Adopt: OAR 836-053-1500(T), 836-053-1505(T) and 836-053-1510(T)
These rules implement the provisions of Senate Bill 231 (2015 Legislative Session).
The rules set forth the annual premium income threshold for the definition of
“prominent carrier” as specified in the legislation. The rules also
set forth prominent carrier reporting requirements related to primary care expenditures.
Temporary rules are necessary to provide direction to prominent carriers who
are required to submit data to DCBS no later than December 31, 2015.
Adopted: October 20, 2015
Effective: October 20, 2015 through April 8, 2016
Adopt: OAR 836-053-0015(T)
Amend: OAR 836-053-0021
Suspend: OAR 836-010-0014(T)
This rulemaking adopts a definition of “small employer” to be used
to determine whether a group belongs in the large or small employer group health
insurance market for purposes of issuing health benefit plans to small employers.
The definition reflects changes by Congress to the federal definition of small
employer to which the Oregon statutes are tied. The definition revises the group
size for a small employer from 1 to 100 employees to 1 to 50 employees on January
1, 2016. The rule also adopts as an exhibit a counting methodology to be used
by insurers and producers in determining the group size. The rulemaking also
suspends a temporary rule providing guidance for expanded transitional plans
which will no longer be necessary because the group size will not be changing
for at least two years and amends an existing rule to remove provisions that
conflict with the new counting methodology adopted in the new rule.
Adopted: October 16, 2015
Effective: October 16, 2015 through April 11, 2016
Exhibit A to OAR 836-053-0015
Adopt: OAR 836-010-0014
This rule provides guidance to insurers to follow related to expanded transitional health benefit plans. Expanded transitional health benefit plans are plans that are issued to or renewed by an employer with 51 to 100 employees before January 1, 2016. The rule incorporates Exhibit 1 which contains guidance provided to insurers on the process and procedures related to these plans and for rate filings for these plans.
This is being refiled due to a filing error. Legislative Counsel did not receive required documentation within 10 days of filing.
Adopted: October 12, 2015
Effective: October 12, 2015 through March 18, 2016
Exhibit 1 to OAR 836-010-0014(T)
Amend: OAR 836-071-0355, 836-071-0370, 836-071-0380
Existing rules of the Insurance Division establish the steps that a rental
company with a limited license to sell rental insurance must take to educate
and monitor employees selling insurance under the limited license. House Bill
2958 now allows a rental company to allow a "designated agent" to
sell rental insurance under the limited license of the rental company. The rental
company must provide the same training and oversight to a designated agent as
it provides for employees. The rules must be amended to add "designated
agents" to the description of the individuals who must be educated and
monitored to sell rental insurance under the limited license of the rental company.
The provisions of HB 2958 take effect on September 22, 2015, so these rules
must be amended by that date.
Adopted: September 15, 2015
Effective: September 15, 2015 through March 4, 2016
Adopt: 836-053-0600, 836-053-0605, 836-053-0610, 836-053-0615
These rules implement the provisions of House
Bill 2758 (2015 Legislative Session). The rules set forth the requirements
imposed on carriers and third party administrators related to the use of the
uniform "Oregon Confidential Communication Request Form" developed
as specified in the legislation. The rules also set forth carrier reporting
requirements related to confidential communication requests and the use of the
Temporary rules are necessary to provide direction to interested stakeholders
as soon as the form becomes available to the public. The legislation specifies
the form must be available not later than 90 days after the effective date of
the legislation, September 16, 2015. The temporary rules are also critical to
provide notice to carriers and third party administrators of the baseline reporting
requirements of information first reportable not later than December 1, 2015.
Adopted: September 15, 2015
Effective: September 15, 2015 through March 4, 2016
OAR 836-054-000(2) currently incorporates by references a specific exhibit
that does not correctly explain the law that will apply to automobile policies
that will be issued or renewed after January 1, 2016. The changes to the rule
remove the reference to a specific exhibit and direct the reader to the website
for a sample form that has been approved by the Insurance Division of the Department
of Consumer and Business Services. The language for the amended rule is consistent
with the statutory language of ORS 742.502(2)(b). The changes to the rule will
allow the Insurance Division to respond more quickly to changes required to
the form by eliminating the need to conduct rulemaking to change the form.
Adopted: September 14, 2015
Effective: September 14, 2015 through January 1, 2016
Amend: 836-027-0010, 836-027-0012, 836-027-0100, 836-027-0160
These rules make changes to forms included as exhibits to the rules. The changes
are necessary to reflect statutory changes made in 2013 related to enterprise
risk reporting. The forms must be updated immediately to allow insurers to submit
requisite documents on the correct forms. Failure to update the forms immediately will result in harm to consumers
and insurers because filings will be in error resulting in delay of company
Adopted: September 2, 2015
Effective: September 2, 2015 through February 26, 2016
Adopt: OAR 836-052-0637 & 836-052-0680
Amend: OAR 836-052-0531, 836-052-0566, 836-052-0636, 836-052-0676,
Recently long term care insurance has experienced extremely
high rate increases and other actions that have harmed consumers, in some cases,
resulting in the loss of a policy at a time the insured is most likely to need
the insurance afforded under a policy. These rules adopt provisions to protect
the consumer while still complying with federal requirements for long term care
These rules incorporate portions of the August 2014 update to the NAIC Long
Term Care Insurance Model Regulation #641. In addition, new policy options are
established for Long Term Care Partnership Policies while still complying with
Adopted: June 10, 2015
Effective: January 1, 2016
Adopt: OAR 836-053-1205
This new permanent rule adopts requirements for payers
to accept a uniform prescription drug prior authorization form. This requirement
was established by the 2013 Legislative Assembly in Senate Bill 382. Acceptance
of a uniform form by all payers in Oregon is expected to streamline and simplify
requests for prior approval for prescription drugs prescribed by providers.
The rule applies to payers as defined in ORS 743.061 which includes health insurers,
third party administrators, prepaid managed care health services organizations,
any person or public body that either individually or jointly establishes a
self-insurance plan, program, or contract, including but not limited to persons
and public bodies that are otherwise exempt from the Insurance Code under ORS
731.036, health care clearinghouses or other entities that process or facilitate
the processing of health care financial and administrative transactions from
a nonstandard format to a standard format, and any other person identified by
the department that processes health care financial and administrative transactions
between a health care provider and an entity described in this subsection.
The rule does not require payers to reject a request for prior authorization
for a prescription drug if the provider submits a form other than the uniform
form, but it does require a payer to accept the form whenever it is used by
a provider to submit a request.
The requirement to accept this uniform prior authorization form applies to
payers on and after July 1, 2015 as established in Senate Bill 382.
Adopted: May 27, 2015
Effective: May 27, 2015
Adopt: OAR 836-053-1407 and 836-053-1408
Amend: OAR 836-053-1404
Many health care providers and insurers are transitioning from 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 rules add appropriate diagnostic codes from the DSM-5 to the rule and clarify allowable exceptions and exclusions to the mental health parity statute.
This permanent rule will apply on and after the date the rules are adopted.
Adopted: May 12, 2015
Effective: May 12, 2015
Adopt: OAR 836-010-0026
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.
For forms approved prior to March 12, 2015, insurers do not have to refile to correct the language, but insurers will have to comply with the rule as of the effective date. For any filings on or after March 12, 2015, the form language must comply with the rule. This rule applies to all lines of business.
Adopted: March 12, 2015
Effective: March 12, 2015
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
Adopted: March 10, 2015
Effective: March 10, 2015