Oregon Revised Statutes
The purpose of this section and ORS 750.005, 750.025 and 750.045 is to encourage and guarantee the development of health care service contractors by licensing and regulating their operation to ensure that they provide high quality health care services through state licensed organizations meeting reasonable standards as to administration, services and financi…
As used in ORS 750.005 to 750.095: “Claims” means any amount incurred by the insurer covering contracted benefits. “Complementary health services” means the following health care services: Chiropractic as defined in ORS 684.010; Naturopathic medicine as defined in ORS 685.010; Massage therapy as defined in ORS 687.011; or Acupuncture as defined in ORS …
Except as provided in subsection (2) of this section, at least one-third of the group of persons vested with managing the affairs of a health care service contractor, as defined in ORS 750.005 (4)(a), must be representatives of the public who are not: Practicing doctors; or Employees or trustees of a participant hospital. Notwithstanding subsection (1) of…
A health care service contractor which is a not-for-profit corporation, shall not distribute, upon liquidation or otherwise, any part of its income to its members, directors, trustees or officers except for the reasonable value of services rendered such contractor. An organization that does not meet the definition of health maintenance organization in ORS 7…
Notwithstanding any other provision of law, except as provided in subsection (2) of this section, any persons doing a hospital association business, as defined in ORS 742.010 (1959 Replacement Part) in compliance with ORS chapter 742 (1959 Replacement Part) on August 12, 1965, may continue such business in compliance with ORS chapter 742 (1959 Replacement Pa…
A health care service contractor that is a for-profit or not-for-profit corporation shall possess and thereafter maintain capital or surplus, or any combination thereof, of not less than $2.5 million. A health care service contractor that is a for-profit or not-for-profit corporation shall file a surety bond or such other bond or securities in the sum of $2…
The following provisions apply to health care service contractors to the extent not inconsistent with the express provisions of ORS 750.005 to 750.095: ORS 705.137, 705.138 and 705.139. ORS 731.004 to 731.150, 731.162, 731.216 to 731.362, 731.382, 731.385, 731.386, 731.390, 731.398 to 731.430, 731.428, 731.450, 731.454, 731.485, as provided in subsection (…
ORS 743A.010 does not apply to group practice maintenance organizations that are federally qualified pursuant to Title XIII of the Public Health Service Act (42 U.S.C. 300e et seq.).
Notwithstanding any provision of contract or agreement entered into by a corporation, association, society, firm, partnership or individual doing business as a hospital association or as a health care service contractor, whenever the contract or agreement provides for payment or reimbursement for a service that is within the lawful scope of practice of a lic…
INSOLVENCY OF HEALTH CARE SERVICE CONTRACTOR
If a final order of liquidation with a finding of insolvency has been entered with respect to a health care service contractor by a court of competent jurisdiction in the domicile of the health care service contractor, subscribers of the health care service contractor must be offered replacement coverage as provided in this section. All insurers and health …
For the purpose of this section only, and only in the event of a finding of impairment by the Director of the Department of Consumer and Business Services or of a final order of liquidation, as described in ORS 750.085, any covered health care service furnished within the state by a provider to a subscriber of a health care service contractor shall be consid…
MULTIPLE EMPLOYER WELFARE ARRANGEMENTS
As used in ORS 750.301 to 750.341, “multiple employer welfare arrangement” has the meaning given that term in section 3 of the federal Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. 1002. Note: 750.301 to 750.341 were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 750 or any ser…
An association or group of employers shall not provide health benefits to employees of the association or employees of any of the employers through a multiple employer welfare arrangement in this state except as authorized by a subsisting certificate of multiple employer welfare arrangement issued by the Director of the Department of Consumer and Business Se…
An association or group of employers seeking to provide health benefits through a multiple employer welfare arrangement must apply for a certificate of multiple employer welfare arrangement on a form prescribed by the Director of the Department of Consumer and Business Services. The application must be completed and submitted to the director along with all o…
A trust carrying out a multiple employer welfare arrangement must be established and maintained by an association or group of employers meeting the following requirements: The association or group must be composed of five or more employers that are in the same trade or industry, including employers in closely related businesses that provide support, service…
The following requirements apply to the trust carrying out a multiple employer welfare arrangement: The trust must hold and maintain adequate facilities for purposes of the multiple employer welfare arrangement and either must have sufficient personnel to service the employee benefit plan or must contract with a third party administrator licensed under ORS …
An association or group of employers may provide health benefits in this state through a multiple employer welfare arrangement established in another state if the association or group of employers first obtains a certificate of multiple employer welfare arrangement in this state. Such a multiple employer welfare arrangement is a foreign multiple employer wel…
The Director of the Department of Consumer and Business Services shall issue a certificate of multiple employer welfare arrangement to a multiple employer welfare arrangement by and through its board of trustees if, upon completion of the application for the certificate and upon investigation and review of all information acquired by the director, the direct…
For purposes of carrying out a multiple employer welfare arrangement, a trust shall maintain adequate reserves. Reserves must be held in cash or obligations guaranteed by the United States or invested in a registered investment company and invested exclusively in cash or obligations guaranteed by the United States. Reserves must be calculated with proper act…
The powers of a multiple employer welfare arrangement, except as otherwise provided, must be exercised by a board of trustees chosen to carry out the purposes of the trust agreement. At least 50 percent of the trustees shall be persons who are covered under the multiple employer welfare arrangement. A trustee may not be an owner, officer or employee of a thi…
The board of trustees of a trust carrying out a multiple employer welfare arrangement shall select officers as designated in the articles or bylaws and may appoint persons to act on behalf of the board as the board determines to be necessary for transacting the business of the multiple employer welfare arrangement. Officers and persons appointed to act on b…
The trust carrying out a multiple employer welfare arrangement may not pay any salary, compensation or emolument to any officer or trustee of the trust unless the payment is first authorized by a majority vote of the board of trustees. The compensation of any trustee or officer may not be unreasonable and may not be calculated, directly or indirectly, as a …
Benefit plans issued by a trust must provide for a charge or deposit payable in cash and, except as provided in this section, for an assessment against member employers for purposes of subsection (2) of this section at least equal to one month’s contribution by the employer. The assessment may be prefunded. A member employer may not be liable under this subs…
A trust shall provide notice of the following in writing to each individual applying to be covered by a multiple employer welfare arrangement: The fact that the multiple employer welfare arrangement is subject to less stringent solvency protection and regulation than are insurers holding certificates of authority. The fact that in the event the trust does …
Each multiple employer welfare arrangement holding a certificate of multiple employer welfare arrangement must file an annual financial statement with the Director of the Department of Consumer and Business Services. The statement must conform to the requirements of ORS 731.574 applicable to annual statements filed by insurers. The director may request addit…
A multiple employer welfare arrangement and its board of trustees and each administrator, insurer or trustee related to the trust or multiple employer welfare arrangement are subject to investigation and examination in the same manner and to the same extent as an insurer under ORS 731.296 to 731.316. Note: See note under 750.301.
A multiple employer welfare arrangement is subject to taxation to the same extent and in the same manner as an insurer transacting health insurance in this state. For purposes of this section, contributions received by a trust for a multiple employer welfare arrangement shall be considered to be premiums received for insurance. Note: See note under 750.301…
In addition to limitations and restrictions imposed by the federal Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. 1001 et seq., on trustees or officers in their capacity as fiduciaries, a trustee or officer of a trust carrying out a multiple employer welfare arrangement shall not do any of the following: Receive directly or indirectl…
The following provisions apply to trusts carrying out a multiple employer welfare arrangement: ORS 705.137, 705.138 and 705.139. ORS 731.004 to 731.150, 731.162, 731.216 to 731.268, 731.296 to 731.316, 731.324, 731.328, 731.378, 731.386, 731.390, 731.398, 731.406, 731.410, 731.414, 731.418 to 731.434, 731.454, 731.484, 731.486, 731.488, 731.512, 731.574 to…
The Director of the Department of Consumer and Business Services may initiate and carry out supervision and delinquency proceedings against a trust carrying out a multiple employer welfare arrangement in the same manner as provided with regard to insurers under ORS chapter 734. Note: See note under 750.301.
A trust carrying out a multiple employer welfare arrangement may not be permitted to join or contribute financially to any insurance insolvency guaranty fund or similar mechanism in this state. Neither such a trust nor its insureds may receive any benefit from any such fund for claims arising out of the operations of the multiple employer welfare arrangement…
An insurer who provides excess loss insurance under ORS 750.309 to a multiple employer welfare arrangement that is offering or providing health benefits in this state without a certificate of multiple employer welfare arrangement or to employers or employees participating in such a multiple employer welfare arrangement shall be liable for any unpaid claims o…
A trust carrying out a multiple employer welfare arrangement shall not provide coverage to more than 20,000 lives unless the trust first obtains a certificate of authority as an insurer in this state. Note: See note under 750.301. LEGAL EXPENSE ORGANIZATIONS AND LEGAL ACCESS PROVIDERS
As used in ORS 750.505 to 750.715: “Administration fee” means a nominal fee that: A legal access provider pays to an attorney; Is not more than $6 per month for each of the legal access provider’s customers, or a greater amount that the Director of the Department of Consumer and Business Services specifies by rule; and Covers overhead and administrative …
A person shall not transact business as a legal expense organization or otherwise offer, provide, market or do business on behalf of a plan unless the person holds a valid certificate of registration as a legal expense organization.
ORS 750.505 to 750.715 do not apply to the following arrangements: A retainer contract that an attorney or firm of attorneys makes with a specific individual, under the terms of which the attorney or firm bases fees on reasonable estimates of the nature and amount of services the attorney or firm will provide, and similar contracts that an attorney or firm …
An applicant for registration as a legal expense organization must do all of the following in order to obtain registration: Apply for the registration under ORS 750.545. File with the Director of the Department of Consumer and Business Services in writing the address, including street and number, and mailing address, if different, of the organization’s ini…
An applicant for a certificate of registration shall apply to the Director of the Department of Consumer and Business Services on a form prescribed by the director. The application shall be accompanied by the applicable fee established by the director. An application shall include the following information: The applicant’s name and the address of the princ…
If the Director of the Department of Consumer and Business Services determines that an applicant has satisfied all requirements of ORS 750.535 and 750.545, the director shall issue the certificate of registration to the applicant. If the director denies a registration application, the director shall so inform the applicant, stating the grounds for the denia…
A certificate of registration of a legal expense organization is effective for one year from the date of issue. A legal expense organization may renew its certificate of registration by paying the applicable fee established by the Director of the Department of Consumer and Business Services.
The Director of the Department of Consumer and Business Services may suspend, revoke, refuse to issue or refuse to renew a certificate of registration for any one or any combination of the following reasons: Fraud or deceit in obtaining or applying for the certificate. Dishonesty, fraud or gross negligence in the transaction of insurance. Conduct resultin…
An organization shall not operate or offer a plan in this state unless the organization first enters into a written provider agreement with the providing attorney or attorneys. The following provisions apply to such an agreement: A provider agreement shall not contain any provision that allows the providing attorney to seek payment from a member, other than…
An organization must provide a membership agreement to each member of a group that is a party to a legal expense plan. Each membership agreement shall contain at least the following: A listing and clear description of the legal services promised or for which expenses are to be reimbursed and a clear explanation of the limits of the services. The copayments…
No provider agreement or membership agreement may contain provisions that are unfair, discriminatory or misleading, that encourage misrepresentation or misunderstandings of the agreement, that might endanger the solvency of the plan or legal expense organization or that are contrary to law. For the duration of each written membership and provider agreement …
An organization shall deposit in an account that is maintained separately from operating funds an amount reasonably calculated to reimburse plan members for unearned premiums. The organization shall hold the amount in a fiduciary capacity. Records shall be kept of all deposits and receipts for a period of not less than six years.
Compensation paid to a providing attorney shall not be contingent on claims experience. This section does not prevent the compensation of a providing attorney from being based on membership fees collected or the number of claims paid or processed, nor does it prevent a providing attorney from sharing in a fund based on services performed.
Each organization shall continuously maintain in this state a registered agent and registered office that may be, but need not be, the same as any of its places of business. A registered agent shall be: An individual who resides in this state and whose business office is identical to the registered office; A domestic corporation or domestic nonprofit corp…
Each organization shall provide annually to the Director of the Department of Consumer and Business Services in as much detail as the director may require: A verified financial statement detailing the legal expense organization’s assets, liabilities, unearned premium reserve, loss records and such other items as the director may require so long as such repo…
A legal expense organization shall file with the Director of the Department of Consumer and Business Services all schedules and tables of premium rates for legal service to be used on risks in this state, and shall file any amendments to or corrections of such schedules and tables.
An organization shall file with the Director of the Department of Consumer and Business Services a copy of the current membership agreement forms and the current provider agreement forms used by the organization, and a schedule of the rates charged its members. An organization shall file any material change in the provider agreement or membership agreement w…
Except as otherwise provided in this section, no legal expense plan shall be issued, sold or offered for sale in this state unless the organization offering the plan is insured under an insurance contract that provides indemnification for the services under the plan, or reimbursement for services performed under a service contract, in the event of default of…
ORS 750.505 to 750.715 do not affect the regulation of the practice of law. Except as provided in ORS 750.505 to 750.715, legal expense plans are not subject to the Insurance Code.
The following provisions of the Insurance Code apply to legal expense organizations to the extent not inconsistent with the express provisions of ORS 750.505 to 750.715: ORS 731.004 to 731.026, 731.036 to 731.150, 731.158, 731.216 to 731.362, 731.385, 731.386, 731.398 to 731.430, 731.450, 731.454, 731.504, 731.508, 731.509, 731.510, 731.511, 731.512, 731.64…
The Director of the Department of Consumer and Business Services may make rules in order to carry out ORS 750.505 to 750.715. _______________