ORS 742.005 Grounds for disapproval of policy forms

The Director of the Department of Consumer and Business Services shall disapprove any form requiring the director’s approval:

If the director finds it does not comply with the law;

If the director finds it contains any provision, including statement of premium, or has any label, description of its contents, title, heading, backing or other indication of its provisions, which is unintelligible, uncertain, ambiguous or abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued;

If, in the director’s judgment, its use would be prejudicial to the interests of the insurer’s policyholders;

If the director finds it contains provisions which are unjust, unfair or inequitable;

If the director finds sales presentation material disapproved by the director pursuant to ORS 742.009 is being used with respect to the form; or

If, with respect to any of the following forms, the director finds the benefits provided therein are not reasonable in relation to the premium charged:

Individual health insurance policy forms, including benefit certificates issued by fraternal benefit societies and individual policies issued by health care service contractors, but excluding policies referred to in ORS 743.402 as exempt from the application of ORS 743.405 to 743.498 and 743A.160;

Small employer group health benefit plan forms for small employers as that term is defined in ORS 743B.005, including small employer group policies issued by health care service contractors; or

Credit life and credit health insurance forms subject to ORS 743.371 to 743.380.