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
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
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
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
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
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
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