New Rules

New rules are posted on this page for six months after they are final.

Adopt: OAR 836-051-0235

This new rule, OAR 836-010-0026 defines discretionary clause and prohibits an insurer from including a discretionary clause in an insurance policy, contract, or agreement that would grant deference to the insurer in proceedings subsequent to the insurer’s decision, denial, or interpretation of terms, coverage, or eligibility for benefits.

This rule is applicable on and after March 12, 2015 to any new or renewal of an insurance policy, contract, or agreement in Oregon.

Adopted: March 12, 2015

Effective: March 12, 2015

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Amend: OAR 836-011-0000

This rulemaking prescribes, for reporting year 2014, the required forms for the annual and supplemental financial statements required of insurers, multiple employer welfare arrangements and health care service contractors under ORS 731.574, as well as the necessary instructions for completing the forms.

Adopted: March 10, 2015

Effective: March 10, 2015

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Adopt: OAR 836-051-0235

Amend: OAR 836-051-0210, 836-051-0220 and 836-051-0230

These permanent rules recognize a new annuity mortality table (2012 IAR Table) for use in determining reserve liabilities for annuities. The National Association of Insurance Commissioners (NAIC) adopted the revisions to NAIC Model Rule (Regulation) #821 in December 2012. Adoption of this table will require insurers to use the new table as the reserve mortality standard for individual annuity or pure endowment contracts issued after January 1, 2015. The 2012 IAR Table is a generational mortality table developed by the Society of Actuaries that incorporates projections for future mortality improvements. For affected contracts, reserves will ore accurately reflect anticipated mortality improvements for years beyond contract issue. Generally, the new table will result in higher reserves than current requirements.

Adopted: December 12, 2014

Effective: January 1, 2015

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Amend: OAR 836-053-1404

Many health care providers and insurers are transitioning using classification codes found in the "Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, Fourth Edition" (DSM-IV) to the coding in the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5). Until all users have transitioned entirely to the DSM-5, it is necessary to include applicable diagnostic codes from both versions in defining mental or nervous condition for purposes of the mandatory requirements of Oregon’s mental health parity statute. These temporary rules add appropriate diagnostic codes from the DSM-5 to the rule.

Adopted: November 14, 2014

Effective: November 14, 2014 through May 12, 2015

Documents:

Adopt: OAR 836-053-0100 and 836-053-0105

These rules implement the provisions of enrolled House Bill 4104 (2014 Legislative Session). The rules compliment rules of the Workers’ Compensation Division intended to facilitate better management and payment for interim medical benefits resulting from a work related injury or disease. These rules prohibit a carrier from imposing a waiver or exclusion in a health benefit plan for coverage of a service otherwise provided solely on the basis that the service is provided for a work-related injury or disease. The rules also establish an expedited preauthorization process for approving interim medical services. The rules also specify how payment is accomplished if a workers’ compensation claim is approved or denied. Finally the rules clarify when a claim for interim medical benefits is deemed a “clean claim” for purposes of requirements in the Insurance Code that require prompt payment of claims.

As specified in House Bill 4104, these requirements apply to health benefit plan contracts entered into or renewed on or after January 1, 2015.

Adopted: October 15, 2014

Effective: January 1, 2015

Documents:

Adopt: OAR 836-010-0013 and 836-053-0066

Amend: OAR 836-053-0431 and 836-053-0465

These permanent rules replace temporary rules ID 6-2014 (Temp), 7-2014 (Temp), and 8-2014 (temp), which established a special enrollment period, set forth the filing and rating requirements and plan guidance for transitional plans in 2015, and implemented the provisions of chapter 80, Oregon Laws 2014.

Adopted: October 6, 2014

Effective: October 6, 2014

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Amend: OAR 836-042-0045

This rule adopts revisions to the revised 2008 edition of the Statistical Plan for Workers’ Compensation and Employers Liability Insurance (Statistical Plan), as filed by the National Council on Compensation Insurance (NCCI). The primary revision to the Statistical Plan is to update the Pension Tables in the plan using updated data for life expectancies and remarriage rates. The revisions also include a number of reporting clarifications and maintenance updates to enhance the rules.

Failure to adopt NCCI’s proposed revisions will cause Oregon’s governing statistical plan for workers’ compensation and employer’s liability insurance to differ from the statistical plan used in other states. The statistical plan information is used in determining annual advisory loss costs. Lack of uniformity in the statistical plan used across states can result in an inability to combine Oregon-specific data with countrywide data to generate stable, credible advisory loss costs. The lack of uniformity may also lead to inconsistencies and errors in reporting by insurers who write workers’ compensation in several states, including Oregon.

Adopted: October 1, 2014

Effective: October 1, 2014

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​Key links

Oregon Revised Statutes 

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