New Rules

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

Click on a rule title below for details.


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 new form.

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


Form 440-5059

Amend: 836-054-0000

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 transactions.

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, 836-052-0740, 836-052-0746

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 partnership policies.

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 federal requirements.

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 the forms.

Adopted: March 10, 2015

Effective: March 10, 2015



​Key links

Oregon Revised Statutes