 §7; renumbered 742.570 in 1989]

743.930 [1971 c.476 §8; 1977 c.600 §4; renumbered 742.572 in 1989]

743.940 [1987 c.774 §36; renumbered 742.700 in 1989]

743.942 [1987 c.774 §37; renumbered 742.702 in 1989]

743.944 [1987 c.774 §38; renumbered 742.704 in 1989]

743.946 [1987 c.774 §§39,40; 1989 c.700 §18; renumbered 742.706 in 1989]

743.948 [1987 c.774 §41; renumbered 742.708 in 1989]

743.950 [1987 c.774 §42; 1989 c.181 §1; renumbered 742.710 in 1989]

743.951 [2009 c.867 §3; repealed by 2015 c.70 §18]

743.960 [2009 c.867 §4; 2012 c.15 §1; repealed by 2015 c.70 §18]

743.961 [2009 c.867 §5; 2010 c.34 §1; repealed by 2015 c.70 §18]

743.965 [2009 c.867 §7; repealed by 2015 c.70 §18]

743.990 [2009 c.867 §6; repealed by 2015 c.70 §18]

_______________