New Rules

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

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

Documents:

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

Documents:

This rule allows an insurer, with the consent of the claimant, to pay claims by means of a prepaid card, direct deposit system, automated teller machine card or debit card or other means of electronic transfer.

This rule will take effect upon adoption.

Adopted: August 15, 2014

Effective: August 15, 2014

Documents:

Amend: OAR 836-053-0431

The federal Affordable Care Act (ACA) and Chapter 681, Oregon Laws 2013, (Enrolled House Bill 2240) require that insurers that issue individual health benefit plans offer coverage to persons 65 or older who are not enrolled in Medicare and, outside of the Oregon Health Insurance Exchange, without regard to a person’s legal status. Permanent changes to the existing rule are necessary to ensure that all persons entitled to coverage can obtain coverage. These amendments to OAR 836-053-0431 clarify that carriers that issue individual health benefit plans must offer and provide individual health benefit plan coverage to applicants who are 65 or older unless such persons are actually enrolled in Medicare; and to applicants who are applying for coverage outside of the Oregon Health Insurance Exchange without regard to the legal status of a person.

The rule also makes non substantive technical corrections and adjusts some provisions in the rule to be consistent with other temporary provisions to the same rule currently in effect.

This rule replaces changes made by amendments included in a temporary rule that expires on July 31, 2014.

Adopted: July 30, 2014

Effective: July 30, 2014

Documents:

Amend: OAR 836-071-0267

Currently, this rule allows an insurance producer to impose an incidental charge for the actual cost of obtaining a motor vehicle report from the Motor Vehicle Division of the Oregon Department of Transportation or from the comparable agency, but limits the charge to not more than $4. The Motor Vehicle Division of the Oregon Department of Transportation currently charges $9.68 for electronically obtained reports. The changes in the proposed rule eliminate the $4 cap and simply allow the producer to pass on to the consumer the actual cost imposed by the Motor Vehicle Division for obtaining the report.

The amendments to these rules will take effect upon adoption.

Adopted: July 21, 2014

Effective: July 21, 2014

Documents:

Adopt: OAR 836-200-0401, 836-200-0406, 836-200-0411, 836-200-0416, 836-200-0421

These rules implement new registration requirements imposed on pharmacy benefit managers in legislation passed by the 2013 Legislative Assembly. Beginning January 1, 2014, individuals or business entities that contract with pharmacies on behalf of an insurer, a third-party administrator or the Oregon Prescription Drug Program (established in ORS 414.312) to process claims, pay pharmacies or negotiate rebates for prescription drugs or medical supplies, must register annually with the Department of Consumer and Business Services. These permanent rules replace temporary rules that established the initial procedures for registration and renewal of registration necessary to allow pharmacy benefit managers to comply with the requirements of the new law.

The rule numbers have changed from the proposed rule because the original numbers were no longer available.

Adopted: July 21, 2014

Effective: July 21, 2014

Documents:

Adopt: OAR 836-010-0150

This rule requires entities regulated by the Department of Consumer and Business Services to treat same-sex marriages validly performed the same as any marriage of heterosexual couples validly performed. The rule is necessary to comply with the recent federal court decisions by the United States Supreme Court and Oregon District Court that held prohibitions on same gender marriages unconstitutional under the U.S. Constitution.

This permanent rule will apply on and after the date the rules are adopted.

Adopted: July 17, 2014

Effective: July 17, 2014

Documents:

Adopt: OAR 836-007-0001

This rule clarifies when and how the director may exercise the discretionary authority to seek restitution or other equitable relief on behalf of a consumer who has suffered damages as a result of an insurer’s violation of the Insurance Code, applicable federal law or the insurer’s breach of an insurance contract or policy that the insurer has with the consumer. The rule defines “consumer,” “actual damages” and “equitable relief” and specifies when the director will seek relief. The rule specifically states that the director will not seek relief on behalf of a consumer who is entitled to an exclusive remedy under the workers compensation laws of this state and specifies that the director may reduce actual damages upon a showing that the consumer has failed to reasonably mitigate damages.

This permanent rule will apply on and after the date the rules are adopted. The department adopted temporary rules effective December 27, 2013 and this permanent rule replaces the temporary rules.

Adopted: June 20, 2014

Effective: June 20, 2014

Documents:

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Amend: OAR 836-052-0142

Some individuals on Medicare rely on individual health plans as their secondary coverage, rather than Medicare Supplement (Medigap) insurance, for services not covered by Medicare parts A, B or D. For at least some of these individuals the commercial individual health plan (IHP) may have been equal to or superior to what they could have through Medigap (e.g., at the time there may have been superior pharmacy coverage through the IHP). In other instances, individuals might not realize the advantage of migrating to Medigap coverage when they became Medicare eligible and the insurer or agent did not guide them to switch to Medigap.

Generally, the only time a person has a right to purchase Medigap coverage on a guaranteed issue basis is upon gaining eligibility for Medicare. For most persons this occurs only once at age 65. For persons determined to be disabled prior to age 65, the first opportunity is at the time of their disability determination with accompanying Medicare eligibility; for these persons a second opportunity is presented at age 65. If a person does not choose a Medigap policy at the time of disability determination or turning 65, the person may be able to purchase Medigap in the future on an underwritten basis, but the opportunity is lost to ever opt in on a guaranteed issue basis.

This permanent rule replaces a temporary rule issued in December 2013 that requires guaranteed issue for individual health plans ending according to the deadlines established under the Affordable Care Act (ACA) for termination of noncompliant plans. Since December, the ACA deadlines have been adjusted on two occasions and insurers have the ability to choose the dates of plan termination within guidelines, resulting in the extension of the previously established termination dates in most cases to a date after the expiration of the emergency rule. The result of the termination when it occurs is to end IHP coverage for persons who relied on this coverage as a substitute for Medigap. This permanent rule extends the period of guaranteed issue to coincide with the termination of IHP under the ACA. This will protect the affected consumers.

The amendments in this rule require guaranteed issue of Medigap for individuals who relied on IHP to supplement Medicare and who have no control over the impending termination of the IHP as required by the ACA. Continuing this protection for Oregon consumers is consistent with the principle of protecting persons who involuntarily lose other coverage.

Adopted: May 19, 2014

Effective: May 19, 2014

Documents:

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​Key links

Oregon Revised Statutes 

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