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
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
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
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
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
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
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
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
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
Adopted: May 19, 2014
Effective: May 19, 2014
Adopt: OAR 836-010-0013 (T)
This rule provides guidance to insurers to follow when submitting rate filings for individual and small business transitional health benefit plans. The rule incorporates as part of the rule Exhibits 1 and 2 which contain previous guidance provided to insurers on the process for rate filings for these plans.
Adopted: April 24, 2014
Effective: April 24, 2014 through October 20, 2014
Amend: OAR 836-053-0431
The open enrollment period for individual health benefit plans ended
on March 31, 2014. Due to ongoing technical problems, delays and resulting
confusion, and market issues relating to implementation of the Affordable
Care Act, there is a need to establish a special enrollment period
to allow Oregonians to submit health benefit plan applications during
April 2014. This additional special enrollment period will provide
Oregonians an additional opportunity to obtain health insurance coverage
and maintain uniformity throughout the market regarding the enrollment
period for individual health insurance coverage.
The time required to complete a permanent rule making does not allow
the special enrollment period to be put in place in a timely manner.
This would hinder the ability of Oregon citizens to obtain necessary
This temporary rule allows an individual to apply for individual
health insurance outside of the Exchange through April 30, 2014.
Adopted: April 2, 2014
Effective: April 2, 2014 through September 24, 2014
Adopt: OAR 836-053-0066
Amend: OAR 836-053-0465
The amendments to OAR 836-053-0465 require issuers of individual transitional health benefit plans to impose a three to one rate band on these policies, so that the highest rate is no higher than three times the lowest rate, and to pool individual transitional plans with individual grandfathered health benefit plans. OAR 836-053-0066 requires issuers of small group transitional health benefit plans to pool small group transitional plans with individual grandfathered health benefit plans.
Adopted: April 11, 2014
Effective: April 11, 2014 through October 8, 2014