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
Adopt: OAR 836-011-0050
This permanent rule replaces temporary rule OAR 836-011-0050(T).
This rule brings the Insurance Division into compliance with Section
1303 of the Affordable Care Act (Pub. L. 111-148, 2010) requirements.
That federal law requires health insurers to establish separate accounts
that segregate federal subsidy funding for essential health benefits
of a health benefit plan from other premium funds received from persons
who enroll through the Oregon Health Insurance Exchange for coverage
that may exceed the essential health benefits. The section also requires
inclusion of notice of the fund segregation in the summary of benefits
and coverage explanation. Section 1303 (b)(E)(i) places the obligation
to ensure compliance with the segregation requirements on state insurance
regulators. This rule is necessary for the Insurance Division to comply
with the Affordable Care Act's requirements in this regard. The rule
requires a health insurer to obtain the approval of the Oregon Insurance
Commissioner of the accounting methodology the insurer will use to
segregate the accounting. The proposed rules also requires health
insurer to file certain information and imposes additional reporting
requirements related to the segregated accounts with the insurer’s
annual financial statement.
Adopted: February 14, 2014
Effective: February 14, 2014
Amend: OAR 836-011-0000
This rulemaking prescribes, for reporting year 2013, 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 14, 2014
Effective: February 14, 2014
Amend: OAR 836-053-0431 (T)
The amendments to OAR 836-053-0431(1) and (2) clarify that carriers that issue
individual health benefit plans must offer and provide individual health benefit
plan coverage to applicants (1) who are 65 or older unless such persons are
enrolled in Medicare or (2) applying for coverage outside of the Oregon Health
Insurance Exchange without regard to the legal status of a person.
Adopted: February 4, 2014
Effective: February 4, 2014 through July 31, 2014