New Rules

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

Click on a rule title below for details.

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Amend: OAR 836-010-0013

This temporary rule provides guidance for a two-month extension of transitional plans for small employer groups as allowed by federal guidance issued on February 29, 2016.

The rules are necessary to allow insurers who wish to extend transitional plans to file rates and forms necessary to extend the plans. It is critical to adopt these rules as soon as possible in order to comply with federally imposed timelines for filing plan documents and rates. Failure to file temporary rules that take effect immediately would result in industry and consumer harm by not allowing the extension of these plans which will facilitate a smooth transition to fully compliant small employer health benefit plans by December 1, 2017.

Adopted: April 22, 2016

Effective: April 28, 2016 through September 30, 2016

Documents:

Exhibits to OAR 836-010-0013

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Adopt: OAR 836-010-0155, 836-053-0004, 836-053-0012, 836-053-0013

Amend: OAR 836-053-0002, 836-053-0008, 836-053-0009, 836-053-1020, 836-053-1404, 836-053-1405

Repeal: OAR 836-053-0004(T), 836-053-0012(T), 836-053-0013(T)

Amend and Renumber: OAR 836-053-0010 to 836-053-0019, 836-053-1406 to 836-053-1409

These new and amended rules establish the Oregon benchmark health benefit plan and standard plans for plan years beginning on and after January 1, 2017. Because the plan selected is a 2014 plan, the plan alone does not reflect current state and federal minimum requirements. Therefore, the proposed rules also include provisions to supplement the selected plan so that the plan complies with state and federal law. The proposed rules clarify existing state and federal requirements adopted since 2014 and make conforming amendments to rules related to coverage of mental or nervous conditions.

Adopted: April 22, 2016

Effective: April 26, 2016

Documents:

Exhibits

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Adopt: 836-053-0015, 836-053-1500, 836-053-1505, 836-053-1510

Amend: 836-010-0013, 836-052-1000, 836-053-0010, 836-053-0021, 836-053-0030, 836-053-0050, 836-053-0066, 836-053-0230, 836-053-0410, 836 -053-0431, 836-053-0465, 836-053-0472, 836-053-0510, 836-053-0825, 836-053-0830, 836-053-0835

Repeal: 836-053-0014(T), 836-053-0015(T), 836-053-1500(T), 836-053-1505(T), 836-053-1510(T), 836-009-0020, 836-009-0025, 836-009-0030, 836 -009-0035, 836-009-0040

These rules reflect changes in state and federal laws and statutes that impact current rules and require new rules. The rules include provisions defining "small employer" and establishing eligible employees and the counting methodology an insurer must use to determine whether an employer is a small employer or a large employer. These rules are necessary to implement requirements of Senate Bill 231 (2015 Session) to establish the definition of "prominent carrier" and to prescribe the primary care services for which costs must be reported to the Department of Consumer and Business Services (DCBS) by prominent carriers. These rules define "prominent carrier" based on annual premium income and clarify the data to be reported to DCBS.

Because federal legislation eliminates the need for expanded transitional plans for small employer groups that have 51-100 employees, these rules also repeal a previously adopted temporary rule that allowed small group transitional plans and provided guidance to insurers who proposed to issue the transitional plans to certain small employers. The rules also eliminate provisions related to individual transitional plans which ended on December 31, 2015, because those provisions will no longer be necessary and update exhibits related to transitional plans.

The rules specify the intent of the DCBS to not enforce provisions of a state mandate related to prosthetics and orthotics that sunset by operation of the state law. Other federal statutes may impose similar coverage requirements.

The rules clarify that an insurer may not rescind a policy or certificate on the basis of statements related to pediatric dental coverage.

Rules relating to a one percent assessment on health insurers are repealed because the assessment is no longer imposed by Oregon statutes.

Finally, the rules eliminate obsolete references to 2014 special enrollment periods, the Oregon Health Insurance Exchange Corporation, the use of health statements for underwriting purposes and make technical changes to reflect the merger of two DCBS divisions, the Insurance Division and the Division of Finance and Corporate Securities, into a single division, the Division of Financial Regulation.

Adopted: April 8, 2016

Effective: April 8, 2016

Documents:

Exhibits

Amend: OAR 836-027-0005, 836-027-0010, 836-027-0012, 836-027-0100, 836-027-0125, 836-027-0140, 836-027-0160

This rulemaking changes to rules to which forms are included as exhibits to the rules. Changes to the forms were necessary to reflect statutory changes made in 2013 and 2015 related to enterprise risk reporting and holding companies. The forms were first updated in a temporary rule to allow insurers to submit requisite documents on the correct forms. This rulemaking will replace the temporary rules and change the language of the rule to allow the division to make changes to the rules without rulemaking. Rather than being an exhibit to the rule, the forms will be available on the DCBS website at the Division of Financial Regulation webpage. Changing the rule in this way will reduce the amount of time it takes to change the forms if future changes to the forms are necessary thus reducing any delay of company transactions. The rules will continue to set forth the requirements for the forms.

Adopted: March 3, 2016

Effective: March 3, 2016

Documents:

Forms

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Amend: OAR 836-011-0000

This amendment to an existing rule prescribes for reporting year 2015, 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: February 2, 2016

Effective: February 3, 2016

Documents:

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Adopt: OAR 836-071-0354

Amend: OAR 836-071-0355, 836-071-0370, 836-071-0380

Existing rules of the Department of Consumer and Business Services 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. Enrolled House Bill 2958 (2015 Legislative Session) allows a rental company to identify a "designated agent" to sell rental insurance under the limited license of the rental company, beginning January 1, 2016. The amendments to those rules add references to a designated agent in the rental vehicle limited license rules to reflect the changes made during the 2015 Legislative Session. The amended rules require that the rental company must provide the same training and oversight to a designated agent as the rental company provides for employees." In addition, a new rule defines "designated agent."

Adopted: January 20, 2016

Effective: January 20, 2016

Documents:

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Amend: OAR 836-052-0142

The rules amend the division's Medicare Supplement insurance guarantee issue rule to specify that the standardized Medicare Supplement products to which eligible persons are entitled include Plans D, G, M, and N and to exclude any 1990 standardized Medicare Supplement products no longer sold after June 1, 2010. These plans were inadvertently omitted in a prior amendment of the rule.

Adopted: December 29, 2015

Effective: January 1, 2016

Documents:

Adopt: OAR 836-051-0150, 836-051-0153, 836-051-0156

The new rules are necessary to address the calculation of surrender charges on payment made for withdrawal of funds from individual deferred annuity insurance contracts. The rules direct that withdrawals demonstrate minimum value compliance. If an insurer subjects funds withdrawn to surrender charges the funds withdrawn must be treated on a first in first out basis to ensure fairness to the contract holder, unless an alternative more beneficial method is available.

Adopted: December 29, 2015

Effective: January 1, 2016

Documents:

Adopt: OAR 836-054-0020

Amend: OAR 836-054-0000

Repeal: OAR OAR 836-054-0000(T)

These rules make two changes related to automobile insurance necessary as a result of passage of Senate Bill 411 (2015 Legislative Session) (SB 411). First, the amendment to OAR 836-054-000(2) changes a reference to a specific exhibit that does not correctly explain the law as it 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 changes to the rule will allow the Insurance Division to respond more quickly to changes that may be necessary to the form by eliminating the need to conduct rulemaking to change the form.

Second, SB 411 changed the language related to the notice of denial of charges that an insurer must provide to medical providers when the insurer denies charges. Prior to SB 411, the statute required the insurers to give notice of denial not more than 60 days after the insurer receives from the provider notice of a claim for services for Personal Injury Protection (PIP) benefits. SB 411 changed this to a requirement that the provider must receive the notice of denial within 60 days after the insurer received the claim for services. The new rule clarifies how to prove "receipt" of the denial by using language similar to language used in the Oregon Rules of Civil Procedure that establishes a presumption of receipt through service by mail with three days added to the prescribed period.

Adopted: December 29, 2015

Effective: January 1, 2016

Documents:

Adopt: OAR 836-053-0600, 836-053-0605, 836-053-0610 and 836-053-0615

Repeal: OAR 836-053-0600T, 836-053-0605T, 836-053-0610T and 836-053-0615T

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.

Adopted: December 29, 2015

Effective: January 1, 2016

Documents:

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​Key links

Oregon Revised Statutes 

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