(1) An insurer may not offer a policy of group health insurance described in ORS 743.522 (1)(c) 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 743.522 (1)(c) are satisfied.
(2) The director shall determine with respect to a policy whether the trustees are the policyholder. If the director determines that the trustees are the policyholder and if the policy is issued or proposed to be issued in this state, the policy is subject to the Insurance Code. If the director determines that the trustees are not the policyholder, the evidence of coverage that is issued or proposed to be issued in this state to a participating employer, labor union or association shall be deemed to be a group health insurance policy subject to the provisions of the Insurance Code. The director may determine that the trustees are not the policyholder if:
(a) The evidence of coverage issued or proposed to be issued to a participating employer, labor union or association is in fact the primary statement of coverage for the employer, labor union or association; and
(b) The trust arrangement is under the actual control of the insurer.
(3) An insurer shall submit evidence to the director showing that the requirements of subsection (2) of this section and ORS 743.522 (1)(c) are satisfied. The director shall review the evidence and may request additional evidence as needed.
(4) An insurer shall submit to the director any changes in the evidence submitted under subsection (3) of this section.
(5) The director may adopt rules to carry out this section. [1989 c.784 §12; 2005 c.22 §494]
Note: Sections 11 and 14, chapter 752, Oregon Laws 2007, provide:
Sec. 11. (1) The Department of Consumer and Business Services shall monitor, on a continuing basis, association health plans to determine the degree to which the claims experience of nonretained association groups exceeds the claims experience of the associationís member groups as a whole.
(2) The Director of the Department of Consumer and Business Services shall report to the Legislative Assembly by February 1 of each odd-numbered year on the findings under subsection (1) of this section and may recommend legislative changes based upon the findings. [2007 c.752 §11]
Sec. 14. Sections 11 and 12 of this 2007 Act are repealed on January 2, 2014. [2007 c.752 §14]Section: Previous 743.516 743.519 743.520 743.522 743.523 743.524 743.525 743.526 743.527 743.528 743.529 743.530 743.531 743.532 743.533 Next
Last modified: August 7, 2008