Oregon Statutes - Chapter 743 - Health and Life Insurance

• 743.003   [1967 c.359 §335; renumbered 742.001 in 1989]
• 743.006   [Formerly 736.300; renumbered 742.003 in 1989]
• 743.009   [1967 c.359 §337; 1969 c.336 §11; 1973 c.608 §1; renumbered 742.005 in 1989]
• 743.010   Health insurance policy and health benefit plan forms; 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...
• 743.011   [1985 c.827 §2; repealed by 1989 c.255 §15]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   Disclosure of differences in replacement health insurance policies; nonduplication for persons 65 and older; rules.
  (1) The Director of the Department of Consumer and Business Services shall adopt by rule requirements for disclosure by group and individual health insurers to...
• 743.015   Filing and approval of credit life and credit health insurance forms; filing of rates.
  (1) 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...
• 743.018   Filing of rates for life and health insurance.
  (1) 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...
• 743.021   [1967 c.359 §341; 1971 c.231 §21; 1973 c.525 §1; renumbered 742.009 in 1989]
• 743.024   Personal insurance, insurable interest and beneficiaries.
  (1) 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...
• 743.027   Consent of individual required for life and health insurance; exceptions.
  No life or health insurance policy upon an individual, except a policy of group life insurance or of group or blanket health insurance, shall be...
• 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...
• 743.030   Life insurance for benefit of charity.
  (1) Life insurance policies may be effected although the person paying the consideration has no insurable interest in the life of the person insured if...
• 743.033   [1967 c.359 §344; renumbered 742.011 in 1989]
• 743.036   [Formerly 736.330; 1973 c.823 §149; repealed by 1973 c.827 §83]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]
• 743.039   Alteration of application for life or health insurance.
  (1) An application for a life insurance policy may not provide for alterations by any person other than the applicant in either the application or...
• 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...
• 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...
• 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.
  (1) 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...
• 743.047   Exemption of proceeds of group life insurance.
  (1) 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...
• 743.048   [Formerly 736.315; renumbered 742.018]
• 743.049   Exemption of proceeds of annuity policies; assignability of rights.
  (1) The benefits, rights, privileges and options which are due or prospectively due an annuitant under any annuity policy issued before, on or after June...
• 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...
• 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...
• 743.054   [1967 c.359 §351; renumbered 742.023 in 1989]
• 743.055   [1991 c.875 §2; repealed by 1995 c.506 §11]
• 743.057   [1967 c.359 §352; renumbered 742.026 in 1989]
• 743.060   [1967 c.359 §353; renumbered 742.028 in 1989]
• 743.063   [1967 c.359 §354; renumbered 742.033 in 1989]
• 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]
• 743.084   [1967 c.359 §361; renumbered 743.041 in 1989]
• 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]
• 743.100   Short title.
  ORS 743.100 to 743.109 may be cited as the Life and Health Insurance Policy Language Simplification Act. [Formerly 743.350]
• 743.101   Purpose.
  (1) The purpose of the Life and Health Insurance Policy Language Simplification Act is to establish minimum standards for language used in policies and certificates...
• 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...
• 743.104   Scope of ORS 743.100 to 743.109.
  (1) ORS 743.100 to 743.109 apply to all policies delivered or issued for delivery in this state, except: (a) Any policy that is a security...
• 743.105   [1967 c.359 §368; renumbered 743.049 in 1989]
• 743.106   Reading ease standards for life and health insurance policies.
  (1) No policy form shall be delivered or issued for delivery in this state unless: (a) The policy text achieves a score of 40 or...
• 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...
• 743.108   [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...
• 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]
• 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. [1967 c.359 §372]
• 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...
• 743.154   Acceleration of death benefits; rules.
  (1) A life insurance policy or a rider to a life insurance policy may provide for the acceleration of death benefits as part of the...
• 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...
• 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...
• 743.162   Payment of premium.
  A life insurance policy shall contain a provision relating to the time and place of payment of premium. [1967 c.359 §376]
• 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...
• 743.168   Incontestability.
  (1) A life insurance policy shall contain a provision that the policy shall be incontestable after it has been in force for two years from...
• 743.171   Incontestability and limitation of liability after reinstatement.
  (1) A reinstated policy of life insurance may be contested on account of fraud or misrepresentation of facts material to the reinstatement only for the...
• 743.174   Entire contract.
  A life insurance policy shall contain a provision that the policy constitutes the entire contract between the parties. [1967 c.359 §380]
• 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,...
• 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...
• 743.183   Dividends.
  (1) A life insurance policy other than a nonparticipating policy shall contain a provision that the policy shall participate in the divisible surplus of the...
• 743.186   Policy loan.
  (1) A life insurance policy shall contain a provision that after three full years’ premiums have been paid and after the policy has a cash...
• 743.187   Maximum interest rate on policy loan; adjustable interest rate.
  (1) 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...
• 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...
• 743.192   Payment of claim; payment of interest upon failure to pay proceeds.
  (1) A life insurance policy shall contain a provision that when the policy becomes a claim by the death of the insured, settlement shall be...
• 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. [1967 c.359 §387]
• 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...
• 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...
• 743.204   Standard Nonforfeiture Law for Life Insurance; applicability.
  (1) ORS 743.204 to 743.222 may be cited as the Standard Nonforfeiture Law for Life Insurance. (2) The operative date of the Standard Nonforfeiture Law...
• 743.207   Required provisions relating to nonforfeiture.
  (1) A life insurance policy shall contain in substance the following provisions, or corresponding provisions which in the opinion of the Director of the Department...
• 743.210   Determination of cash surrender values; applicability to certain policies.
  (1) Except as otherwise provided in subsections (2) and (3) of this section, any cash surrender value available under a life insurance policy in the...
• 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...
• 743.215   Calculation of adjusted premiums.
  (1) This section applies to all life insurance policies issued on or after the operative date defined in this subsection for the issuing insurer. After...
• 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: (1) Except as provided in...
• 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...
• 743.219   Supplemental rules for calculating nonforfeiture benefits.
  (1) 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...
• 743.221   Cash surrender values upon default in premium payment.
  (1) This section shall apply to all life insurance policies issued on or after January 1, 1986. (2) Any cash surrender value available in the...
• 743.222   Policy benefits and premiums that shall be disregarded in calculating cash surrender values and paid-up nonforfeiture benefits.
  (1) 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...
• 743.225   Prohibited provisions.
  No life insurance policy shall contain any of the following provisions: (1) A provision limiting the time within which any action at law or suit...
• 743.228   Acts of corporate insured or beneficiary with respect to policy.
  (1) Whenever a corporation organized under the laws of this state or qualified to do business in this state has caused to be insured the...
• 743.230   Variable life policy provisions.
  A variable life insurance policy shall contain in substance the following provisions: (1) A provision that there will be a period of grace of 30...
• 743.231   “Profit-sharing policy” defined.
  “Profit-sharing policy” means: (1) A life insurance policy which by its terms expressly provides that the policyholder will participate in the distribution of earnings or...
• 743.234   “Charter policy” or “founders policy” defined.
  “Charter policy” or “founders policy” means: (1) A life insurance policy which by its terms expressly provides that the policyholder will receive some preferential or...
• 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....
• 743.240   Profit-sharing, charter or founders policies prohibited.
  No profit-sharing, charter or founders policy shall be issued or delivered in this state. [Formerly 739.720]
• 743.243   Restrictions on form of coupon policy.
  Coupon policies issued or delivered in this state shall be subject to the following provisions: (1) No detachable coupons or certificates or passbooks may be...
• 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...
• 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...
• 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...
• 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...
• 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,...
• 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...
• 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...
• 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...
• 743.268   Advancement of policy loans.
  (1) An insurer may advance a policy loan equal to or less than the loan value of an annuity policy or a pure endowment policy...
• 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...
• 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...
• 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: (1) A provision that there will be...
• 743.272   Computing benefits.
  (1) A variable annuity policy shall specify the investment increment factors to be used in computing the dollar amount of variable benefits or other variable...
• 743.273   Standard provisions of reversionary annuities.
  A policy of reversionary annuity shall contain in substance the following provisions: (1) The provisions specified in ORS 743.255 to 743.267, except that under ORS...
• 743.275   Standard Nonforfeiture Law for Individual Deferred Annuities; application.
  (1) ORS 743.275 to 743.295 may be cited as the Standard Nonforfeiture Law for Individual Deferred Annuities. (2) The Standard Nonforfeiture Law for Individual Deferred...
• 743.278   Required provisions in annuity policies; exception.
  (1) An annuity policy shall contain in substance the following provisions, or corresponding provisions that in the opinion of the Director of the Department of...
• 743.281  
  [1977 c.320 §4; repealed by 2003 c.370 §9]
• 743.284   Computation of benefits.
  (1) 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...
• 743.287   Commencement of annuity payments at optional maturity dates; calculation of benefits.
  (1) 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...
• 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...
• 743.293   Minimum forfeiture amounts for annuity policies; rules.
  (1) 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...
• 743.295   Effect of certain life insurance and disability benefits on minimum nonforfeiture amounts.
  (1) For an annuity policy that includes, by rider or supplemental contract provision, both annuity benefits and life insurance benefits that exceed the greater of...
• 743.303   Requirements for issuance of group life insurance policies.
  Policies of group life insurance are subject to the following requirements: (1) The policy shall be issued upon the lives of persons who are associated...
• 743.306   Required provisions in group life insurance policies.
  (1) 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...
• 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...
• 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...
• 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...
• 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...
• 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...
• 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...
• 743.327   Payments under policy; payment of interest upon failure to pay proceeds.
  (1) A group life insurance policy shall contain a provision that any sum becoming due by reason of the death of a person insured shall...
• 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...
• 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...
• 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...
• 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...
• 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...
• 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...
• 743.348   Certain sales practices prohibited.
  (1) No person selling group life insurance is authorized to sell membership in a common group for the purpose of qualifying an applicant who is...
• 743.350   [1979 c.708 §2; renumbered 743.100 in 1989]
• 743.351   Eligibility of association to be group life policyholder; rules.
  (1) An insurer shall not offer a policy of group life insurance in this state to an association as the policyholder or offer coverage under...
• 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.
  (1) An insurer shall not offer in this state a policy of group life insurance that is described in this section and insures persons in...
• 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...
• 743.357   [1979 c.708 §4; renumbered 743.103 in 1989]
• 743.358   Borrowing by certificate holders under group life policy.
  (1) An insurer of a group life insurance policy may authorize certificate holders under the policy to borrow upon the policy, subject to the following...
• 743.360   Alternative group life insurance coverage.
  (1) Group life insurance coverage offered to a resident in this state under a group life insurance policy issued to a group other than one...
• 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]
• 743.371   Definitions for credit life and credit health insurance provisions.
  (1) “Credit life insurance” means insurance on the life of a debtor pursuant to or in connection with a specific loan or other credit transaction....
• 743.372   Applicability of credit life and credit health insurance provisions.
  (1) All life or health insurance in connection with loans or other credit transactions shall be subject to ORS 743.371 to 743.380, except: (a) Insurance...
• 743.373   Forms of credit life and credit health insurance.
  Credit life and credit health insurance shall be issued only in the following forms: (1) Individual policies of life insurance issued to debtors on the...
• 743.374   Limits on amount of credit life insurance.
  (1) The initial amount of credit life insurance shall not exceed the total amount repayable under the contract of indebtedness and, where an indebtedness is...
• 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...
• 743.376   Duration of credit life and credit health insurance.
  (1) The term of any credit life or credit health insurance shall, subject to acceptance by the insurer, commence on the date when the debtor...
• 743.377   Credit life and credit health insurance policy or group certificate; contents; delivery of policy, certificate or copy of application.
  (1) All credit life or credit health insurance shall be evidenced by an individual policy or, in the case of group insurance, by a certificate...
• 743.378   Charges and refunds to debtor.
  (1) Each individual policy or group certificate of credit life or credit health insurance, or both, shall provide that in the event of termination of...
• 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...
• 743.380   Claim report and payment.
  (1) All claims under policies of credit life or credit health insurance, or both, shall be promptly reported to the insurer or its designated claim...
• 743.402   Exceptions to individual health insurance policy requirements.
  Nothing in ORS 743.405 to 743.498, 743A.160 and 743A.164 shall apply to or affect: (1) Any workers’ compensation insurance policy or any liability insurance policy...
• 743.405   General requirements.
  An individual health insurance policy must meet the following requirements: (1) The entire money and other considerations therefor shall be expressed therein. (2) The time...
• 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 and 743A.160. Such provisions...
• 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...
• 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.
  (1) A health insurance policy shall contain a provision as follows: “TIME LIMIT ON CERTAIN DEFENSES: After two years from the date of issue of...
• 743.417   Grace period.
  (1) An individual health insurance policy shall contain a provision as follows: “GRACE PERIOD: A minimum grace period of 10 days after the premium due...
• 743.420   Reinstatement.
  (1) A health insurance policy shall contain a provision as follows: “REINSTATEMENT: If any renewal premium is not paid within the grace period, a subsequent...
• 743.423   Notice of claim.
  (1) A health insurance policy shall contain a provision as follows: “NOTICE OF CLAIM: Written notice of claim must be given to the insurer within...
• 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...
• 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...
• 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...
• 743.435   Payment of claims.
  (1) A health insurance policy shall contain a provision as follows: “PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with...
• 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...
• 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...
• 743.444   Change of beneficiary.
  (1) A health insurance policy shall contain a provision as follows: “CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right...
• 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 and 743A.164 shall...
• 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...
• 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...
• 743.456   Other insurance in same insurer.
  (1) A health insurance policy may contain a provision as follows: “OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness...
• 743.459   Insurance with other insurers; expense incurred benefits.
  (1) A health insurance policy may contain a provision as follows: “INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer,...
• 743.462   Insurance with other insurers; other than expense incurred benefits.
  (1) A health insurance policy may contain a provision as follows: “INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer,...
• 743.465   Relation of earnings to insurance.
  (1) A health insurance policy may contain a provision as follows: “RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time...
• 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...
• 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...
• 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...
• 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...
• 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...
• 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 which are the subject of ORS 743.408 to 743.477, 743A.160 and 743A.164, or any corresponding provisions which are...
• 743.486   Scope of term “insured” in statutory policy provisions.
  As used in ORS 743.402 to 743.498, 743A.160 and 743A.164, the word “insured” shall not be construed as preventing a person other than the insured...
• 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...
• 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...
• 743.495   Use of terms “noncancelable” or “guaranteed renewable”; synonymous terms.
  (1) No health insurance policy shall contain the following unqualified terms except as provided in this subsection: (a) The unqualified terms “noncancelable” or “noncancelable and...
• 743.498   Statement in policy of cancelability or renewability.
  (1) 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...
• 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]
• 743.522   “Group health insurance” described.
  (1) “Group health insurance” means that form of health insurance covering groups of persons described in this section, with or without one or more members...
• 743.523   Certain sales practices prohibited.
  (1) No person selling group health insurance is authorized to sell membership in an association, including a labor union, for the purpose of qualifying an...
• 743.524   Eligibility of association to be group health policyholder; rules.
  (1) An insurer may not offer a policy of group health insurance to an association as the policyholder or offer coverage under such a policy,...
• 743.525   [1967 c.359 §462; repealed by 1981 c.752 §17]
• 743.526   Determination of whether trustees are policyholders; consequences; rules.
  (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...
• 743.527   When group health insurance policies to continue in effect upon payment of premium by insured individual.
  (1) Every group health insurance policy delivered or issued for delivery in this state shall contain in substance the following provisions, applicable to the coverage...
• 743.528   Required provisions in group health insurance policies.
  A group health insurance policy shall contain in substance the following provisions: (1) A provision that, in the absence of fraud, all statements made by...
• 743.529   Continuation of benefits after termination of group health insurance policy; rules.
  (1) Every group health insurance policy that provides coverage for hospital or medical services or expenses shall provide that the insurer shall continue its obligation...
• 743.530   Continuation of benefits after injury or illness covered by workers’ compensation.
  Every policy of group health insurance delivered or issued for delivery in this state shall contain a provision applicable to the coverage for hospital or...
• 743.531   Direct payment of hospital and medical services; rate limitations.
  (1) A group health insurance policy may on request by the group policyholder provide that all or any portion of any indemnities provided by such...
• 743.532   [1987 c.782 §2; repealed by 1989 c.1044 §7]
• 743.533   Leased workers; offering group health insurance.
  (1) A leasing company may offer group health insurance to its leased workers. If the leasing company does not offer group health insurance to its...
• 743.534   “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...
• 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...
• 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...
• 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,...
• 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...
• 743.549   Restriction on reduction of benefits provisions in group and blanket health insurance policies.
  No group or blanket health insurance policy providing hospital, medical or surgical expense benefits, and which contains a provision for the reduction of benefits otherwise...
• 743.550   Student health insurance.
  (1) Student health insurance is subject to ORS 743.537, 743.540, 743.543, 743.546 and 743.549, except as provided in this section. (2) Coverage under a student...
• 743.552   Guidelines for application of ORS 743.549; rules.
  The Director of the Department of Consumer and Business Services shall by rule establish guidelines for the application of ORS 743.549, including: (1) The procedures...
• 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   Minimum grace period; notice upon termination of policy; effect of failure to notify.
  (1) A group health insurance policy shall contain a provision allowing a minimum grace period of 10 days after the premium due date for payment...
• 743.561   [Formerly 739.565; renumbered 743.371 in 1989]
• 743.562   Applicability of ORS 743.560.
  ORS 743.560 applies to multiple employer trusts when an employer ceases to participate therein. [1991 c.673 §5]
• 743.564   [Formerly 739.570; 1969 c.336 §13; 1989 c.1073 §1; renumbered 743.372 in 1989]
• 743.565   Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium.
  Before a health insurer selling an individual policy or group health benefit plan, as defined in ORS 743.730, may cancel a policy for nonpayment of...
• 743.566   Rules for certain notice requirements.
  The Director of the Department of Consumer and Business Services shall adopt rules necessary for the implementation and administration of ORS 743.565 and the amendments...
• 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   Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older.
  (1) A group health insurance policy providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, shall...
• 743.601   Procedure for obtaining continuation of coverage under ORS 743.600.
  (1) As used in subsections (1) to (6) of this section, “plan administrator” means: (a) The person designated as the plan administrator by the instrument...
• 743.602   Premium for continuation of coverage under ORS 743.600; termination of right to continuation.
  If a legally separated, divorced or surviving spouse elects continuation of coverage under ORS 743.601 (1) to (6): (1) The monthly premium for the continuation...
• 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   Continuation of coverage under group policy upon termination of employment or membership or dissolution of marriage; applicability of waiting period to rehired employee.
  (1) A group health insurance policy providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, shall...
• 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]
• 743.650   Long Term Care Insurance Act; purpose; application.
  (1) ORS 743.650 to 743.664 may be known and cited as the “Long Term Care Insurance Act.” (2) The purpose of ORS 743.650 to 743.664...
• 743.651   [1967 c.359 §496; renumbered 742.234 in 1989]
• 743.652   Definitions for ORS 743.650 to 743.664.
  As used in ORS 743.650 to 743.664, unless the context requires otherwise: (1) “Applicant” means: (a) In the case of an individual long term care...
• 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...
• 743.654   [1967 c.359 §497; renumbered 742.236 in 1989]
• 743.655   Rules; disclosure; contents of policy.
  (1)(a) The Director of the Department of Consumer and Business Services shall adopt rules that include standards for full and fair disclosure setting forth the...
• 743.656   Eligibility for benefits; providers required to be covered.
  (1) No long term care insurance policy shall be delivered or issued for delivery in this state unless the policy determines eligibility for benefits through...
• 743.657   [1967 c.359 §498; renumbered 742.238 in 1989]
• 743.660   [1967 c.359 §499; renumbered 742.240 in 1989]
• 743.662   Rescission of policy and denial of claims.
  (1) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long term care insurance...
• 743.663   [1967 c.359 §500; renumbered 742.242 in 1989]
• 743.664   Offer of nonforfeiture benefit; rules.
  (1) Except as provided in subsection (2) of this section, a long term care insurance policy may not be delivered or issued for delivery in...
• 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]
• 743.680   Definitions for ORS 743.680 to 743.689.
  As used in ORS 743.680 to 743.689, unless the context requires otherwise: (1) “Applicant” means: (a) In the case of an individual Medicare supplement policy...
• 743.681   [Formerly 744.460; renumbered 742.254 in 1989]
• 743.682   Application of ORS 743.680 to 743.689.
  (1) Except as otherwise specifically provided, ORS 743.680 to 743.689 apply to: (a) All Medicare supplement policies and subscriber contracts delivered or issued for delivery...
• 743.683   Policy contents; standards for benefit and claims payments; rules.
  (1) No Medicare supplement insurance policy, contract or certificate in force in the state shall contain benefits which duplicate benefits provided by Medicare. (2) The...
• 743.684   Filing of policy; loss ratio standards; insurance producer compensation.
  (1) 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...
• 743.685   Outline of coverage; information brochure; rules.
  (1) In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be...
• 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...
• 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...
• 743.688   Rules.
  Rules adopted pursuant to ORS 743.680 to 743.689 shall be subject to the provisions of ORS chapter 183. [1989 c.255 §9]
• 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...
• 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   Definitions for ORS 743.730 to 743.773.
  For purposes of ORS 743.730 to 743.773: (1) “Actuarial certification” means a written statement by a member of the American Academy of Actuaries or other...
• 743.731   Purposes.
  The purposes of ORS 743.730 to 743.773 are: (1) To promote the availability of health insurance coverage to groups regardless of their enrollees’ health status...
• 743.732   [Formerly 747.080; renumbered 742.350 in 1989]
• 743.733   Issuance of group health benefit plan to affiliated group of employers; determination of number of employees for purpose of determining eligibility; small employer carrier.
  (1) If an affiliated group of employers is treated as a single employer under subsection (b), (c), (m) or (o) of section 414 of the...
• 743.734   Group health benefit plans subject to provisions of specified laws; exemptions.
  (1) Every group health benefit plan shall be subject to the provisions of ORS 743.733 to 743.737, if the plan provides health benefits covering one...
• 743.735   [Formerly 747.100; 1973 c.823 §151; renumbered 742.352 in 1989]
• 743.736   Requirements for basic plans; approval of plans and forms; offering of plan by carriers.
  (1) In order to improve the availability and affordability of health benefit coverage for small employers, the Health Insurance Reform Advisory Committee created under ORS...
• 743.737   Requirements for small employer health benefit plans.
  Health benefit plans covering small employers shall be subject to the following provisions: (1) A preexisting conditions provision in a small employer health benefit plan...
• 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   Health Insurance Reform Advisory Committee; appointment; duties.
  The Director of the Department of Consumer and Business Services shall appoint a Health Insurance Reform Advisory Committee. This committee shall consist of at least...
• 743.746   [1997 c.716 §9c; repealed by 1999 c.987 §28]
• 743.747   [Formerly 747.150; renumbered 742.360 in 1989]
• 743.748   Submission of information by carriers offering health benefit plans.
  (1) Each carrier offering a health benefit plan shall submit to the Director of the Department of Consumer and Business Services on or before April...
• 743.749   Certifications and disclosure of coverage.
  All carriers that offer individual or group health benefit plans shall provide certifications and disclosure of coverage in accordance with 42 U.S.C. 300gg(e) and 300gg-43...
• 743.750   [1967 c.359 §516; renumbered 742.362 in 1989]
• 743.751   Use of health statements in group health benefit plans.
  (1) Except to determine the application of a preexisting conditions provision for a late enrollee, a carrier offering group health benefit plans shall not use...
• 743.752   Coverage in group health benefit plans; consideration of prospective enrollee health status restricted; effect of discontinuing offer of plans; exceptions; coverage by multiple employer welfare arrangements.
  (1) Except in the case of a late enrollee and as otherwise provided in this section, a carrier offering a group health benefit plan to...
• 743.753   [Formerly 747.170; 1969 c.526 §2; renumbered 742.364 in 1989]
• 743.754   Requirements for group health benefit plans.
  The following requirements apply to all group health benefit plans covering two or more certificate holders: (1) A preexisting conditions provision in a group health...
• 743.755   [1969 c.526 §1; renumbered 742.366 in 1989]
• 743.756   [Formerly 747.180; renumbered 742.368 in 1989]
• 743.757   Health benefit coverage for guaranteed association.
  (1) As used in this section, “guaranteed association” means an association that: (a) The Director of the Department of Consumer and Business Services has determined...
• 743.758   Implementation of Health Insurance Portability and Accountability Act of 1996; rules.
  The Department of Consumer and Business Services may adopt rules incorporating, implementing and administering the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191)...
• 743.759   [Formerly 747.190; renumbered 742.370 in 1989]
• 743.760   Approval of portability plans; offering of plans by carriers; required provisions; actuarial certification.
  (1) As used in this section: (a) “Carrier” means an insurer authorized to issue a policy of health insurance in this state. “Carrier” does not...
• 743.761   Satisfaction of requirements of ORS 743.760 by carrier offering individual health benefit plans.
  (1) A carrier approved pursuant to subsection (4) of this section that offers individual health benefit plans may satisfy the requirements of ORS 743.760 by...
• 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]
• 743.765   [Formerly 747.084; 1989 c.634 §2; renumbered 742.374 in 1989]
• 743.766   Use of health statements in individual health benefit plans; exclusions or limitations on coverage; eligibility to apply for Oregon Medical Insurance Pool; renewal; discontinuation of coverage.
  (1) All carriers who offer individual health benefit plans and evaluate the health status of individuals for purposes of eligibility shall use the standard health...
• 743.767   Premium rates for individual health benefit plans.
  Premium rates for individual health benefit plans shall be subject to the following provisions: (1) Each carrier must file the geographic average rate for its...
• 743.768   [Formerly 747.086; 1983 c.338 §964; 1989 c.634 §3; renumbered 742.376 in 1989]
• 743.769   Carrier marketing of individual health benefit plans; rules; duties of carrier regarding applications; effect of discontinuing offer of plans.
  (1) Each carrier shall actively market all individual health benefit plans sold by the carrier. (2) Except as provided in subsection (3) of this section,...
• 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   Rules for ORS 743.766 to 743.769.
  The Director of the Department of Consumer and Business Services shall adopt all rules necessary for the implementation and administration of ORS 743.766 to 743.769....
• 743.774   [Formerly 486.097; renumbered 806.190 in 1987]
• 743.775   Submission of information by carriers offering individual health benefit plans.
  Each carrier that offers individual health benefit plans shall submit to the Director of the Department of Consumer and Business Services any information requested by...
• 743.776   [Formerly 486.541; renumbered 742.450 in 1989]
• 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]
• 743.787   Definitions for ORS 743.788.
  As used in ORS 743.788: (1) “Carrier” has the meaning given that term in ORS 743.730. (2) “Enrollee” has the meaning given that term in...
• 743.788   Prescription drug identification card.
  (1) A carrier that provides coverage for prescription drugs provided on an outpatient basis and issues a card or other technology for claims processing, or...
• 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...
• 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   Definitions.
  As used in ORS 743.801, 743.803, 743.804, 743.806, 743.807, 743.808, 743.811, 743.814, 743.817, 743.819, 743.821, 743.823, 743.827, 743.829, 743.831, 743.834, 743.837, 743.839, 743.854, 743.856, 743.857,...
• 743.802   [1987 c.588 §5; renumbered 742.522 in 1989]
• 743.803   Medical services contract provisions; nonprovider party prohibitions; future contracts.
  (1) A medical services contract may not require the provider, as an element of the contract or as a condition of compensation for services, to...
• 743.804   Requirements for insurer offering health benefit plan.
  All insurers offering a health benefit plan in this state shall: (1) Have a written policy that recognizes the rights of enrollees: (a) To voice...
• 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   Utilization review requirements for medical services contracts to which insurer not party.
  All utilization review performed pursuant to a medical services contract to which an insurer is not a party shall comply with the following: (1) The...
• 743.807   Utilization review requirements for insurers offering health benefit plan.
  (1) All insurers offering a health benefit plan in this state that provide utilization review or have utilization review provided on their behalf shall file...
• 743.808   Requirements for insurers that require designation of participating primary care physician; exceptions.
  (1) All insurers offering a health benefit plan in this state that requires an enrollee to designate a participating primary care physician shall: (a) Permit...
• 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   Applicability.
  The provisions of ORS 743.801, 743.803, 743.806 and 743.808 do not apply to medical services contracts for services to be provided under ORS chapter 656....
• 743.812   [1987 c.588 §4; renumbered 742.528 in 1989]
• 743.813   [1995 c.669 §2; renumbered 743.845 in 1997]
• 743.814   Requirements for insurers offering managed health insurance; quality assessment; rules.
  All insurers offering managed health insurance in this state shall: (1) Have a quality assessment program that enables the insurer to evaluate, maintain and improve...
• 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   Requirements for insurers offering managed health or preferred provider organization insurance; rules; opportunity to participate.
  An insurer offering managed health insurance or preferred provider organization insurance in this state shall: (1) File an annual summary with the Department of Consumer...
• 743.819   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 743.804, 743.807,...
• 743.820   [1971 c.523 §6; 1975 c.784 §5; 1981 c.414 §4; renumbered 742.532 in 1989]
• 743.821   Required managed health insurance contract provision; enrollee liability.
  All insurers offering managed health insurance in this state shall include in contracts with providers a provision requiring that in the event the insurer fails...
• 743.823   Enforcement of Newborns’ and Mothers’ Health Protection Act of 1996.
  The Department of Consumer and Business Services shall enforce insurer compliance with the federal Newborns’ and Mothers’ Health Protection Act of 1996. [1997 c.343 §8]
• 743.825   [1971 c.523 §7; 1975 c.784 §6; 1987 c.569 §4; 1987 c.632 §2; renumbered 742.534 in 1989]
• 743.827   Health Care Consumer Protection Advisory Committee.
  The Director of the Department of Consumer and Business Services shall appoint a Health Care Consumer Protection Advisory Committee with fair representation of health care...
• 743.828   [1975 c.784 §8; renumbered 742.536 in 1989]
• 743.829   Decisions regarding health care facility length of stay, level of care and follow-up care.
  (1) All clinical decisions regarding length of stay in a health care facility as defined in ORS 442.015, transfer between levels of care and follow-up...
• 743.830   [1971 c.523 §8; 1975 c.784 §9; renumbered 742.538 in 1989]
• 743.831   Consortium established; managed health care performance.
  (1) The Administrator of the Office for Oregon Health Policy and Research shall establish a consortium of interested parties that shall: (a) Develop, on a...
• 743.833   [1975 c.784 §12; renumbered 742.540 in 1989]
• 743.834   Insurer prohibited practices; patient communication and referral.
  No insurer may terminate or otherwise financially penalize a provider for: (1) Providing information to or communicating with a patient in a manner that is...
• 743.835   [1971 c.523 §9; 1975 c.784 §10; 1987 c.632 §3; renumbered 742.542 in 1989]
• 743.837   Prior authorization requirements.
  Except in the case of misrepresentation, prior authorization determinations shall be subject to the following requirements: (1) Prior authorization determinations relating to benefit coverage and...
• 743.839   Disclosure of information.
  Nothing in ORS 743.804, 743.807, 743.814 to 743.839 and 743A.012 shall be construed to require disclosure of information that is otherwise privileged or confidential under...
• 743.840   [1985 c.527 §2; renumbered 742.466 in 1989]
• 743.842   Emergency eye care services without referral from primary care provider.
  (1) As used in this section: (a) “Eye care practitioner” means an optometrist or ophthalmologist licensed by the State of Oregon. (b) “Eye care services”...
• 743.845   Designation of women’s health care provider as primary care provider; direct access to women’s health care provider.
  (1) For purposes of this section: (a) “Pregnancy care” means the care necessary to support a healthy pregnancy and care related to labor and delivery....
• 743.847   Medicaid not considered in coverage eligibility determination; claims by state Medicaid agency; prohibited ground for denial of enrollment of child; insurer duties.
  (1) For the purposes of this section: (a) “Health insurer” or “insurer” means an employee benefit plan, self-insured plan, managed care organization or group health...
• 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   Continuity of care.
  (1) As used in this section, “continuity of care” means the feature of a health benefit plan under which an enrollee who is receiving care...
• 743.855   [1981 c.752 §2; renumbered 743.611 in 1989]
• 743.856   Referrals to specialists.
  (1) If an insurer offers a health benefit plan that requires, as a condition of coverage for specialty care services, a referral by a physician...
• 743.857   External review.
  (1) An insurer offering health benefit plans in this state shall have an external review program that meets the requirements of this section and ORS...
• 743.858   Director to contract with independent review organizations to provide external review; rules.
  (1) The Director of the Department of Consumer and Business Services shall contract with independent review organizations as provided in this section for the purpose...
• 743.859   Inclusion of statements regarding external review in health benefit plans.
  (1) An insurer of a health benefit plan shall include in the plan the following statements, in boldfaced type or otherwise emphasized: (a) A statement...
• 743.860   [1981 c.752 §3; renumbered 743.613 in 1989]
• 743.861   Enrollee application for external review.
  (1) An enrollee shall apply in writing for external review of an adverse decision by the insurer of a health benefit plan not later than...
• 743.862   Duties of independent review organizations.
  (1) An independent review organization shall perform the following duties when appointed under ORS 743.857 to review a dispute under a health benefit plan between...
• 743.863   Civil penalty for failure to comply by insurer that agreed to be bound by decision.
  (1) If an insurer has agreed under the provisions of a health benefit plan to be bound by the decision of an independent review organization...
• 743.864   Private right of action.
  (1) An enrollee who is the subject of a decision of an independent review organization has a private right of action against the insurer for...
• 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   Definitions for ORS 743.871 to 743.893.
  As used in ORS 743.871 to 743.893: (1) “In-network” means performed by a provider or provider group that has directly contracted with the insurer. (2)...
• 743.874   Estimate of costs for in-network procedure or service.
  (1) An insurer offering a health benefit plan as defined in ORS 743.730 must establish a procedure for providing to an enrollee in the plan...
• 743.875   [1981 c.752 §6; renumbered 743.617 in 1989]
• 743.876   Estimate of costs for out-of-network procedure or service.
  (1) An insurer offering a health benefit plan as defined in ORS 743.730 must establish a procedure for providing to an enrollee in the plan...
• 743.878   Submission of methodology used to determine insurer’s allowable charges.
  (1) An insurer offering a health benefit plan as defined in ORS 743.730 must submit to the Director of the Department of Consumer and Business...
• 743.880   [1981 c.752 §7; renumbered 743.619 in 1989]
• 743.883   Alternative mechanism for disclosure of costs and charges.
  The Director of the Department of Consumer and Business Services may waive the requirements of ORS 743.874 or 743.876 to allow an insurer to use...
• 743.885   [1981 c.752 §8; renumbered 743.620 in 1989]
• 743.890   [1981 c.752 §9; renumbered 743.622 in 1989]
• 743.893   Rules.
  The Director of the Department of Consumer and Business Services shall adopt rules necessary to carry out the purposes of ORS 743.871 to 743.893. [2007...
• 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   Payment or denial of health benefit plan claims; rules.
  (1) Except as provided in this subsection, when a claim under a health benefit plan is submitted to an insurer by a provider on behalf...
• 743.913   Interest on unpaid claims.
  (1) An insurer that fails to pay a claim to a provider within the timelines established in ORS 743.911 shall pay simple interest of 12...
• 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]
• 743.920   [1971 c.476 §6; renumbered 742.568 in 1989]
• 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]

Last modified: August 7, 2008