Chapter 735 — Alternative
Insurance
2011 EDITION
ALTERNATIVE INSURANCE
INSURANCE
ESSENTIAL PROPERTY INSURANCE
735.005 Definitions
for ORS 735.005 to 735.145
735.015 Purpose
735.025 Construction
735.035 Application
735.045 Oregon
FAIR Plan Association; insurers required to be members; plan of operation
735.055 Association
board of directors; appointment; compensation, expenses of members; quorum
735.065 Required
association functions; assessments
735.075 Discretionary
association functions
735.085 Plan
of operation; submission to director; approval of plan; compliance with plan;
rules
735.095 Contents
of plan of operation
735.105 Regulation
of association as insurer; financial report to director
735.115 Exemption
of association from fees and taxes
735.145 Immunity
from legal action in carrying out duties
MARKET ASSISTANCE PLANS; JOINT
UNDERWRITING ASSOCIATIONS
735.200 Legislative
findings; purpose
735.205 Definitions
for ORS 735.200 to 735.260
735.210 Formation
of market assistance plans; rules
735.215 Findings
prior to formation of joint underwriting association; hearing
735.220 Formation
of joint underwriting association; funds
735.225 Membership
in joint underwriting association
735.230 Rates;
approval
735.235 Board
of directors
735.240 Annual
statement
735.245 Conditions
for policyholder surcharge
735.250 Exemption
from liability
735.255 State
not liable to pay debts of association
735.260 Rules
735.265 Liquor
liability insurance risk and rate classifications; rules
LIABILITY RISK RETENTION LAW
735.300 Purpose
of ORS 735.300 to 735.365
735.305 Definitions
for ORS 735.300 to 735.365
735.310 Qualifications
for risk retention group; plan of operation; application; notification to
National Association of Insurance Commissioners
735.315 Foreign
risk retention groups; conditions of doing business in Oregon; prohibited acts
735.320 Relationship
to insurance guaranty fund and joint underwriting association
735.325 Exemption
of purchasing groups from certain laws
735.330 Purchasing
groups; notice of intent to do business; registration; exceptions
735.335 Purchase
of insurance by purchasing group
735.340 Insurance
Code enforcement authority subject to federal law
735.345 Violation
of ORS 735.300 to 735.365; penalties
735.350 Agent
or broker; license
735.355 Court
orders enforceable in Oregon
735.360 Rules
735.365 Short
title
SURPLUS LINES LAW
735.400 Purposes
of ORS 735.400 to 735.495
735.405 Definitions
for ORS 735.400 to 735.495
735.406 Cost
of living adjustment to net worth, revenues and expenses of exempt commercial
purchasers
735.410 Conditions
for procuring insurance through nonadmitted insurer;
rules
735.415 Qualifications
for placement of coverage with nonadmitted insurer
735.417 Insured
required to report and pay taxes on independently procured insurance covering
Oregon home state risks
735.418 Director
authorized to enter into interstate compact for premium tax allocation
735.420 Declaration
of ineligibility of surplus lines insurer
735.425 Filing
by licensee after placement of surplus lines insurance
735.430 Surplus
Line Association of Oregon; fees
735.435 Evidence
of insurance; contents; change; penalty; notice regarding Insurance Guaranty
Association; rules
735.440 Validity
of contracts
735.445 Effect
of payment of premium to surplus lines licensee
735.450 Requirements
for license as surplus lines insurance licensee
735.455 Authority
of licensee; rules
735.460 Records
of licensee; examination
735.465 Monthly
reports; rules
735.470 Premium
tax; collection; payment; refund; rules
735.475 Suit
to recover unpaid tax
735.480 Suspension
or revocation of license; refusal to renew; grounds
735.485 Actions
against surplus lines insurer
735.490 Jurisdiction
in action against insurer; service of summons and complaint; response
735.492 Application
of certain Insurance Code provisions to surplus lines insurers
735.495 Short
title; severability
RETAINER MEDICAL PRACTICE
735.500 Requirements
for certification as retainer medical practice; disclosures; rules
735.510 Notice
to department of specified changes to practice
DENTAL SERVICES CONTRACTS
(Temporary provisions relating to dental
services contracts are compiled as notes following ORS 735.510)
MEDICAL INSURANCE POOL
(Oregon Medical Insurance Pool)
735.600 Legislative
intent
735.605 Definitions
for ORS 735.600 to 735.650
735.610 Oregon
Medical Insurance Pool Board; members; authority; rules
735.612 Oregon
Medical Insurance Pool Account; sources; uses
735.614 Assessments
for expenses of pool and reinsurance program for children’s coverage
735.615 Eligibility
for pool coverage; rules
735.616 Portability
coverage under pool
735.620 Administration
of insurance pool program
735.625 Coverage;
rules
735.630 Exemption
from liability
735.635 Exemption
from taxation
735.640 Study;
adjustment of operation and benefits plans
735.645 Notice
of existence of pool
735.650 Application
of provisions of Insurance Code
(Temporary High Risk Pool Program)
(Temporary provisions relating to
Temporary High Risk Pool Program are compiled as notes following ORS 735.650)
OFFICE OF PRIVATE HEALTH PARTNERSHIPS
735.700 Definitions
for ORS 735.700 to 735.710
735.701 Office
of Private Health Partnerships
735.702 Duties
of office
735.703 Administrator
735.705 Appointment
of deputy director, officers and employees
735.707 Rules
735.709 Appointment
of advisory committees
735.710 Additional
duties of office; rules
735.712 Office
to encourage health insurance coverage among small employers
COMMUNITY-BASED HEALTH CARE INITIATIVES
735.721 Definitions
for ORS 735.721 to 735.727
735.723 Requirements
for approval; rules
735.725 Enrollment
requirements
735.727 Annual
report to Legislative Assembly
ESSENTIAL PROPERTY INSURANCE
735.005 Definitions for ORS 735.005 to 735.145.
As used in ORS 735.005 to 735.145, unless the context requires otherwise:
(1)
“Association” means the Oregon FAIR Plan Association created by ORS 735.045.
(2)
“Board” means the board of directors of the association.
(3)
“Essential property insurance” means insurance against direct loss to property
as defined and limited in standard fire policies and extended coverage indorsements thereon, as approved by the Director of the
Department of Consumer and Business Services, and insurance against the perils
of vandalism and malicious mischief. “Essential property insurance” does not
include automobile insurance or insurance on such types of manufacturing risks
as may be excluded by the director.
(4)
“Inspection bureau” means the person or persons designated by the association
with the approval of the director to make inspections as required under ORS
731.418, 733.010 and 735.005 to 735.145 and to perform such other duties as may
be authorized by the association.
(5)
“Service insurer” means any insurer designated as such by the board.
(6)
“Member insurer” means an insurer authorized to transact insurance in this
state that writes any kind of essential property insurance.
(7)
“Net direct written premiums” means direct gross premiums written in this state
on insurance policies to which ORS 735.005 to 735.145 apply, less return
premiums thereon and dividends paid or credited to policyholders on such direct
business. “Net direct written premiums” does not include premiums on contracts
between insurers or reinsurers.
(8)
“Plan” means the plan of operation of the association established pursuant to
ORS 735.085. [1971 c.321 §5; 1979 c.818 §2]
735.015 Purpose.
The purpose of ORS 735.005 to 735.145 is:
(1)
To assure stability in the property insurance market for certain property
located in this state.
(2)
To assure the availability of essential property insurance to the owners of
insurable property.
(3)
To encourage maximum use, in obtaining essential property insurance, of the
normal insurance market provided by authorized insurers.
(4)
To provide for the equitable distribution among authorized insurers of the
responsibility for insuring certain insurable property for which essential
property insurance cannot be obtained through the normal insurance market by
the establishment of the Oregon FAIR Plan Association. [1971 c.321 §2]
735.025 Construction.
ORS 735.005 to 735.145 shall be liberally construed to effect the purpose
provided in ORS 735.015. [1971 c.321 §3]
735.035 Application.
ORS 735.005 to 735.145 apply only to essential property insurance on domestic
risks. [1971 c.321 §4]
735.045 Oregon FAIR Plan Association;
insurers required to be members; plan of operation.
There is hereby created the Oregon FAIR Plan Association. Each insurer that is
a member insurer shall become and remain a member of the association as a
condition of its authority to transact insurance in this state. The association
shall perform its functions in accordance with a plan of operation established
pursuant to ORS 735.085, and shall exercise its powers through its board of
directors. [1971 c.321 §6]
735.055 Association board of directors;
appointment; compensation, expenses of members; quorum.
(1) The board of directors of the Oregon FAIR Plan Association shall consist of
five members selected by the member insurers, subject to the approval of the
Director of the Department of Consumer and Business Services, and four persons
selected by the Governor, one of whom shall be an insurance producer holding an
appointment as an Oregon insurance producer of a member insurer. Of the other
three persons appointed by the Governor, one shall be a resident of a county of
over 400,000 population and none shall have been an employee or insurance
producer of a member insurer. The term of each member shall be as specified in
the plan, but in no event for longer than four years. A vacancy on the board
shall be filled for the remainder of the unexpired term in the same manner as
for the initial selection.
(2)
In making or approving selections to the board, the Director of the Department
of Consumer and Business Services shall consider among other things whether
member insurers are fairly represented.
(3)
A member of the board shall receive no compensation for services as a member.
However, a member shall be reimbursed from the assets of the association for
actual and necessary travel and other expenses incurred by the member in the
performance of duties.
(4)
A majority of the members of the board constitutes a quorum for the transaction
of business. [1971 c.321 §7; 1979 c.818 §2a; 2003 c.364 §88]
735.065 Required association functions;
assessments. (1) The Oregon FAIR Plan Association
shall:
(a)
Have authority on behalf of its members to arrange for the issuance of property
insurance policies by service insurers and to reinsure any of those policies in
whole or in part and to cede such reinsurance, subject to the plan.
(b)
Assess member insurers the amounts necessary to pay the expenses incurred by
the association in meeting its obligations and exercising its duties and powers
under ORS 735.005 to 735.145.
(2)
Except as provided in subsection (3)(a) and (b) of this section, the assessment
of each member insurer for a particular calendar year shall be in the
proportion that the net direct written premiums of the member insurer for the
second preceding calendar year bears to the net direct written premiums of all
member insurers for the second preceding calendar year. Each member insurer
shall be notified of an assessment not later than the 30th day before the day
it is due. If the funds of the association do not provide in any one year an
amount sufficient to pay the expenses of the association, the funds available
shall be prorated among the expenses and the unpaid portion shall be paid as
soon thereafter as funds become available. If an assessment would cause a
member insurer’s financial statement to reflect an amount of surplus less than
the minimum amount required for a certificate of authority by any jurisdiction
in which the member insured is authorized to transact insurance, the
association may, in whole or in part, exempt the member insurer from payment of
the assessment or defer payments.
(3)(a)
The maximum assessment of a member insurer for any calendar year shall be two
percent of the insurer’s net direct written premiums for the second preceding
calendar year.
(b)
The minimum assessment of a member insurer for any calendar year shall be $50.
(4)
Reimburse inspection bureaus, service insurers and employees of the association
for expenses incurred in the inspection or insuring of property on behalf of
the association, and pay all other expenses the association incurs in carrying
out the provisions of ORS 735.005 to 735.145.
(5)
Undertake a continuing public education program in cooperation with member
insurers and insurance producers to assure that the plan receives adequate
attention.
(6)
Undertake a continuing education program to advise the public of the steps
which may be taken to make property more insurable against crime, personal liability
and the perils named in ORS 735.005 (3). [1971 c.321 §8; 1979 c.818 §3; 2003
c.364 §89]
735.075 Discretionary association
functions. The Oregon FAIR Plan Association may:
(1)
With the approval of the Director of the Department of Consumer and Business
Services, employ or retain such persons and designate such inspection bureaus
and service insurers as are necessary to handle applications, inspect and
insure property and perform the other duties of the association.
(2)
Borrow funds as necessary to carry out ORS 735.005 to 735.145 in such manner as
may be specified in the plan.
(3)
Sue or be sued.
(4)
Negotiate and become a party to such contracts as are necessary to carry out
ORS 735.005 to 735.145.
(5)
At the end of any calendar year, refund to member insurers, in proportion to
each insurer’s payments to the association, the amount by which the board of
directors finds that the funds of the association exceed its current
liabilities plus the liabilities estimated for the coming year.
(6)
Perform such other acts as are necessary or proper to carry out ORS 735.005 to
735.145. [1971 c.321 §9]
735.085 Plan of operation; submission to
director; approval of plan; compliance with plan; rules.
(1) The Oregon FAIR Plan Association shall submit to the Director of the
Department of Consumer and Business Services, not later than September 7, 1971,
a plan of operation, and may thereafter submit such amendments thereto as will
provide for the reasonable and equitable exercise of the duties and powers of the
association. The plan of operation, and any amendments thereto, shall become
effective upon approval in writing by the director.
(2)
If the association fails to submit a plan that receives the approval of the
director as provided in subsection (1) of this section, or if the association
after such approval fails to maintain a plan satisfactory to the director, the
director shall by rule prescribe a plan of operation that meets the standards
provided in subsection (1) of this section. A plan prescribed by the director
shall remain in effect until the director by rule provides otherwise.
(3)
No member insurer shall fail to comply with the currently effective plan. [1971
c.321 §10]
735.095 Contents of plan of operation.
The plan shall:
(1)
Establish procedures for the submission and processing of applications for
insurance and the payment of claims for losses.
(2)
Establish procedures for record keeping, payment of other expenses and
administration of all other financial affairs of the Oregon FAIR Plan Association.
(3)
Establish times and places for meetings of the board.
(4)
Establish procedures for selection of members of the board and for approval of
such selections by the Director of the Department of Consumer and Business
Services.
(5)
Establish a procedure for appeal to the director of final actions or decisions
of the association.
(6)
Establish such other procedures as may be necessary or proper to carry out the
duties and powers of the association.
(7)
Provide that the association shall file periodically with the director
statements of the insurance provided through the association and estimates of
anticipated claims against the association. [1971 c.321 §11; 1979 c.818 §4]
735.105 Regulation of association as
insurer; financial report to director. The Oregon
FAIR Plan Association is subject to regulation by the Director of the
Department of Consumer and Business Services in the same manner as an insurer,
to the extent determined by the director to be necessary to carry out the
purpose of ORS 735.005 to 735.145. Not later than March 30 of each year the
board shall submit to the director, in a form approved by the director, a
financial report for the preceding calendar year. [1971 c.321 §12]
735.115 Exemption of association from fees
and taxes. Except for taxes levied on real or
personal property, the Oregon FAIR Plan Association shall be exempt from the
payment of all fees and taxes levied by this state or by any city, county,
district or other political subdivision of this state. [1971 c.321 §13]
735.125 [1971
c.321 §14; repealed by 1979 c.818 §5]
735.135 [1971
c.321 §15; repealed by 1979 c.818 §5]
735.145 Immunity from legal action in
carrying out duties. No person shall have a cause of
action against the Oregon FAIR Plan Association or its employees or servicing
facilities, any member of the board, or the Director of the Department of
Consumer and Business Services or the employees of the director for any action
taken by them in carrying out ORS 735.005 to 735.145. [1971 c.321 §16]
MARKET ASSISTANCE PLANS; JOINT
UNDERWRITING ASSOCIATIONS
735.200 Legislative findings; purpose.
(1) The Legislative Assembly finds that:
(a)
Some businesses and service providers in Oregon have experienced major problems
in both the availability and affordability of commercial liability insurance.
Premiums for such insurance policies have recently grown as much as 500 percent
and the availability of such insurance in Oregon markets has greatly
diminished.
(b)
These businesses and service providers are essential to achieve goals such as
increased workforce productivity, family self-sufficiency and the maintenance
and improvement of the health of the citizens of Oregon. The lack of adequate
commercial liability insurance threatens these businesses and services.
(2)
The Legislative Assembly therefore declares it is the purpose of ORS 735.200 to
735.260 to remedy the problem of unavailable commercial liability insurance for
these businesses and service providers by authorizing the Director of the
Department of Consumer and Business Services to assist in the establishment of
a market assistance plan for providing commercial liability insurance for these
businesses and service providers, or, if necessary, by requiring all insurers
authorized to write commercial liability insurance in Oregon to be members of
one or more joint underwriting associations created to provide commercial
liability insurance for these businesses and service providers. [1987 c.774 §73]
735.205 Definitions for ORS 735.200 to
735.260. As used in ORS 735.200 to 735.260:
(1)
“Joint underwriting association” means a mechanism requiring casualty insurers
doing business in Oregon to provide commercial liability insurance to certain
businesses and service providers on either an assigned risk basis or through a
joint underwriting pool underwritten to standards adopted under the Insurance
Code.
(2)
“Market assistance plan” means a mechanism through which admitted casualty
insurers in this state provide commercial liability insurance for classes of
risks designated by the Director of the Department of Consumer and Business
Services. [1987 c.774 §74]
735.210 Formation of market assistance
plans; rules. (1) After a public hearing, the
Director of the Department of Consumer and Business Services may by rule
require insurers authorized to write and writing commercial liability insurance
in this state to form a market assistance plan to assist businesses and service
providers unable to purchase specified classes of commercial liability
insurance in adequate amounts from either the admitted or nonadmitted
market.
(2)
The market assistance plan shall operate under a plan of operations prepared by
admitted insurers, eligible surplus line insurers and insurance producers, and
approved by the director. [1987 c.774 §75; 2003 c.364 §90]
735.215 Findings prior to formation of
joint underwriting association; hearing. (1) The
Director of the Department of Consumer and Business Services may mandate the
formation of a joint underwriting association under ORS 735.220 if after
directing the formation of a market assistance plan and allowing it a
reasonable time to alleviate insurance availability problems, the director
finds that:
(a)
There exist in Oregon certain businesses or service providers for which no
commercial liability insurance is available; and
(b)
There is a need in Oregon for the goods or services provided by these
businesses or service providers and the lack of available commercial liability
insurance will cause a substantial number of the entities to cease operations
within the state.
(2)
Notwithstanding subsection (1) of this section, if the lack of availability of
insurance is due to legitimate insurance underwriting considerations, including
past claims experience, licensing noncompliance or inadequate risk management,
formation of a joint underwriting association shall not be appropriate.
(3)
The director may make the findings required under subsection (1) of this
section only after conducting a public hearing according to the applicable
provisions of ORS chapter 183. The director must specify the specific classes
of business or lines of insurance determined to be unavailable.
(4)
At least once each year, the director shall hold a public hearing to determine
if the classes of business or lines of insurance offered by the joint
underwriting association are still unavailable in the voluntary insurance
market. If any class or line is found to be available, the joint underwriting
association shall cease to underwrite such class of business or line of insurance.
[1987 c.774 §76]
735.220 Formation of joint underwriting
association; funds. After finding under ORS 735.215
that there is a need in Oregon for a joint underwriting association, the
Director of the Department of Consumer and Business Services may form and put
into operation a temporary, nonprofit, nonexclusive joint underwriting
association constituting a legal entity separate and distinct from its members
for commercial liability insurance subject to the conditions and limitations
contained in the Insurance Code. All funds and reserves of the association
shall be separately held and invested. [1987 c.774 §77]
735.225 Membership in joint underwriting
association. The joint underwriting association
established under ORS 735.220 shall be comprised of all insurers authorized to
write and who are writing commercial liability insurance within this state on a
direct basis, including the commercial liability portions of multiperil policies. Every such insurer shall remain a
member of the association as a condition of its authority to continue to
transact insurance in this state. [1987 c.774 §78]
735.230 Rates; approval.
The board of directors of the joint underwriting association shall engage the
services of an independent actuarial firm to develop and recommend actuarially
sound rates, rating plans, rating rules and classifications. The Director of
the Department of Consumer and Business Services shall approve rates filed by
the joint underwriting association in accordance with ORS 737.310. All rates approved
for the joint underwriting association shall be actuarially sound and
calculated to be self-supporting. [1987 c.774 §79]
735.235 Board of directors.
The joint underwriting association formed under ORS 735.220 shall be under the
administrative control of a seven person board of directors appointed by the
Governor. Two directors shall represent insurance carriers participating in the
association; one director shall represent insurance producers; three directors
shall represent the affected classes of insureds; and
one director shall be a public member with no ties to the insurance industry.
The board shall elect one of its members as chairperson. [1987 c.774 §80; 2003
c.364 §91]
735.240 Annual statement.
The joint underwriting association shall file an annual statement prepared by
an independent certified public accountant containing a financial statement, a
summary of its transactions and operations for the prior year and other
information as prescribed by the Director of the Department of Consumer and
Business Services by rule. [1987 c.774 §81]
735.245 Conditions for policyholder
surcharge. (1) Upon a determination of the board
of directors that the joint underwriting association will be unable to pay its
outstanding lawful obligations as they mature, the board shall certify the
existence of this condition to the Director of the Department of Consumer and
Business Services. A schedule for policyholder surcharges shall be submitted by
the board at the time of certification.
(2)
The surcharge schedule shall become final 30 days after certification unless
the director finds, after a public hearing, that the surcharge amounts are
unreasonable or unjustifiable. Such surcharges may be adjusted to take into
consideration the past and prospective loss and expense experience in different
geographical areas within the state. Such surcharges shall be in addition to
and not in lieu of the premiums charged for the coverages
provided.
(3)
Moneys collected in accordance with subsection (2) of this section shall be
held in a fund separate from other joint underwriting association funds. Such
funds shall be invested in accordance with applicable law governing publicly
held trust funds. The association shall file an annual financial statement
covering such funds.
(4)
Surcharge funds shall be subject to the control of the board of directors and
may be used to satisfy the legal obligations of the joint underwriting
association.
(5)
No part of the profit or loss of the joint underwriting association shall inure
to the benefit of any member insurer or be an obligation of any member insurer.
[1987 c.774 §82]
735.250 Exemption from liability.
There shall be no liability or cause of action against any member insurer,
self-insurer, or its agents or employees, the joint underwriting association or
its agents or employees, members of the board of directors, the Department of
Consumer and Business Services or its representatives for any action taken by
or statement made by them in performance of their powers and duties under ORS
735.210 to 735.260. [1987 c.774 §83]
735.255 State not liable to pay debts of
association. The state is not liable to pay any
debts or obligations of any association formed under ORS 735.220 and no person
may assert any claim against the state or any of its agencies for any act or
omission of the association. [1987 c.774 §84]
735.260 Rules.
The Director of the Department of Consumer and Business Services may adopt all
rules necessary to insure the efficient, equitable operation of the market
assistance plan or the joint underwriting association, including but not
limited to rules requiring or limiting certain policy provisions. [1987 c.774 §85]
735.265 Liquor liability insurance risk
and rate classifications; rules. If a market
assistance plan is formed under ORS 735.210, or a joint underwriting
association is formed under ORS 735.220, the Director of the Department of
Consumer and Business Services shall by rule establish such liquor liability
insurance risk and rate classifications as may be necessary to facilitate the
availability and affordability of this commercial insurance product. Risk and
rate classifications shall be established for all facets of the liquor industry
including those who sell at wholesale or retail and the State of Oregon, as allowed
by law. Risk classifications and rating plans shall be developed upon
considerations including, but not limited to, the following factors:
(1)
Past loss experience and prospective loss experience of different license
types.
(2)
Past loss experience and prospective loss experience in different geographic
areas.
(3)
Prior claims experience of the individual licensee.
(4)
Prior compliance with public safety and alcoholic beverage laws, rules and
ordinances pertaining to the sale and service of alcoholic beverages.
(5)
Evidence of responsible management policies including, but not limited to,
procedures and actions which:
(a)
Encourage persons not to become intoxicated if they consume alcoholic beverages
on the licensee’s premises;
(b)
Promote availability of nonalcoholic beverages and food;
(c)
Promote safe transportation alternatives to driving while intoxicated;
(d)
Prohibit employees and agents of the licensee from consuming alcoholic
beverages while acting in their capacity as employee or agent;
(e)
Establish promotions and marketing efforts which publicize responsible business
practices to the licensee’s customers and community;
(f)
Implement comprehensive training procedures; and
(g)
Maintain an adequate, trained number of employees and agents for the type and
size of licensee’s business. [1987 c.774 §88]
LIABILITY RISK RETENTION LAW
735.300 Purpose of ORS 735.300 to 735.365.
The purpose of ORS 735.300 to 735.365 is to regulate the formation and
operation of risk retention groups and purchasing groups in this state formed
pursuant to the provisions of the federal Liability Risk Retention Act of 1986
(P.L. 99-563). [1987 c.774 §98; 1989 c.700 §10]
735.305 Definitions for ORS 735.300 to
735.365. As used in ORS 735.300 to 735.365:
(1)
“Director” means the Director of the Department of Consumer and Business
Services of this state or the commissioner, director or superintendent of
insurance in any other state.
(2)
“Completed operations liability” means liability arising out of the installation,
maintenance or repair of any product at a site that is not owned or controlled
by any person who performs that work or by any person who hires an independent
contractor to perform that work. The term also includes liability for
activities that are completed or abandoned before the date of the occurrence
giving rise to the liability.
(3)
“Domicile,” for purposes of determining the state in which a purchasing group
is domiciled, means:
(a)
For a corporation, the state in which the purchasing group is incorporated; and
(b)
For an unincorporated entity, the state of its principal place of business.
(4)
“Hazardous financial condition” means that a risk retention group, based on its
present or reasonably anticipated financial conditions, although not yet
financially impaired or insolvent, is unlikely to be able:
(a)
To meet obligations to policyholders with respect to known claims and
reasonably anticipated claims; or
(b)
To pay other obligations in the normal course of business.
(5)
“Insurance” means primary insurance, excess insurance, reinsurance, surplus
lines insurance and any other arrangement for shifting and distributing risk
that is determined to be insurance under the laws of this state.
(6)
“Liability”:
(a)
Means legal liability for damages, including costs of defense, legal costs and
fees and other claims expenses, because of injuries to other persons, damage to
their property or other damage or loss to such other persons resulting from or
arising out of:
(A)
Any business that is for-profit or not-for-profit, or any trade, product,
premises, operations or services, including professional services; or
(B)
Any activity of any state or local government, or any agency or political
subdivision thereof.
(b)
Does not include personal risk liability and an employer’s liability with
respect to its employees other than legal liability under the Federal Employers’
Liability Act (45 U.S.C. 51 et seq.).
(7)
“Personal risk liability” means liability for damages because of injury to any
person, damage to property or other loss or damage resulting from any personal,
familial or household responsibilities or activities, rather than from
responsibilities or activities referred to in subsection (6) of this section.
(8)
“Plan of operation or a feasibility study” means an analysis that presents the
expected activities and results of a risk retention group, and includes at a
minimum:
(a)
The coverages, deductibles, coverage limits, rates
and rating classification systems for each line of insurance the group intends
to offer;
(b)
Historical and expected loss experience of the proposed members and national
experience of similar exposures to the extent that this experience is
reasonably available;
(c)
Pro forma financial statements and projections;
(d)
Appropriate opinions by a qualified independent casualty actuary, including a
determination of minimum premium or participation levels required to commence
operations and prevent a hazardous financial condition;
(e)
Identification of management, underwriting procedures, managerial oversight
methods and investment policies; and
(f)
Other matters that the director requires for liability insurance companies
authorized by the insurance laws of the state in which the risk retention group
is chartered.
(9)
“Product liability” means liability for damages because of any personal injury,
death, emotional harm, consequential economic damage or property damage,
including damages resulting from the loss of use of property, arising out the
manufacture, design, importation, distribution, packaging, labeling, lease or
sale of a product. The term does not include the liability of any person for
those damages if the product involved was in the possession of such a person
when the incident giving rise to the claim occurred.
(10)
“Purchasing group” means any group that:
(a)
Has as one of its purposes the purchase of liability insurance on a group
basis;
(b)
Purchases such insurance only for its group members and only to cover their
similar or related liability exposure, as described in paragraph (c) of this
subsection;
(c)
Is composed of members whose business or activities are similar or related with
respect to the liability to which members are exposed by virtue of any related,
similar or common business, trade, product, services, premises or operations;
and
(d)
Is domiciled in any state.
(11)
“Risk retention group” means any corporation or other limited liability
association formed under the laws of any state:
(a)
Whose primary activity consists of assuming and spreading all, or any portion
of, the liability exposure of its group members;
(b)
That is organized for the primary purpose of conducting the activity described
in paragraph (a) of this subsection;
(c)
That:
(A)
Is chartered and licensed as a liability insurance company and authorized to
engage in the business of insurance under the laws of any state; or
(B)
Before January 1, 1985, was chartered or licensed and authorized to engage in
the business of insurance under the laws of Bermuda or the Cayman Islands and,
before that date, had certified to the insurance commissioner of at least one
state that it satisfied the capitalization requirements of that state. However,
any such group shall be considered to be a risk retention group only if it has
been engaged in business continuously since that date and only for the purpose
of continuing to provide insurance to cover product liability or completed
operations liability, as such terms were defined in the federal Product
Liability Risk Retention Act of 1981, as amended by the Risk Retention
Amendments of 1986, before the date of the enactment of the federal Liability
Risk Retention Act of 1986 (P.L. 99-563);
(d)
That does not exclude any person from membership in the group solely to provide
for members of such a group a competitive advantage over such a person;
(e)
That:
(A)
Has as its members only persons who have an ownership interest in the group and
has as its owners only persons who are members that are provided insurance by
the risk retention group; or
(B)
Has as its sole member and sole owner an organization that is owned by persons
who are provided insurance by the risk retention group;
(f)
Whose members are engaged in businesses or activities similar or related with
respect to the liability to which such members are exposed by virtue of any
related, similar or common business, trade, product, services, premises or
operations;
(g)
Whose activities do not include the provision of insurance other than:
(A)
Liability insurance for assuming and spreading all or any portion of the
liability of its group members; and
(B)
Reinsurance with respect to the liability of any other risk retention group, or
any members of such other group, that is engaged in businesses or activities so
that such group or member meets the requirement described in paragraph (f) of
this subsection for membership in the risk retention group that provides such
reinsurance; and
(h)
The name of which includes “Risk Retention Group.”
(12)
“State” means any state of the United States or the District of Columbia. [1987
c.774 §99; 1993 c.744 §29]
735.310 Qualifications for risk retention
group; plan of operation; application; notification to National Association of
Insurance Commissioners. (1) A risk retention group
seeking to be organized in this state:
(a)
Must be organized as a liability insurer in this state and authorized by a
subsisting certificate of authority issued by the director to transact
liability insurance in this state, as provided in ORS chapter 732; and
(b)
Except as otherwise provided in ORS 735.300 to 735.365, must comply with all
laws, rules and other requirements applicable to such insurers authorized to
transact insurance in this state and with ORS 735.315 to the extent the
requirements under ORS 735.315 are not a limitation on other laws, rules or
requirements of this state.
(2)
Before a risk retention group may offer insurance in any state, the risk
retention group shall submit for approval to the director of this state a plan
of operation or a feasibility study and revisions of such plan or study if the
group intends to offer any additional lines of liability insurance.
(3)
Immediately upon receipt of an application for organization, the director shall
provide summary information concerning the filing to the National Association
of Insurance Commissioners, including the name of the risk retention group, the
identity of the initial members of the group, the identity of those individuals
who organized the group or who will provide administrative services or
otherwise influence or control the activities of the group, the amount and
nature of initial capitalization, the coverages to be
afforded and the states in which the group intends to operate. Providing
notification to the National Association of Insurance Commissioners is in addition
to and shall not be sufficient to satisfy the requirements of ORS 735.300 to
735.365. [1987 c.774 §100]
735.315 Foreign risk retention groups;
conditions of doing business in Oregon; prohibited acts.
Risk retention groups chartered in states other than this state and seeking to
do business as a risk retention group in this state must observe and abide by
the laws of this state as follows:
(1)
Before transacting insurance in this state, a risk retention group shall submit
to the director:
(a)
A statement identifying the state or states in which the risk retention group
is chartered and licensed as a liability insurance company, its date of
chartering, its principal place of business and such information, including
information on its membership, as the director may require to verify that the
risk retention group is qualified under ORS 735.305 (11);
(b)
A copy of its plan of operation or a feasibility study and revisions of such
plan or study submitted to its state of domicile. The requirement of the
submission of a plan of operation or a feasibility study shall not apply with
respect to any line or classification of liability insurance that:
(A)
Was defined in the federal Product Liability Risk Retention Act of 1981, as
amended by the Risk Retention Amendments of 1986, before October 27, 1986; and
(B)
Was offered before October 27, 1986, by any risk retention group that had been
chartered and operating for not less than three years before October 27, 1986;
and
(c)
A statement of registration that designates the director as its agent for the
purpose of receiving service of legal documents or process.
(2)
A risk retention group doing business in this state shall submit to the
director:
(a)
A copy of the group’s financial statement submitted to its state of domicile,
which shall be certified by an independent public accountant and contain a
statement of opinion on loss and loss adjustment expense reserves made by a
member of the American Academy of Actuaries or a qualified loss reserve
specialist, under criteria established by the National Association of Insurance
Commissioners;
(b)
A copy of each examination of the risk retention group as certified by the
director or public official conducting the examination;
(c)
Upon request by the director, a copy of any audit performed with respect to the
risk retention group; and
(d)
Such information as may be required to verify its continuing qualification as a
risk retention group under ORS 735.305 (11).
(3)
A risk retention group is subject to taxation in this state as follows:
(a)
All premiums paid for coverage within this state to risk retention groups shall
be subject to taxation at the rate applicable to foreign admitted insurers and
the taxes owing shall be subject to the same interest, fines and penalties for
nonpayment as those applicable to foreign admitted insurers.
(b)
To the extent insurance producers are used, they shall report and pay the taxes
for the premiums for the risks that they have placed with or on behalf of a
risk retention group not organized in this state.
(c)
To the extent insurance producers are not used or fail to pay the tax, each
risk retention group shall pay the tax for risks insured within the state.
Further, each risk retention group shall report all premiums paid to it for
risks insured within the state.
(4)
A risk retention group and its agents and representatives shall comply with ORS
746.230 and 746.240. If the director seeks an injunction regarding such
conduct, the injunction must be obtained from a court of competent
jurisdiction.
(5)
A risk retention group must submit to an examination by the director to
determine its financial condition if the director of the jurisdiction in which
the group is chartered has not initiated an examination or does not initiate an
examination within 60 days after a request by the director of this state. Any
such examination shall be coordinated to avoid unjustified repetition.
Examinations may be conducted in accordance with the examiner handbook of the
National Association of Insurance Commissioners.
(6)
A policy issued by a risk retention group shall contain in 10 point type on the
front page and the declaration page, the following notice:
______________________________________________________________________________
Notice
This
policy is issued by your risk retention group. Your risk retention group may
not be subject to all of the insurance laws and rules of your state. State
insurance insolvency guaranty funds are not available for your risk retention
group.
______________________________________________________________________________
(7)
The following acts by a risk retention group are prohibited:
(a)
The solicitation or sale of insurance by a risk retention group to any person
who is not eligible for membership in such group; and
(b)
The solicitation or sale of insurance by, or operation of, a risk retention
group that is in a hazardous financial condition or is financially impaired.
(8)
No risk retention group shall be allowed to do business in this state if an
insurer is directly or indirectly a member or owner of the risk retention
group, other than in the case of a risk retention group all of whose members
are insurers.
(9)
No risk retention group may offer insurance policy coverage prohibited by the
Insurance Code.
(10)
A risk retention group not organized in this state and doing business in this
state must comply with a lawful order issued in a voluntary dissolution
proceeding or in a delinquency proceeding commenced by the insurance
commissioner of any state if there has been a finding of financial impairment
after an examination under subsection (5) of this section. [1987 c.774 §101;
2003 c.364 §92]
735.320 Relationship to insurance guaranty
fund and joint underwriting association. (1) No risk
retention group shall be permitted to join or contribute financially to any
insurance insolvency guaranty fund, or similar mechanism, in this state. No
risk retention group, or its insureds, shall receive
any benefit from any such fund for claims arising out of the operations of the
risk retention group.
(2)
A risk retention group shall participate in this state’s joint underwriting
associations and mandatory liability pools as provided by the Insurance Code. [1987
c.774 §102]
735.325 Exemption of purchasing groups
from certain laws. Any purchasing group meeting the
criteria established under the provisions of the federal Liability Risk
Retention Act of 1986 (P.L. 99-563), shall be exempt from any law of this state
relating to the creation of groups for the purchase of insurance or the
prohibition of group purchasing, or any law that would discriminate against a
purchasing group or its members. In addition, an insurer shall be exempt from
any law of this state that prohibits providing or offering to provide
advantages to a purchasing group or its members based on their loss and expense
experience not afforded to other persons with respect to rates, policy forms, coverages or other matters. A purchasing group shall be
subject to all other applicable laws of this state. [1987 c.774 §103]
735.330 Purchasing groups; notice of
intent to do business; registration; exceptions.
(1) A purchasing group that intends to do business in this state shall furnish
notice to the director, which shall:
(a)
Identify the state in which the group is domiciled;
(b)
Specify the lines and classifications of liability insurance that the
purchasing group intends to purchase;
(c)
Identify the insurer from which the group intends to purchase its insurance and
the domicile of the insurer;
(d)
Identify the principal place of business of the group; and
(e)
Provide such other information as may be required by the director to verify
that the purchasing group is qualified under ORS 735.305 (10).
(2)
The purchasing group shall register with the director and designate the
director as its agent solely for the purpose of receiving service of legal
documents or process, except that such requirements shall not apply in the case
of a purchasing group that meets the following qualifications:
(a)
That:
(A)
Was domiciled before April 1, 1986, in any state; and
(B)
Is domiciled on and after October 27, 1986, in any state;
(b)
That:
(A)
Before October 27, 1986, purchased insurance from an insurance carrier licensed
in any state; and
(B)
On and after October 27, 1986, purchased insurance from an insurance carrier
licensed in any state;
(c)
That was a purchasing group under the requirements of the federal Product
Liability Risk Retention Act of 1981, as amended by the Risk Retention
Amendments of 1986, before October 27, 1986; and
(d)
That does not purchase insurance that was not authorized for purposes of an
exemption under the federal Product Liability Risk Retention Act of 1981, as in
effect before October 27, 1986. [1987 c.774 §104]
735.335 Purchase of insurance by
purchasing group. A purchasing group may not
purchase insurance from a risk retention group that is not chartered in a state
or from an insurer not admitted in the state in which the purchasing group is
located, unless the purchase is effected through a licensed insurance producer
acting pursuant to the surplus lines laws and regulations of that state. [1987
c.774 §105; 2003 c.364 §93]
735.340 Insurance Code enforcement authority
subject to federal law. The director is authorized to
make use of any of the powers established under the Insurance Code to enforce
the laws of this state so long as those powers are not specifically preempted
by the federal Product Liability Risk Retention Act of 1981, as amended by the
Risk Retention Amendments of 1986. This includes, but is not limited to, the
director’s administrative authority to investigate, issue subpoenas, conduct
depositions and hearings, issue orders and impose penalties. With regard to any
investigation, administrative proceedings or litigation, the director may rely
on the procedural law and rules of the state. The injunctive authority of the
director in regard to risk retention groups is restricted by the requirement
that any injunction be issued by a court of competent jurisdiction. [1987 c.774
§106]
735.345 Violation of 735.300 to 735.365;
penalties. A risk retention group that violates
any provision of ORS 735.300 to 735.365 is subject to criminal and civil
penalties applicable to insurers generally, and to suspension or revocation of
its certificate of authority to transact insurance. [1987 c.774 §107]
735.350 Agent or broker; license.
Any person acting or offering to act as an insurance producer for a risk
retention group or purchasing group that solicits members, sells insurance
coverage, purchases coverage for its members located within this state or
otherwise does business in this state shall, before commencing any such
activity, obtain a license as an insurance producer from the director under ORS
chapter 744. [1987 c.774 §108; 1989 c.701 §71; 2003 c.364 §94]
735.355 Court orders enforceable in
Oregon. An order issued by any district court
of the United States enjoining a risk retention group from soliciting or
selling insurance or operating in any state or in all states or in any territory
or possession of the United States, upon a finding that such a group is in a
hazardous financial condition shall be enforceable in the courts of this state.
[1987 c.774 §109]
735.360 Rules.
The director may adopt rules that the director determines are necessary for
carrying out ORS 735.300 to 735.365. [1987 c.774 §110; 1989 c.700 §11]
735.365 Short title.
ORS 735.300 to 735.365 shall be known and may be cited as the Oregon Liability
Risk Retention Law. [1987 c.774 §98a]
SURPLUS LINES LAW
735.400 Purposes of ORS 735.400 to
735.495. ORS 735.400 to 735.495 shall be
liberally construed and applied to promote its underlying purposes which
include:
(1)
Protecting persons seeking insurance in this state;
(2)
Permitting surplus lines insurance to be placed with reputable and financially
sound nonadmitted insurers and exported from this
state pursuant to ORS 735.400 to 735.495;
(3)
Establishing a system of regulation which will permit orderly access to surplus
lines insurance in this state and encourage admitted insurers to provide new
and innovative types of insurance available to consumers in this state; and
(4)
Protecting revenues of this state. [1987 c.774 §117]
735.405 Definitions for ORS 735.400 to
735.495. As used in ORS 735.400 to 735.495:
(1)
“Admitted insurer” means an insurer authorized to do an insurance business in
this state.
(2)
“Affiliated group” means any group of entities that, with respect to an
insured, exercise control over the insured, are under the control of the
insured, or are under common control with the insured.
(3)
“Capital” means funds paid in for stock or other evidence of ownership.
(4)
“Control” means a situation where a controlling entity:
(a)
Directly, or acting through one or more other persons, owns or has the power to
vote 25 percent or more of any class of voting securities of the controlled
entity; or
(b)
Directs in any manner the election of a majority of directors or trustees of
the controlled entity.
(5)
“Eligible surplus lines insurer” means a nonadmitted insurer
with which a surplus lines licensee may place surplus lines insurance.
(6)
“Exempt commercial purchaser” means any person purchasing commercial insurance
that, at the time of placement:
(a)
Employs or retains a qualified risk manager to negotiate insurance coverage;
(b)
Has paid aggregate nationwide commercial property and casualty insurance
premiums in excess of $100,000 in the immediately preceding 12 months; and
(c)
Meets at least one of the following criteria:
(A)
The person possesses a net worth in excess of $10 million, as such amount is
adjusted pursuant to ORS 735.406.
(B)
The person generates annual revenues in excess of $20 million, as such amount
is adjusted pursuant to ORS 735.406.
(C)
The person employs more than 50 full-time or full-time equivalent employees for
each insured or is a member of an affiliated group employing more than 100
employees in the aggregate.
(D)
The person is a not-for-profit organization or public entity generating annual
budgeted expenses of at least $30 million, as such amount is adjusted pursuant
to ORS 735.406.
(E)
The person is a municipality with a population in excess of 50,000 individuals.
(7)
“Export” means to place surplus lines insurance with a nonadmitted
insurer.
(8)
“Home state” means, with respect to an insured:
(a)
The state in which an insured maintains the insured’s principal place of
business or, in the case of an individual, the individual’s principal
residence;
(b)
If 100 percent of the insured risk is located out of the state described in
paragraph (a) of this subsection, the state to which the greatest percentage of
the insured’s taxable premium for that insurance contract is allocated; or
(c)
If two or more insureds from an affiliated group are
named as insureds on a single nonadmitted
insurance contract, the state, as determined pursuant to paragraph (a) or (b)
of this subsection, of the member of the affiliated group that has the greatest
percentage of premium attributed to it under the insurance contract.
(9)
“Kind of insurance” means one of the types of insurance required to be reported
in the annual statement that must be filed with the Director of the Department
of Consumer and Business Services by authorized insurers.
(10)
“Nonadmitted insurer” means an insurer not authorized
to do an insurance business in this state. “Nonadmitted
insurer” includes insurance exchanges as authorized under the laws of various
states. “Nonadmitted insurer” does not include a risk
retention group as defined in ORS 735.305.
(11)
“Premium tax” means any tax, assessment or other charge imposed by this state
directly or indirectly based upon any payment made as consideration for
insurance in an insurance contract.
(12)
“Producing insurance producer” means the individual insurance producer dealing
directly with the party seeking insurance.
(13)
“Qualified risk manager” means, with respect to a policyholder of commercial
insurance, a person who meets all of the following requirements:
(a)
The person is an employee of, or third party consultant retained by, the
commercial policyholder.
(b)
The person provides skilled services in:
(A)
Loss prevention;
(B)
Loss reduction; or
(C)
Risk and insurance coverage analysis and purchase of insurance.
(c)
The person has:
(A)
A bachelor’s degree, from an accredited college or university, in risk
management, business administration, finance, economics or any other field
determined by an insurance commissioner or other regulatory official of this or
any other state to demonstrate minimum competence in risk management, and has:
(i) Three years of experience in risk financing, claims
administration, loss prevention, risk and insurance coverage analysis, or
purchasing commercial lines of insurance; or
(ii)
Any designation, certification or license issued by a national insurance
certification organization that is determined by the Director of the Department
of Consumer and Business Services to demonstrate minimum competency in risk
management;
(B)
At least seven years of experience in risk financing, claims administration,
loss prevention, risk and insurance coverage analysis, or purchasing commercial
lines of insurance, and has a designation, certification or license specified
in subparagraph (A)(ii) of this paragraph;
(C)
At least 10 years of experience in risk financing, claims administration, loss
prevention, risk and insurance coverage analysis or purchasing commercial lines
of insurance; or
(D)
A graduate degree, from an accredited college or university, in risk
management, business administration, finance, economics or any other field
determined by the director to demonstrate minimum competence in risk
management.
(14)
“Surplus” means funds over and above liabilities and capital of the insurer for
the protection of policyholders.
(15)
“Surplus lines licensee” means an insurance producer licensed under ORS chapter
744 to place insurance on Oregon home state risks with nonadmitted
insurers. [1987 c.774 §118; 1991 c.810 §25; 2001 c.191 §44a; 2003 c.364 §38;
2011 c.660 §6]
735.406 Cost of living adjustment to net
worth, revenues and expenses of exempt commercial purchasers.
Beginning on January 1, 2015, and each fifth January 1 occurring thereafter,
the amounts in ORS 735.405 (6)(c)(A), (B) and (D) shall be adjusted to reflect
the percentage change for such five-year period in the Portland-Salem, OR-WA,
Consumer Price Index for All Urban Consumers for All Items as published by the
Bureau of Labor Statistics of the United States Department of Labor. [2011
c.660 §7]
735.410 Conditions for procuring insurance
through nonadmitted insurer; rules.
(1) Insurance may be procured through a surplus lines licensee from a nonadmitted insurer if:
(a)
The insurer is an eligible surplus lines insurer;
(b)
A diligent search has first been made among the insurers who are authorized to
transact and are actually writing the particular kind and class of insurance in
this state, and it is determined that the full amount or kind of insurance
cannot be obtained from those insurers; and
(c)
All other requirements of ORS 735.400 to 735.495 are met.
(2)
Subsection (1)(b) of this section does not apply to a surplus lines licensee
seeking to procure or place nonadmitted insurance in
this state for an exempt commercial purchaser if:
(a)
The surplus lines licensee procuring or placing the surplus lines insurance has
disclosed to the exempt commercial purchaser that such insurance may or may not
be available from the admitted market that may provide greater protection with
more regulatory oversight; and
(b)
The exempt commercial purchaser has subsequently requested in writing that the
surplus lines licensee procure or place such insurance from a nonadmitted insurer.
(3)
The Director of the Department of Consumer and Business Services by rule may
establish requirements applicable to the placement of surplus lines insurance
on Oregon home state risks by a nonresident surplus lines licensee. The rules
may not interfere with or hinder implementation of the federal
Gramm-Leach-Bliley Act (P.L. 106-102) with respect to licensing reciprocity among
the states, or the Nonadmitted and Reinsurance Reform
Act of 2010 (P.L. 111-203, Title V, Subtitle B). [1987 c.774 §119; 2001 c.191 §44b;
2011 c.660 §9]
735.415 Qualifications for placement of
coverage with nonadmitted insurer.
(1) A surplus lines licensee may not place any coverage with a nonadmitted insurer unless at the time of placement the nonadmitted insurer has done all of the following:
(a)
Obtained authorization to write the kind of insurance to be placed by the
surplus lines licensee by the insurance supervisory official in the insurer’s
domiciliary jurisdiction.
(b)
Qualified under one of the following subparagraphs:
(A)
Has capital and surplus or its equivalent under the laws of its domiciliary
jurisdiction that equals the greater of either the minimum capital and surplus
requirements of its domiciliary jurisdiction or $15 million, except that the
requirements of this subparagraph may be satisfied by an insurer possessing
less than the minimum capital and surplus upon an affirmative finding of
acceptability by the Director of the Department of Consumer and Business
Services. The finding shall be based upon such factors as quality of
management, capital and surplus of any parent company, company underwriting
profit and investment income trends, market availability and company record and
reputation within the industry. In no event shall the director make an
affirmative finding of acceptability when the nonadmitted
insurer’s capital and surplus is less than $4.5 million.
(B)
In the case of an alien insurer, in addition to the requirements in
subparagraph (A) of this paragraph, maintains in the United States an
irrevocable trust fund in either a national bank or a member of the Federal
Reserve System, in an amount not less than $5.4 million for the protection of
all its policyholders in the United States and such trust fund consists of
cash, securities, irrevocable letters of credit, or of investments of
substantially the same character and quality as those which are eligible
investments for the capital and statutory reserves of admitted insurers
authorized to write like kinds of insurance in this state. Such trust fund,
which shall be included in any calculation of capital and surplus or its
equivalent, shall have an expiration date which at no time shall be less than
five years.
(C)
In the case of a group of insurers that includes incorporated and individual
unincorporated underwriters that are not listed in accordance with subparagraph
(E) of this paragraph, maintains a trust fund of not less than $100 million as
security to the full amount thereof for all policyholders and creditors in the
United States of each member of the group, and such trust shall likewise comply
with the terms and conditions established in subparagraph (B) of this paragraph
for alien insurers, except that the incorporated members of the group may not
be engaged in any business other than underwriting as a member of the group and
shall be subject to the same level of solvency regulation and control by the
group’s domiciliary regulators as are the unincorporated members.
(D)
In the case of an insurance exchange created by the laws of individual states,
maintains capital and surplus, or the substantial equivalent thereof, of not
less than $75 million in the aggregate. For insurance exchanges that maintain
funds for the protection of all insurance exchange policyholders, each
individual syndicate shall maintain minimum capital and surplus, or the
substantial equivalent thereof, of not less than $5 million. In the event the
insurance exchange does not maintain funds for the protection of all insurance
exchange policyholders, each individual syndicate shall meet the minimum
capital and surplus requirements of subparagraph (A) of this paragraph.
(E)
Is listed on the NAIC Quarterly Listing of Alien Insurers maintained by the
National Association of Insurance Commissioners and meets additional
requirements regarding the use of the list established by rule of the director.
(c)
Unless qualified under paragraph (b)(E) of this subsection, provided to the
director no more than six months after the close of the period reported upon a
certified copy of its current annual statement that is:
(A)
Filed with and approved by the regulatory authority in the domicile of the nonadmitted insurer;
(B)
Certified by an accounting or auditing firm licensed in the jurisdiction of the
insurer’s domicile; or
(C)
In the case of an insurance exchange, an aggregate combined statement of all
underwriting syndicates operating during the period reported.
(2)
When a nonresident surplus lines licensee places surplus lines insurance
outside this state that covers an Oregon home state risk, the licensee or
insurance producer is subject to the requirements of subsection (1) of this
section. [1987 c.774 §120; 1995 c.99 §2; 2001 c.191 §44c; 2005 c.185 §11; 2011
c.660 §10]
735.417 Insured required to report and pay
taxes on independently procured insurance covering Oregon home state risks.
(1) Each insured in this state who obtains independently procured insurance, or
continues or renews independently procured insurance on Oregon home state
risks, other than insurance procured through a surplus lines licensee, shall
file, within 30 days after the date the insurance was procured, continued or
renewed, a written report with the Director of the Department of Consumer and
Business Services showing:
(a)
The name and address of the insurer;
(b)
The subject of the insurance;
(c)
The amount of premium currently charged; and
(d)
Additional pertinent information reasonably requested by the director.
(2)
The insured filing a report under subsection (1) of this section shall pay, at
the time of filing the report, the director an amount equal to the taxes
imposed under ORS 735.470 for the premium reported under subsection (1)(c) of
this section. The filing of the report and payment of the taxes may be made by
a person authorized by the insured to act on the insured’s behalf.
(3)(a)
The director may require that reports filed under subsection (1) of this
section be filed with the Surplus Line Association of Oregon. The director may
require that such filings be made electronically, but may allow an exemption to
this requirement for good cause shown.
(b)
The director may require that amounts to be paid to the director under subsection
(2) of this section be paid to the Surplus Line Association of Oregon. [2011
c.660 §5]
735.418 Director authorized to enter into
interstate compact for premium tax allocation.
For purposes of carrying out the Nonadmitted and
Reinsurance Reform Act of 2010 (P.L. 111-203, Title V, Subtitle B), after
receiving express legislative approval, the Director of the Department of
Consumer and Business Services is authorized to enter into a compact or to
otherwise establish procedures with other states to allocate among the states
the premium taxes paid to an insured’s home state. [2011 c.660 §4]
735.420 Declaration of ineligibility of
surplus lines insurer. (1) The Director of the
Department of Consumer and Business Services may declare a surplus lines insurer
described in ORS 735.415 (1) ineligible if the director has reason to believe
that the surplus lines insurer:
(a)
Is in unsound financial condition;
(b)
Is no longer eligible under ORS 735.415;
(c)
Has willfully violated the laws of this state; or
(d)
Does not make reasonably prompt payment of just losses and claims in this state
or elsewhere.
(2)
The director shall promptly mail notice of all such declarations to each
surplus lines licensee. [1987 c.774 §121; 2001 c.191 §44d]
735.425 Filing by licensee after placement
of surplus lines insurance. (1) Within 90 days after the
placing of any surplus lines insurance in this state on an Oregon home state
risk, each surplus lines licensee shall file with the Director of the
Department of Consumer and Business Services:
(a)
A statement signed by the licensee regarding the insurance, which shall be kept
confidential as provided in ORS 705.137, including the following:
(A)
The name and address of the insured;
(B)
The identity of the insurer or insurers;
(C)
A description of the subject and location of the risk;
(D)
The amount of premium charged for the insurance; and
(E)
Such other pertinent information as the director may reasonably require.
(b)
A statement on a standardized form furnished by the director, as to the
diligent efforts by the producing insurance producer to place the coverage with
admitted insurers and the results thereof. The statement shall be signed by the
producing insurance producer and shall affirm that the insured was expressly advised
prior to placement of the insurance that:
(A)
The surplus lines insurer with whom the insurance was to be placed is not
licensed in this state and is not subject to its supervision; and
(B)
In the event of the insolvency of the surplus lines insurer, losses will not be
paid by the state insurance guaranty fund.
(2)
A surplus lines licensee placing nonadmitted
insurance in this state for an exempt commercial purchaser satisfies the
requirements of subsection (1)(b) of this section if the surplus lines licensee
provides proof of compliance with ORS 735.410 (2).
(3)
The director may direct that filings required under subsection (1) of this
section be made to the Surplus Line Association of Oregon. The director may
also require that such filings be made electronically but may exempt a licensee
from the requirement for good cause shown.
(4)
A nonresident surplus lines licensee who places a surplus lines policy on an
Oregon home state risk shall satisfy the requirements in ORS 735.410 and the
filing requirements in subsections (1) and (2) of this section.
(5)
Facsimile signatures and electronic signatures subject to ORS 84.001 to 84.061
are acceptable and have the same force as original signatures. [1987 c.774 §122;
1993 c.182 §1; 2001 c.377 §§13,13a; 2003 c.364 §39; 2005 c.185 §12; 2011 c.660 §11]
735.430 Surplus Line Association of
Oregon; fees. (1) The Surplus Line Association of
Oregon shall be the advisory organization of surplus lines licensees to:
(a)
Facilitate and encourage compliance by resident and nonresident surplus lines
licensees with the laws of this state and the rules of the Director of the
Department of Consumer and Business Services relative to surplus lines
insurance;
(b)
Provide means for the examination, which shall remain confidential as provided
in ORS 705.137, of all surplus lines coverage written by resident and
nonresident surplus lines licensees to determine whether the coverages comply with the Oregon Surplus Lines Law;
(c)
Communicate with organizations of admitted insurers with respect to the proper
use of the surplus lines market;
(d)
Receive and disseminate to resident and nonresident surplus lines licensees
information relative to surplus lines coverages; and
(e)
At the request of the director, receive and collect on behalf of the state and
remit to the state premium receipts taxes for surplus lines insurance pursuant
to ORS 735.417 or 735.470.
(2)
The Surplus Line Association of Oregon shall file with the director:
(a)
A copy of its constitution, articles of agreement or association or certificate
of incorporation;
(b)
A copy of its bylaws and rules governing its activities;
(c)
A current list of members;
(d)
The name and address of a resident of this state upon whom notices or orders of
the director or processes issued at the direction of the director may be
served;
(e)
An agreement that the director may examine the Surplus Line Association of
Oregon in accordance with the provisions of this section; and
(f)
A schedule of fees and charges.
(3)
The director may make or cause to be made an examination of the Surplus Line
Association of Oregon. The reasonable cost of any such examination shall be
paid by the association upon presentation to it by the director of a detailed
account of each cost. The officers, managers, agents and employees of the
association may be examined at any time, under oath, and shall exhibit all
books, records, accounts, documents or agreements governing its method of
operation. The director shall furnish two copies of the examination report to
the association and shall notify the association that it may, within 20 days
thereof, request a hearing on the report or on any facts or recommendations
therein. If the director finds the association or any member thereof to be in
violation of ORS 735.400 to 735.495, the director may issue an order requiring
the discontinuance of such violation.
(4)(a)
The Surplus Line Association of Oregon may charge resident and nonresident
surplus lines licensees and nonresident producing insurance producers a fee for
reviewing surplus lines policies and for collecting, on behalf of the state,
taxes imposed under ORS 735.470.
(b)
The association may charge insureds a fee for
collecting, on behalf of the state, reports required and taxes imposed under
ORS 735.417.
(c)
The association shall adopt bylaws implementing paragraphs (a) and (b) of this
subsection. [1987 c.774 §123; 2001 c.377 §14; 2005 c.185 §13; 2007 c.71 §235;
2011 c.660 §12]
735.435 Evidence of insurance; contents;
change; penalty; notice regarding Insurance Guaranty Association; rules.
(1) Upon placing surplus lines insurance on an Oregon home state risk, the
surplus lines licensee shall promptly deliver to the insured or the producing
insurance producer the policy, or if such policy is not then available, a
certificate as described in subsection (4) of this section, cover note or
binder. The certificate, as described in subsection (4) of this section, cover
note or binder shall be executed by the surplus lines licensee and shall show
the description and location of the subject of the insurance, coverages including any material limitations other than
those in standard forms, a general description of the coverages
of the insurance, the premium and rate charged and taxes to be collected from
the insured, and the name and address of the insured and surplus lines insurer
or insurers and proportion of the entire risk assumed by each, and the name of
the surplus lines licensee and the licensee’s license number.
(2)
A surplus lines licensee may not issue or deliver any insurance policy or
certificate of insurance or represent that insurance will be or has been
written by any eligible surplus lines insurer, unless the licensee has
authority from the insurer to cause the risk to be insured, or has received
information from the insurer in the regular course of business that such
insurance has been granted.
(3)
If, after delivery of an insurance policy or certificate of insurance, there is
any change in the identity of the insurers, or the proportion of the risk assumed
by any insurer, or any other material change in coverage as stated in the
surplus lines licensee’s original insurance policy, or in any other material as
to the insurance coverage, the surplus lines licensee shall promptly issue and
deliver to the insured or the original producing insurance producer an
appropriate substitute for, or indorsement of the
original document, accurately showing the current status of the coverage and
the insurers responsible thereunder.
(4)
As soon as reasonably possible after the placement of any such insurance the
surplus lines licensee shall deliver a copy of the policy or, if not available,
a certificate of insurance to the insured or producing insurance producer to
replace an insurance policy or certificate of insurance theretofore issued.
Each certificate or policy of insurance shall contain or have attached thereto
a complete record of all policy insuring agreements, conditions, exclusions,
clauses, indorsements or any other material facts
that would regularly be included in the policy.
(5)
Any surplus lines licensee who fails to comply with the requirements of this
section shall be subject to the penalties provided in ORS 731.988.
(6)
Each insurance policy or certificate of insurance negotiated, placed or
procured under the provisions of ORS 735.400 to 735.495 by the surplus lines
licensee shall bear the name of the licensee and the following legend in bold
type: “This insurance was procured and developed under the Oregon surplus lines
laws. It is NOT covered by the provisions of ORS 734.510 to 734.710 relating to
the Oregon Insurance Guaranty Association. If the insurer issuing this
insurance becomes insolvent, the Oregon Insurance Guaranty Association has no
obligation to pay claims under this insurance.”
(7)
The Director of the Department of Consumer and Business Services by rule may
establish requirements relating to insurance policies and certificates of
insurance and other applicable requirements governing placement of insurance by
a nonresident surplus lines licensee outside this state that covers an Oregon
home state risk. [1987 c.774 §124; 2001 c.191 §45a; 2003 c.364 §40; 2011 c.660 §13]
735.440 Validity of contracts.
Insurance contracts procured under ORS 735.400 to 735.495 shall be valid and
enforceable as to all parties. [1987 c.774 §125]
735.445 Effect of payment of premium to
surplus lines licensee. A payment of premium to a
surplus lines licensee acting for a person other than the surplus lines
licensee in negotiating, continuing or renewing any policy of insurance under
ORS 735.400 to 735.495 shall be deemed to be payment to the insurer, whatever
conditions or stipulations may be inserted in the policy or contract
notwithstanding. [1987 c.774 §126]
735.450 Requirements for license as
surplus lines insurance licensee. A person may
not procure any contract of surplus lines insurance with any nonadmitted insurer for an Oregon home state risk unless
the person is licensed under ORS chapter 744 to transact surplus lines
insurance. A person may obtain a license to transact surplus lines insurance
only if the person is licensed as an insurance producer under ORS chapter 744
to transact property and casualty insurance. [1987 c.774 §127; 1989 c.288 §1;
1991 c.810 §26; 1995 c.639 §14; 2001 c.191 §46; 2003 c.364 §41; 2011 c.660 §14]
735.455 Authority of licensee; rules.
(1) A surplus lines licensee may originate surplus lines insurance on an Oregon
home state risk or accept such insurance from any other insurance producer duly
licensed as to the kinds of insurance involved on an Oregon home state risk,
and the surplus lines licensee may compensate the insurance producer therefor.
(2)
A surplus lines licensee may charge a producing insurance producer a fee or a
combination of a fee and a commission when transacting surplus lines for the
producing insurance producer if the surplus lines licensee has a written
agreement with the producing insurance producer prior to the binding or
issuance of a surplus lines insurance policy. When a surplus lines licensee
transacts surplus lines insurance directly for a prospective insured, the
surplus lines licensee may charge the prospective insured a fee or a
combination of a fee and a commission if the surplus lines licensee has a
written agreement with the prospective insured prior to the binding or issuance
of a surplus lines insurance policy.
(3)
A producing insurance producer may charge a fee to a prospective insured when
the producing insurance producer pays a fee or a combination of a fee and a
commission to a surplus lines licensee under subsection (2) of this section if
the producing insurance producer has a written agreement with the prospective
insured prior to the binding or issuance of the surplus lines insurance policy.
The fee may not exceed the amount of compensation paid by the producing
insurance producer to the surplus lines licensee.
(4)
For the purpose of determining the charge under subsection (2) of this section,
the producing insurance producer and the surplus lines licensee may agree to
any allocation of the fee that the producing insurance producer charges the
prospective insured under this section.
(5)
The fee or the fee and commission charged by a surplus lines licensee under
subsection (2) of this section must be commensurate with the services provided
by the surplus lines licensee. The Director of the Department of Consumer and
Business Services may establish by rule minimum conditions for written
agreements entered into under this section. An insurer or insurance producer
who enters into a written agreement as provided in this section is not in
violation of ORS 746.035 or 746.045. [1987 c.774 §128; 2003 c.364 §42; 2011
c.660 §15]
735.460 Records of licensee; examination.
(1) Each surplus lines licensee shall keep a full and true record of each
surplus lines insurance contract placed on an Oregon home state risk by or
through the licensee as required by ORS 744.068, including a copy of the
policy, certificate, cover note or other evidence of insurance showing any of
the following items that are applicable:
(a)
Amount of the insurance and perils insured;
(b)
Brief description of the property insured and its location;
(c)
Gross premium charged;
(d)
Any return premium paid;
(e)
Rate of premium charged upon the several items of property;
(f)
Effective date of the contract and the terms thereof;
(g)
Name and address of the insured;
(h)
Name and address of the insurer;
(i) Amount of tax and other sums to be collected from the
insured; and
(j)
Identity of the producing insurance producer, any confirming correspondence
from the insurer or its representative and the application.
(2)
The record of each contract shall be kept open at all reasonable times to
examination by the Director of the Department of Consumer and Business Services
without notice for a period not less than five years following termination of
the contract. [1987 c.774 §129; 2001 c.191 §47; 2003 c.364 §43; 2011 c.660 §16]
735.465 Monthly reports; rules.
(1) On or before the end of each month, each surplus lines licensee shall file
with the Director of the Department of Consumer and Business Services, as
prescribed by the director, a verified report of all surplus lines insurance
transacted on Oregon home state risks during the preceding 90 days. The report
need not show transacted surplus lines insurance that was reported in an
earlier report. The report shall show:
(a)
Aggregate gross premiums written;
(b)
Aggregate return premiums; and
(c)
Amount of aggregate tax.
(2)
The director may direct that reports required under subsection (1) of this
section be made to the Surplus Line Association of Oregon and that the Surplus
Line Association of Oregon file a combined report thereof with the director.
The director may also require that reports required under subsection (1) of
this section be made electronically but may exempt a licensee from the
requirement for good cause shown.
(3)
For the purpose of collecting taxes on insurance covering Oregon home state
risks when the insurance is placed outside this state, the director may
establish by rule requirements for filing reports on surplus lines insurance
transacted outside this state on Oregon home state risks. [1987 c.774 §130;
2001 c.191 §48; 2007 c.71 §236; 2011 c.660 §17]
735.470 Premium tax; collection; payment;
refund; rules. (1)(a) The surplus lines licensee shall
pay the Director of the Department of Consumer and Business Services a surplus
lines premium tax equal to two percent of the gross amount of premiums received
on Oregon home state risks as shown in the report required by ORS 735.465.
(b)
Notwithstanding ORS 731.820, the surplus lines licensee shall also pay to the
director a tax equal to 0.3 percent of the premium or fees charged by the
insurer or the insurer’s insurance producer and other intermediaries for the
insurance, for the purpose of maintaining the office of the State Fire Marshal
and paying the expenses incident thereto.
(c)
The taxes shall be collected by the surplus lines licensee as specified by the
director, in addition to the gross amount of premiums charged by the insurer or
the insurer’s insurance producer and other intermediaries for the insurance.
The taxes on any portion of the premium unearned at termination of insurance
having been credited by the state to the licensee shall be returned to the
policyholder directly by the surplus lines licensee or through the producing
insurance producer, if any. The surplus lines licensee is prohibited from
absorbing the taxes, and from rebating for any reason, any part of the taxes.
(2)
The surplus lines taxes are due quarterly on the 45th day following the
calendar quarter in which the premium is collected. The taxes shall be paid to
and reported on forms prescribed by the director or upon the director’s order
paid to and reported on forms prescribed by the Surplus Line Association of
Oregon.
(3)
Notwithstanding subsection (2) of this section, if a surplus lines license is
terminated or nonrenewed for any reason, the taxes
described in this section are due on the 30th day after the termination or
nonrenewal.
(4)
For the purposes of carrying out the Nonadmitted and
Reinsurance Reform Act of 2010 (P.L. 111-203, Title V, Subtitle B), the
director may collect taxes on 100 percent of the gross amount of premiums on
Oregon home state risks. If the director enters into a compact or otherwise
establishes procedures with other states pursuant to ORS 735.418, the director
by rule shall establish procedures to facilitate the reporting, collection,
payment, allocation and disbursement of premium taxes on Oregon home state
risks that also include risks allocable to other states.
(5)
As used in this section, “gross amount of premiums” has the meaning given that
term in ORS 731.808. [1987 c.774 §131; 1989 c.288 §2; 1995 c.786 §10; 2001
c.191 §48a; 2003 c.364 §44; 2007 c.71 §237; 2011 c.660 §8]
735.475 Suit to recover unpaid tax.
If the tax collectible by a surplus lines licensee under ORS 735.400 to 735.495
is not paid within the time prescribed, the same shall be recoverable in a suit
brought by the Director of the Department of Consumer and Business Services
against the surplus lines licensee. [1987 c.774 §132; 1989 c.288 §3; 2001 c.191
§48b]
735.480 Suspension or revocation of
license; refusal to renew; grounds. The Director
of the Department of Consumer and Business Services may suspend, revoke or
refuse to renew the license of a surplus lines licensee after notice and
hearing as provided under the applicable provision of this state’s laws upon
any one or more of the following grounds:
(1)
Removal of the surplus lines licensee’s office from this state, if the licensee
is a resident insurance producer;
(2)
Removal of the surplus lines licensee’s office accounts and records from the
principal place of business of the licensee under ORS 744.068 during the period
during which such accounts and records are required to be maintained under ORS
735.460;
(3)
Closing of the surplus lines licensee’s office for a period of more than 30
business days, unless permission is granted by the director;
(4)
Failure to make and file required reports;
(5)
Failure to transmit required tax on surplus lines premiums;
(6)
Violation of any provision of ORS 735.400 to 735.495; or
(7)
For any cause for which an insurance license could be denied, revoked,
suspended or renewal refused under ORS 744.074. [1987 c.774 §133; 1989 c.288 §4;
2001 c.191 §49; 2003 c.364 §45]
735.485 Actions against surplus lines
insurer. (1) A surplus lines insurer may be sued
upon any cause of action arising in this state under any surplus lines
insurance contract on an Oregon home state risk made by it or evidence of
insurance issued or delivered by the surplus lines licensee pursuant to the
procedure provided in ORS 735.490. Any surplus lines policy issued by the
surplus lines licensee shall contain a provision stating the substance of this
section and designating the person to whom process shall be delivered.
(2)
Each surplus lines insurer assuming surplus lines insurance shall be considered
thereby to have subjected itself to ORS 735.400 to 735.495.
(3)
The remedies provided in this section are in addition to any other methods
provided by law for service of process upon insurers.
(4)
When a nonresident surplus lines insurance producer transacts outside this
state a surplus lines insurance contract covering an Oregon home state risk,
the producer and the surplus lines insurer of the contract are subject to this
section and to ORS 735.490 or to rules adopted by the director in lieu thereof.
[1987 c.774 §134; 1989 c.288 §5; 2001 c.191 §49a; 2011 c.660 §18]
735.490 Jurisdiction in action against
insurer; service of summons and complaint; response.
(1) An insurer transacting insurance on an Oregon home state risk under the
provisions of ORS 735.400 to 735.495 may be sued upon any cause of action,
arising under any policy of insurance so issued and delivered by it, in the
courts for the county where the insurance producer who registered or delivered
the policy resides or transacts business, by the service of summons and
complaint made upon the insurance producer for the insurer.
(2)
Any insurance producer served with summons and complaint in any such cause
shall forthwith mail the summons and complaint, or a true and complete copy
thereof, by registered or certified mail with proper postage affixed and
properly addressed, to the insurer being sued.
(3)
The insurer shall have 40 days from the date of the service of the summons and
complaint upon the insurance producer in which to plead, answer or defend any
such cause.
(4)
Upon service of summons and complaint upon the insurance producer for the
insurer, the court in which the action is begun shall be deemed to have duly
acquired personal jurisdiction of the defendant insurer so served.
(5)
An insurer and policyholder may agree to waive the provisions of subsections
(1) to (4) of this section governing service and venue with respect to a
surplus lines insurance contract for commercial property and casualty risk if
the waiver is specifically referred to in the contract or in an indorsement attached to the contract. [1987 c.774 §137; 2001
c.191 §49b; 2003 c.364 §46; 2011 c.660 §19]
735.492 Application of certain Insurance
Code provisions to surplus lines insurers. ORS
731.324, 731.328, 731.512 and 731.624 do not apply to surplus lines insurers. [2005
c.185 §17]
735.495 Short title; severability.
(1) ORS 735.400 to 735.495 shall be known and may be cited as “The Oregon
Surplus Lines Law.”
(2)
If any provisions of ORS 735.400 to 735.495, or the application of such
provision to any person or circumstance, is held invalid, the remainder of ORS
735.400 to 735.495 and the application of such provision to persons or
circumstances other than those as to which it is held invalid, shall not be
affected. [1987 c.774 §§116,136]
RETAINER MEDICAL PRACTICE
735.500 Requirements for certification as
retainer medical practice; disclosures; rules.
(1) As used in this section and ORS 735.510:
(a)
“Control” means the possession, directly or indirectly, of the power to direct
or cause the direction of the management and policies of a person, whether through
the ownership of voting stock, by contract or otherwise. A person who is the
owner of 10 percent or more ownership interest in a retainer medical practice
or applicant for a certificate to operate a retainer medical practice is
presumed to have control.
(b)
“Primary care” means outpatient, nonspecialty medical
services or the coordination of health care for the purpose of:
(A)
Promoting or maintaining mental and physical health and wellness; and
(B)
Diagnosis, treatment or management of acute or chronic conditions caused by
disease, injury or illness.
(c)
“Provider” means a health care professional licensed or certified under ORS
chapter 677, 678, 684 or 685 who provides primary care in the ordinary course
of business or practice of a profession.
(d)
“Retainer medical agreement” means a written agreement between a retainer
medical practice and a patient or a legal representative or guardian of a
patient specifying a defined and predetermined set of primary care services to
be provided in consideration for a retainer medical fee.
(e)
“Retainer medical fee” means any fee paid to a retainer medical practice
pursuant to a medical retainer agreement.
(f)
“Retainer medical practice” means a provider, a group of providers or a person
that employs or contracts with a provider or a group of providers to provide
services under the terms of a retainer medical agreement.
(2)
A retainer medical practice must be certified by the Department of Consumer and
Business Services. To qualify to become a certified retainer medical practice
or to renew a certificate, the practice:
(a)
May not have or have ever had a certificate of authority to transact insurance
in this state.
(b)
May not be or have ever been licensed, certified or otherwise authorized in
this state or any other state to act as an insurer, managed care organization,
health care service contractor or similar entity.
(c)
May not be controlled by an entity described in paragraph (a) or (b) of this
subsection.
(3)
A certified retainer medical practice:
(a)
Must provide only primary care and must limit the scope of services provided or
the number of patients served to an amount that is within the capacity of the
practice to provide in a timely manner;
(b)
May not bill an insurer, a self-insured plan or the state medical assistance
program for a service provided by the practice to a patient pursuant to a
retainer medical agreement;
(c)
Must be financially responsible and have the necessary business experience or
expertise to operate the practice;
(d)
Must give the written disclosures described in subsection (4) of this section;
(e)
May not use or disseminate misleading, deceptive or false statements in
marketing, advertising, promotional, sales or informational materials regarding
the practice or in communications with patients or prospective patients;
(f)
May not engage in dishonest, fraudulent or illegal conduct in any business or
profession; and
(g)
May not discriminate based on race, religion, gender, sexual identity, sexual
preference or health status.
(4)
A certified retainer medical practice must make the following written
information available to prospective patients by prominently disclosing, in the
manner prescribed by the department by rule, in marketing materials and
retainer medical agreements:
(a)
That the practice is not insurance;
(b)
That the practice provides only the limited scope of primary care services
specified in the retainer medical agreement;
(c)
That a patient must pay for all services not specified in the retainer medical
agreement; and
(d)
Any other disclosures required by the department by rule.
(5)
The department may by written order deny, suspend or revoke a retainer medical
practice certificate or may refuse to renew a retainer medical practice
certificate if the department finds that:
(a)
The retainer medical practice does not meet the criteria in subsections (2) to
(4) of this section;
(b)
The retainer medical practice has provided false, misleading, incomplete or
inaccurate information in the application for a certificate or renewal of a
certificate;
(c)
The retainer medical practice provides medical services through a provider
whose license to provide the medical services offered on behalf of the retainer
medical practice is revoked;
(d)
The authority of the retainer medical practice to operate a retainer medical
practice or similar practice in another jurisdiction is denied, suspended,
revoked or not renewed;
(e)
The retainer medical practice, a person who has control over the retainer
medical practice or a health care provider providing services on behalf of the
retainer medical practice is charged with a felony or misdemeanor involving
dishonesty; or
(f)
The retainer medical practice fails to comply with subsection (7) of this
section.
(6)
With respect to a certified retainer medical practice or a retainer medical
practice operating without a certificate, the department is authorized to:
(a)
Investigate;
(b)
Subpoena documents and records related to the business of the practice; and
(c)
Take any actions authorized by the Insurance Code that are necessary to
administer and enforce this section.
(7)
A retainer medical practice subject to an investigation under subsection (5) of
this section must:
(a)
Within five business days, respond to inquiries in the form and manner
specified by the department; and
(b)
Reimburse the expenses incurred by the department in conducting the
investigation.
(8)
A retainer medical practice may contest any order made under subsection (5) of
this section in accordance with ORS chapter 183.
(9)
A certificate issued under subsection (2) of this section is effective for one
year or for a longer period as prescribed by the department by rule.
(10)
The department may adopt rules necessary or appropriate to implement the
provisions of this section. [2011 c.499 §2]
Note:
735.500 and 735.510 were added to and made a part of the Insurance Code by
legislative action but were not added to ORS chapter 735 or any series therein.
See Preface to Oregon Revised Statutes for further explanation.
735.510 Notice to department of specified
changes to practice. A certified retainer medical
practice shall:
(1)
Notify the Department of Consumer and Business Services immediately whenever:
(a)
The license of a provider who has provided services on behalf of the practice
is denied, suspended, revoked or not renewed in this state or in any other
jurisdiction; or
(b)
The authority of the practice to operate in another jurisdiction is denied,
suspended, revoked or not renewed.
(2)
Notify the department no later than 30 days after any change to the name,
address or contact information that is provided in the application for
certification under ORS 735.500. [2011 c.499 §3]
Note: See
note under 735.500.
DENTAL SERVICES CONTRACTS
Note:
Sections 2 and 4, chapter 74, Oregon Laws 2010, provide:
Sec. 2. (1) As
used in this section:
(a)
“Dental services contract” means a contract between an insurer and a provider
or a group of providers to provide dental health services for enrollees. “Dental
services contract” does not include a contract of employment or a contract
creating legal entities and ownership thereof that are authorized under ORS
chapter 58, 60 or 70, or other similar professional organizations permitted by
statute.
(b)
“Enrollee” means a person entitled to receive dental health benefits from an
insurer.
(c)
“Provider” means a person licensed or otherwise authorized by the laws of this
state to administer dental health services in the ordinary course of business
or practice of a profession.
(2)
A dental services contract may not restrict the price that a provider may
charge for services provided to an enrollee unless the services are covered by
the insurer. [2010 c.74 §2]
Sec. 4.
Section 2 of this 2010 Act is repealed on January 2, 2015. [2010 c.74 §4]
MEDICAL INSURANCE POOL
(Oregon Medical Insurance Pool)
735.600 Legislative intent.
The intent of the Legislative Assembly in enacting ORS 735.600 to 735.650 is to
provide access to medical insurance coverage to all residents of this state who
are denied adequate medical insurance, while at the same time avoiding undue
financial impact on the state and on private insurers. [1987 c.838 §2]
735.605 Definitions for ORS 735.600 to
735.650. As used in ORS 735.600 to 735.650:
(1)
“Benefits plan” means the coverages to be offered by
the pool to eligible persons pursuant to ORS 735.600 to 735.650.
(2)
“Board” means the Oregon Medical Insurance Pool Board.
(3)
“Insured” means any individual resident of this state who is eligible to
receive benefits from any insurer.
(4)
“Insurer” means:
(a)
Any insurer as defined in ORS 731.106 or fraternal benefit society as defined
in ORS 748.106 required to have a certificate of authority to transact health
insurance business in this state, and any health care service contractor as
defined in ORS 750.005.
(b)
Any reinsurer reinsuring medical insurance in this state.
(c)
To the extent consistent with federal law, any self-insurance arrangement
covered by the Employee Retirement Income Security Act of 1974, as amended,
that provides health care benefits in this state.
(d)
All self-insurance arrangements not covered by the Employee Retirement Income
Security Act of 1974, as amended, that provides health care benefits in this
state.
(5)
“Medical insurance” means insurance of humans against bodily injury,
disablement or death by accident or accidental means, or the expense thereof,
or against disablement or expense resulting from sickness or childbirth, or
against expense incurred in prevention of sickness, in dental care or optometrical service, and every insurance appertaining
thereto, including insurance against the risk of economic loss assumed under a
less than fully insured employee health benefit plan. “Medical insurance” does
not include workers’ compensation coverages.
(6)
“Medicare” means coverage under Part A, Part B and Part D of Title XVIII of the
Social Security Act, 42 U.S.C. 1395c et seq., as amended.
(7)
“Plan of operation” means the plan of operation of the pool, including
articles, bylaws and operating rules, adopted by the board pursuant to ORS
735.600 to 735.650.
(8)
“Pool” means the Oregon Medical Insurance Pool as created by ORS 735.610.
(9)
“Reinsurer” means any insurer as defined in ORS 731.106 from whom any person
providing medical insurance to Oregon insureds
procures insurance for itself in the insurer, with respect to all or part of
the medical insurance risk of the person.
(10)
“Self-insurance arrangement” means any plan, program, contract or any other
arrangement under which one or more employers, unions or other organizations
provide health care services or benefits to their employees or members in this
state, either directly or indirectly through a trust or third party
administrator, unless the health care services or benefits are provided by an
insurance policy issued by an insurer other than a self-insurance arrangement. [1987
c.838 §3; 1989 c.838 §6; 2003 c.33 §4; 2005 c.634 §4; 2009 c.695 §1]
735.610 Oregon Medical Insurance Pool
Board; members; authority; rules. (1) There is
created in the Oregon Health Authority the Oregon Medical Insurance Pool Board.
The board shall establish the Oregon Medical Insurance Pool and otherwise carry
out the responsibilities of the board under ORS 735.600 to 735.650.
(2)
The board shall consist of 10 individuals, eight of whom shall be appointed by
the Director of the Oregon Health Authority. The Director of the Department of
Consumer and Business Services or the director’s designee and the Director of
the Oregon Health Authority or the director’s designee shall be members of the
board. The chair of the board shall be elected from among the members of the
board. The board shall at all times, to the extent possible, include at least
one representative of a domestic insurance company licensed to transact health
insurance, one representative of a domestic not-for-profit health care service
contractor, one representative of a health maintenance organization, one
representative of reinsurers and two members of the general public who are not
associated with the medical profession, a hospital or an insurer. A majority of
the voting members of the board constitutes a quorum for the transaction of
business. An act by a majority of a quorum is an official act of the board.
(3)
The Director of the Oregon Health Authority may fill any vacancy on the board
by appointment.
(4)
The board shall have the general powers and authority under the laws of this
state granted to insurance companies with a certificate of authority to
transact health insurance and the specific authority to:
(a)
Enter into such contracts as are necessary or proper to carry out the
provisions and purposes of ORS 735.600 to 735.650 including the authority to
enter into contracts with similar pools of other states for the joint
performance of common administrative functions, or with persons or other
organizations for the performance of administrative functions;
(b)
Recover any assessments for, on behalf of, or against insurers;
(c)
Take such legal action as is necessary to avoid the payment of improper claims
against the pool or the coverage provided by or through the pool;
(d)
Establish appropriate rates, rate schedules, rate adjustments, expense
allowances, insurance producers’ referral fees, claim reserves or formulas and
perform any other actuarial function appropriate to the operation of the pool.
Rates may not be unreasonable in relation to the coverage provided, the risk
experience and expenses of providing the coverage. Rates and rate schedules may
be adjusted for appropriate risk factors such as age and area variation in
claim costs and shall take into consideration appropriate risk factors in
accordance with established actuarial and underwriting practices;
(e)
Issue policies of insurance in accordance with the requirements of ORS 735.600
to 735.650;
(f)
Appoint from among insurers appropriate actuarial and other committees as
necessary to provide technical assistance in the operation of the pool, policy
and other contract design, and any other function within the authority of the
board;
(g)
Seek advances to effect the purposes of the pool; and
(h)
Establish rules, conditions and procedures for reinsuring risks under ORS
735.600 to 735.650.
(5)
Each member of the board is entitled to compensation and expenses as provided
in ORS 292.495.
(6)
The Director of the Oregon Health Authority shall adopt rules, as provided
under ORS chapter 183, implementing policies recommended by the board for the
purpose of carrying out ORS 735.600 to 735.650.
(7)
In consultation with the board, the Director of the Oregon Health Authority
shall employ such staff and consultants as may be necessary for the purpose of
carrying out responsibilities under ORS 735.600 to 735.650. [1987 c.838 §4;
1989 c.838 §7; 1993 c.744 §190; 1995 c.79 §361; 2001 c.356 §1; 2003 c.364 §95;
2009 c.595 §1118; 2009 c.828 §71; 2011 c.70 §19]
735.612 Oregon Medical Insurance Pool
Account; sources; uses. (1) There is established in the
State Treasury, the Oregon Medical Insurance Pool Account, which shall consist
of:
(a)
Moneys appropriated to the account by the Legislative Assembly to obtain the
coverage described in ORS 735.625.
(b)
Interest earnings from the investment of moneys in the account.
(c)
Assessments and other revenues collected or received by the Oregon Medical
Insurance Pool Board.
(2)
All moneys in the Oregon Medical Insurance Pool Account are continuously
appropriated to the Oregon Medical Insurance Pool Board to carry out the
provisions of ORS 735.600 to 735.650.
(3)
The Oregon Medical Insurance Pool Board shall transfer to the Oregon Health
Authority Fund established in ORS 413.101 an amount equal to the operating
budget authorized by the Legislative Assembly or as that budget may be modified
by the Emergency Board or the Oregon Department of Administrative Services, for
operation of the Oregon Medical Insurance Pool Board. [1989 c.838 §§2,3; 1993
c.744 §191; 2009 c.595 §1119]
735.614 Assessments for expenses of pool
and reinsurance program for children’s coverage.
(1)(a) If the Oregon Medical Insurance Pool Board determines at any time that
funds in the Oregon Medical Insurance Pool Account are or will become
insufficient for payment of expenses of the pool in a timely manner, the board
shall determine the amount of funds needed and shall impose and collect assessments
against insurers for that amount, as provided in this section.
(b)
If the Department of Consumer and Business Services adopts rules establishing a
reinsurance program for children’s coverage, the board shall include the costs
of such program, as determined by the department, in the determination of the
amount of funds needed under paragraph (a) of this subsection.
(2)
Each insurer’s assessment shall be determined by multiplying the total amount
to be assessed by a fraction, the numerator of which equals the number of
Oregon insureds and certificate holders insured or
reinsured by each insurer, and the denominator of which equals the total of all
Oregon insureds and certificate holders insured or
reinsured by all insurers, all determined as of March 31 each year.
(3)
The board shall ensure that each insured and certificate holder is counted only
once with respect to any assessment. For that purpose, the board shall require
each insurer that obtains reinsurance for its insureds
and certificate holders to include in its count of insureds
and certificate holders all insureds and certificate
holders whose coverage is reinsured in whole or part. The board shall allow an
insurer who is a reinsurer to exclude from its number of insureds
those that have been counted by the primary insurer or the primary reinsurer
for the purpose of determining its assessment under this subsection.
(4)
All insurers authorized to transact medical insurance in Oregon and that insure
persons residing in Oregon are subject to the assessment under this section. Insureds under the following types of coverage, as defined
by rule by the board, are excluded in the calculation of the assessment:
(a)
Medicaid;
(b)
State Children’s Health Insurance Program;
(c)
Medicare;
(d)
Disability income insurance;
(e)
Hospital only insurance;
(f)
Dental insurance;
(g)
Vision only insurance;
(h)
Accident only insurance;
(i) Automobile insurance;
(j)
Specific disease insurance;
(k)
Medical supplemental plans;
(L)
TRICARE;
(m)
CHAMPUS;
(n)
Prescription drug only plans;
(o)
Long term care insurance; and
(p)
Federal Employees Health Benefits Program.
(5)
If assessments exceed the amounts actually needed, the excess shall be held and
invested and, with the earnings and interest, used by the board to offset
future net losses or to reduce pool premiums. For purposes of this subsection, “future
net losses” includes reserves for claims incurred but not reported.
(6)
Each insurer’s proportion of participation in the pool shall be determined by
the board based on annual statements and other reports deemed necessary by the
board and filed by the insurer with the board. The board may use any reasonable
method of estimating the number of insureds and
certificate holders of an insurer if the specific number is unknown. With
respect to insurers that are reinsurers, the board may use any reasonable
method of estimating the number of persons insured by each reinsurer.
(7)
The board may abate or defer, in whole or in part, the assessment of an insurer
if, in the opinion of the board, payment of the assessment would endanger the
ability of the insurer to fulfill the insurer’s contractual obligations. In the
event an assessment against an insurer is abated or deferred in whole or in
part, the amount by which the assessment is abated or deferred may be assessed
against the other insurers in a manner consistent with the basis for
assessments set forth in this section. The insurer receiving the abatement or
deferment shall remain liable to the board for the deficiency for four years.
(8)
The board shall abate or defer assessments authorized by this section if a
court orders that assessments cannot be made applicable to reinsurers. However,
if a court orders that assessments cannot be made applicable to reinsurers, the
board may continue to assess insurers to the end of the biennium in which the
determination is made.
(9)
Subject to the approval of the Director of the Oregon Health Authority, the
board may develop a program for adjusting the assessment of an insurer in the
individual health benefits market based on that insurer’s contribution to
reducing the enrollment in the Oregon Medical Insurance Pool. When developing
the program, the board may consider, but is not limited to, the following
factors:
(a)
The insurer’s level of participation;
(b)
Level of health benefit plan coverage offered; and
(c)
Assumption of risk in the individual health benefits market. [1989 c.838 §4;
1991 c.333 §1; 1995 c.603 §28; 2005 c.304 §1; 2005 c.635 §1; 2009 c.595 §1120;
2009 c.695 §3; 2011 c.131 §1]
735.615 Eligibility for pool coverage;
rules. (1) Except as provided in subsection
(3) of this section, a person who is a resident of this state, as defined by
the Oregon Medical Insurance Pool Board, is eligible for medical pool coverage
if:
(a)
An insurer, or an insurance company with a certificate of authority in any
other state, has made within a time frame established by the board an adverse
underwriting decision, as defined in ORS 746.600 (1)(a)(A), (B) or (D), on
individual medical insurance for health reasons while the person was a
resident;
(b)
The person has a history of any medical or health conditions on the list
adopted by the board under subsection (2) of this section;
(c)
The person is a spouse or dependent of a person described in paragraph (a) or
(b) of this subsection; or
(d)
The person is eligible for the credit for health insurance costs under section
35 of the federal Internal Revenue Code, as amended and in effect on December
31, 2004.
(2)
The board may adopt a list of medical or health conditions for which a person
is eligible for pool coverage without applying for individual medical insurance
pursuant to this section.
(3)
A person is not eligible for coverage under ORS 735.600 to 735.650 if:
(a)
Except as provided in ORS 735.625 (3) and subsection (5) of this section, the
person is eligible for Medicare;
(b)
The person is eligible to receive health services as defined in ORS 414.025
that meet or exceed those adopted by the board;
(c)
The person has terminated coverage in the pool within the last 12 months and
the termination was for:
(A)
A reason other than becoming eligible to receive health services as defined in
ORS 414.025; or
(B)
A reason that does not meet exception criteria established by the board;
(d)
The person has exceeded the maximum lifetime benefit established by the board;
(e)
The person is an inmate of or a patient in a public institution named in ORS
179.321;
(f)
The person has, on the date of issue of coverage by the board, coverage under
health insurance or a self-insurance arrangement that is substantially
equivalent to coverage under ORS 735.625; or
(g)
The person has the premiums paid or reimbursed by a public entity or a health
care provider, reducing the financial loss or obligation of the payer.
(4)
A person applying for coverage shall establish initial eligibility by providing
evidence that the board requires.
(5)(a)
Notwithstanding ORS 735.625 (4)(c), if a person:
(A)
Becomes eligible for Medicare after being enrolled in the pool for a period of
time as determined by the board by rule, that person may continue coverage
within the pool as secondary coverage to Medicare.
(B)
Is eligible for Medicare but is not yet eligible to enroll in Medicare Parts B
and D, the individual may receive coverage under the pool until enrolled in
Medicare Parts B and D.
(b)
The board may adopt rules concerning the terms and conditions for the coverage
provided under paragraph (a) of this subsection.
(6)
The board may adopt rules to establish additional eligibility requirements for
a person described in subsection (1)(d) of this section. [1987 c.838 §5; 1989
c.838 §11; 1993 c.130 §1; 1993 c.212 §1; 1999 c.754 §1; 2005 c.305 §§1,3; 2005
c.634 §1; 2005 c.635 §§2,3; 2009 c.695 §4; 2011 c.70 §20; 2011 c.602 §57]
735.616 Portability coverage under pool.
(1) An applicant may qualify for portability health insurance coverage under
the Oregon Medical Insurance Pool if:
(a)
An application for coverage is made not later than the 63rd day after the date of
first eligibility; and
(b)
The individual is an Oregon resident at the time of the application.
(2)
In addition to individuals otherwise qualified under ORS 735.615, the following
individuals qualify for portability health insurance coverage under the Oregon
Medical Insurance Pool:
(a)
An individual who has left coverage that was in effect for a minimum of 180
consecutive days under one or more group health benefit plans, if the
terminated coverage was in a plan issued or established in a state other than
Oregon;
(b)
An eligible individual, as defined in ORS 743.760, who has left coverage under
a group health benefit plan or a portability health benefit plan and whose
carrier cannot offer a portability plan under ORS 743.760 (6) because of:
(A)
A change in residence of the eligible individual within Oregon;
(B)
A change in the geographic area served by the group carrier; or
(C)
The carrier’s withdrawal from the group market in Oregon in accordance with ORS
743.737 and 743.754;
(c)
An individual who has left coverage that was in effect for an uninterrupted
period of 180 days or more under one or more Oregon group health benefit plans
and the terminated coverage was provided by:
(A)
An employee welfare benefit plan that is exempt from state regulation under the
federal Employee Retirement Income Security Act of 1974, as amended;
(B)
A multiple employer welfare arrangement subject to ORS 750.301 to 750.341; or
(C)
A public body of this state in accordance with ORS 731.036; and
(d)
On or after January 1, 1998, an individual who meets the eligibility
requirements of 42 U.S.C. 300gg-41, as amended and in effect on January 1,
1998, and does not otherwise qualify to obtain portability coverage from an
Oregon group carrier in accordance with ORS 743.760.
(3)
Eligibility for coverage pursuant to subsections (1) and (2) of this section is
subject to the following provisions:
(a)
An eligible individual does not include:
(A)
An individual who remains eligible for the individual’s prior group coverage or
would remain eligible for prior group coverage in a plan under the federal
Employee Retirement Income Security Act of 1974, as amended, were it not for
action by the plan sponsor relating to the actual or expected health condition
of the individual;
(B)
An individual who is covered under another health benefit plan at the time that
portability coverage would commence;
(C)
An individual who is eligible to enroll in another health benefit plan offered
by the employer, other than as a late enrollee, at the time that portability
coverage would commence; or
(D)
An individual who is eligible for the federal Medicare program.
(b)
If an eligible individual has left group coverage issued by an insurance
company, a health care service contractor or a health maintenance organization,
the date of first eligibility is the day following the termination date of the
group coverage, including any period of continuation coverage that was elected
by the individual under federal law or under ORS 743.600 or 743.610.
(c)
If an eligible individual has left group coverage issued by an entity other
than an insurance company, a health care service contractor or a health
maintenance organization, the date of first eligibility is the day following
the termination date of the group coverage, including the full extent of
continuation coverage available to the individual under federal law and ORS
743.600 and 743.610.
(d)
If an individual is eligible for coverage pursuant to subsection (2)(b) of this
section, the date of first eligibility is the day following the loss of the
group or portability coverage.
(4)
Coverage under the Oregon Medical Insurance Pool pursuant to subsections (1)
and (2) of this section shall be offered according to the following provisions:
(a)
Coverage is subject to ORS 743.760 (2) and (8);
(b)
Coverage may not be subject to a preexisting conditions provision, exclusion
period, waiting period, residency period or other similar limitation on
coverage; and
(c)
The individual shall be required to pay a premium rate not more than the
applicable portability risk rate determined by the Oregon Medical Insurance
Pool Board pursuant to ORS 735.625. [Formerly 743.763; 1999 c.987 §1; 2001
c.356 §2; 2009 c.695 §5]
735.620 Administration of insurance pool
program. (1) Except as provided in subsection
(4) of this section, the Oregon Medical Insurance Pool Board shall select an
insurer or insurers through a competitive bidding process to administer the
insurance program or components of the insurance program. The board shall evaluate
bids submitted based on criteria established by the board that include but are
not limited to:
(a)
The insurer’s proven ability to handle individual medical insurance.
(b)
The efficiency of the insurer’s claim paying procedures.
(c)
An estimate of total charges for administering the plan.
(d)
The insurer’s ability to administer the pool in a cost-effective manner.
(2)(a)
The administering insurer shall serve for a period of three years subject to
removal for cause.
(b)
At least one year prior to the expiration of each three-year period of service
by an administering insurer, the board shall invite all insurers, including the
current administering insurer, to submit bids to serve as the administering
insurer for the succeeding three-year period. Selection of the administering
insurer for the succeeding period shall be made at least six months prior to
the end of the current three-year period.
(3)
The administering insurer shall be responsible for one or more of the
following:
(a)
Performing eligibility and administrative claims payment functions relating to
the pool.
(b)
Establishing a premium billing procedure for collection of premiums from
insured persons on a periodic basis as determined by the board.
(c)
Performing all necessary functions to assure timely payment of benefits to
covered persons under the pool including:
(A)
Making available information relating to the proper manner of submitting a
claim for benefits and distributing forms upon which submission shall be made.
(B)
Evaluating the eligibility of each claim for payment.
(d)
Submitting regular reports to the board regarding the operation of the pool.
The frequency, content and form of the report shall be as determined by the
board.
(e)
Following the close of each calendar year, determining net written and earned
premiums, the expense of administration and the paid and incurred losses for
the year and reporting this information to the board on a form prescribed by
the board.
(f)
Being paid as provided in the plan of operation for its expenses incurred in
the performance of its services.
(4)
The board may contract with third party administrators or other vendors to
provide services described in subsection (5) of this section that are in
addition to or that replace services provided by the administering insurer.
(5)
A third party administrator or vendor may provide services that include but are
not limited to:
(a)
Any or all of the services provided by an administering insurer.
(b)
Disease case management.
(c)
Direct provider or provider network contracts.
(d)
Pharmacy benefit management. [1987 c.838 §6; 1989 c.838 §12; 2005 c.635 §4]
Note:
Section 1, chapter 803, Oregon Laws 2009, provides:
Sec. 1.
Notwithstanding ORS 735.620, the Oregon Medical Insurance Pool Board is authorized
to extend the three-year period of service for no more than an additional 36
months, on terms mutually agreed upon with an insurer that is administering the
insurance program or components of the insurance program pursuant to ORS
735.620 on July 23, 2009. [2009 c.803 §1; 2011 c.70 §21]
735.625 Coverage; rules.
(1) Except as provided in subsection (3)(c) of this section, the Oregon Medical
Insurance Pool Board shall offer major medical expense coverage to every
eligible person.
(2)
The coverage to be issued by the board, its schedule of benefits, exclusions
and other limitations, shall be established through rules adopted by the board,
taking into consideration the advice and recommendations of the pool members.
In the absence of such rules, the pool shall adopt by rule the minimum benefits
prescribed by section 6 (Alternative 1) of the Model Health Insurance Pooling
Mechanism Act of the National Association of Insurance Commissioners (1984).
(3)(a)
In establishing portability coverage under the pool, the board shall consider
the levels of medical insurance provided in this state and medical economic
factors identified by the board. The board may adopt rules to establish benefit
levels, deductibles, coinsurance factors, exclusions and limitations that the
board determines are equivalent to the portability health benefit plans
established under ORS 743.760.
(b)
In establishing medical insurance coverage under the pool, the board shall
consider the levels of medical insurance provided in this state and medical
economic factors identified by the board. The board may adopt rules to
establish benefit levels, deductibles, coinsurance factors, exclusions and
limitations that the board determines are equivalent to those found in the
commercial group or employer-based medical insurance market.
(c)
The board may provide a separate Medicare supplement policy for individuals
under the age of 65 who are receiving Medicare disability benefits. The board
shall adopt rules to establish benefits, deductibles, coinsurance, exclusions
and limitations, premiums and eligibility requirements for the Medicare
supplement policy.
(d)
In establishing medical insurance coverage for persons eligible for coverage
under ORS 735.615 (1)(d), the board shall consider the levels of medical
insurance provided in this state and medical economic factors identified by the
board. The board may adopt rules to establish benefit levels, deductibles,
coinsurance factors, exclusions and limitations to create benefit plans that
qualify the person for the credit for health insurance costs under section 35
of the federal Internal Revenue Code, as amended and in effect on December 31,
2004.
(4)(a)
Premiums charged for coverages issued by the board
may not be unreasonable in relation to the benefits provided, the risk
experience and the reasonable expenses of providing the coverage.
(b)
Separate schedules of premium rates based on age and geographical location may
apply for individual risks.
(c)
The board shall determine the applicable medical and portability risk rates
either by calculating the average rate charged by insurers offering coverages in the state comparable to the pool coverage or
by using reasonable actuarial techniques. The risk rates shall reflect
anticipated experience and expenses for such coverage. Rates for pool coverage
may not be more than 125 percent of rates established as applicable for
medically eligible individuals or for persons eligible for pool coverage under
ORS 735.615 (1)(d), or 100 percent of rates established as applicable for
portability eligible individuals.
(d)
The board shall annually determine adjusted benefits and premiums. The
adjustments shall be in keeping with the purposes of ORS 735.600 to 735.650,
subject to a limitation of keeping pool losses under one percent of the total
of all medical insurance premiums, subscriber contract charges and 110 percent
of all benefits paid by member self-insurance arrangements. The board may
determine the total number of persons that may be enrolled for coverage at any
time and may permit and prohibit enrollment in order to maintain the number
authorized. Nothing in this paragraph authorizes the board to prohibit
enrollment for any reason other than to control the number of persons in the
pool.
(5)(a)
The board may apply:
(A)
A waiting period of not more than 90 days during which the person has no
available coverage; or
(B)
Except as provided in paragraph (c) of this subsection, a preexisting
conditions provision of not more than six months from the effective date of
coverage under the pool.
(b)
In determining whether a preexisting conditions provision applies to an
eligible enrollee, except as provided in this subsection, the board shall
credit the time the eligible enrollee was covered under a previous health
benefit plan if the previous health benefit plan was continuous to a date not
more than 63 days prior to the effective date of the new coverage under the
Oregon Medical Insurance Pool, exclusive of any applicable waiting period. The
Oregon Medical Insurance Pool Board need not credit the time for previous
coverage to which the insured or dependent is otherwise entitled under this
subsection with respect to benefits and services covered in the pool coverage
that were not covered in the previous coverage.
(c)
The board may adopt rules applying a preexisting conditions provision to a
person who is eligible for coverage under ORS 735.615 (1)(d).
(d)
For purposes of this subsection, a “preexisting conditions provision” means a
provision that excludes coverage for services, charges or expenses incurred
during a specified period not to exceed six months following the insured’s
effective date of coverage, for a condition for which medical advice,
diagnosis, care or treatment was recommended or received during the six-month
period immediately preceding the insured’s effective date of coverage.
(6)(a)
Benefits otherwise payable under pool coverage shall be reduced by all amounts
paid or payable through any other health insurance, or self-insurance
arrangement, and by all hospital and medical expense benefits paid or payable
under any workers’ compensation coverage, automobile medical payment or
liability insurance whether provided on the basis of fault or nonfault, and by any hospital or medical benefits paid or
payable under or provided pursuant to any state or federal law or program
except the Medicaid portion of the medical assistance program offering a level
of health services described in ORS 414.707.
(b)
The board shall have a cause of action against an eligible person for the
recovery of the amount of benefits paid which are not for covered expenses.
Benefits due from the pool may be reduced or refused as a setoff
against any amount recoverable under this paragraph.
(7)
Except as provided in ORS 735.616, no mandated benefit statutes apply to pool
coverage under ORS 735.600 to 735.650.
(8)
Pool coverage may be furnished through a health care service contractor or such
alternative delivery system as will contain costs while maintaining quality of
care. [1987 c.838 §8; 1989 c.838 §13; 1993 c.130 §2; 1995 c.603 §27; 1999 c.987
§2; 2001 c.356 §3; 2003 c.684 §5; 2005 c.634 §2; 2005 c.635 §5a; 2009 c.595 §1120a]
735.630 Exemption from liability.
Neither participation in the pool as members, the establishment of rates, forms
or procedures, nor any other action taken in the performance of the powers and
duties under ORS 735.600 to 735.650 shall be the basis of any legal action,
criminal or civil liability or penalty against the Oregon Medical Insurance
Pool Board, any members, the Director of the Oregon Health Authority or any of
their agents or employees. [1987 c.838 §9; 1989 c.838 §14; 2009 c.595 §1121]
735.635 Exemption from taxation.
The pool established pursuant to ORS 735.600 to 735.650 shall be exempt from
any and all taxes assessed by the State of Oregon. [1987 c.838 §10; 1989 c.838 §15]
735.640 Study; adjustment of operation and
benefits plans. After two years of operation of
the pool, and every two years thereafter, the Oregon Medical Insurance Pool
Board shall conduct a study of the pool and adjust the plan of operation and
benefits plan to reflect the findings of the study. The board may also
recommend amendments to ORS 735.600 to 735.650 and other statutes as necessary
to the Legislative Assembly to address the claims loss experience of the pool. [1987
c.838 §12; 1989 c.838 §16]
735.645 Notice of existence of pool.
Every insurer shall include a notice of the existence of the Oregon Medical
Insurance Pool in any adverse underwriting decision on individual medical insurance
for reasons of the health of the applicant, as described in ORS 735.615 (1)(a).
[1987 c.838 §13; 1989 c.838 §17; 1993 c.130 §3; 2005 c.22 §489; 2005 c.634 §3]
735.650 Application of provisions of Insurance
Code. (1) The following provisions of the Insurance
Code shall apply to the pool to the extent applicable and not inconsistent with
the express provisions of ORS 735.600 to 735.650: ORS 731.004 to 731.022,
731.052 to 731.146, 731.162, 731.216 to 731.328, 742.023, 742.028, 742.046,
742.051, 742.056, 743.024, 743.027, 743.028, 743.041, 743.050, 743.100 to
743.106, 743.402, 743.801, 743.803, 743.804, 743.806, 743.807, 743.808,
743.811, 743.814, 743.817, 743.819, 743.821, 743.823, 743.827, 743.829,
743.834, 743.837, 743.839, 743.845, 743A.084, 743A.090, 746.005 to 746.370,
746.600, 746.605, 746.607, 746.608, 746.610, 746.615, 746.625, 746.635,
746.650, 746.655, 746.660, 746.668, 746.670, 746.675, 746.680 and 746.690.
(2)
For the purposes of this section only, the pool shall be deemed an insurer,
pool coverage shall be deemed individual health insurance and pool coverage
contracts shall be deemed policies. [1987 c.838 §14; 1989 c.701 §72; 1989 c.838
§18; 1999 c.987 §3; 2001 c.356 §4; 2003 c.87 §20]
(Temporary High Risk Pool Program)
Note:
Sections 1, 2 and 5, chapter 47, Oregon Laws 2010, provide:
Sec. 1. (1)
The Temporary High Risk Pool Program Fund is established in the State Treasury,
separate and distinct from the General Fund, consisting of:
(a)
Moneys appropriated to the Temporary High Risk Pool Program Fund by the
Legislative Assembly;
(b)
Premiums paid to the Oregon Medical Insurance Pool Board by enrollees in the
Temporary High Risk Pool Program established in section 2 of this 2010 Act; and
(c)
Federal moneys provided to administer the Temporary High Risk Pool Program and
pay health insurance premiums for enrollees in the program.
(2)
All moneys in the Temporary High Risk Pool Program Fund are continuously
appropriated to the Oregon Medical Insurance Pool Board for the purpose of
carrying out section 2 of this 2010 Act. [2010 c.47 §1]
Sec. 2. (1)
The Temporary High Risk Pool Program is established to ensure health insurance
coverage for individuals who are uninsured and are not enrolled in the Oregon
Medical Insurance Pool or other publicly funded medical assistance.
(2)
The program shall be administered by the Oregon Medical Insurance Pool Board
created by ORS 735.610. The board shall adopt rules for the program that are
designed to obtain the maximum level of federal funding. The rules shall
establish:
(a)
Eligibility criteria for enrollment in the program;
(b)
Health care benefits available through the program;
(c)
The cost of premiums for participation in the program; and
(d)
Other enrollment or benefit coverage conditions for the program.
(3)
The board may limit enrollment in the program based on the anticipated federal
funding and enrollee premium payments.
(4)
The board has the authority to enter into contracts as necessary or proper to
carry out this section. [2010 c.47 §2; 2011 c.70 §22]
Sec. 5.
Sections 1 to 3 of this 2010 Act are repealed on January 2, 2016. [2010 c.47 §5]
OFFICE OF PRIVATE HEALTH PARTNERSHIPS
735.700 Definitions for ORS 735.700 to
735.710. As used in ORS 735.700 to 735.710,
unless the context requires otherwise:
(1)
“Carrier” means an insurance company or health care service contractor holding
a valid certificate of authority from the Director of the Department of
Consumer and Business Services, or two or more companies or contractors acting
together pursuant to a joint venture, partnership or other joint means of
operation.
(2)
“Family member” means one of the related individuals within a family as defined
in ORS 414.841.
(3)
“Health benefit plan” has the meaning given that term in ORS 414.841. [Formerly
653.705; 2003 c.742 §§1,6; 2005 c.238 §§1,2; 2005 c.262 §§1,2; 2005 c.727 §§1,2;
2005 c.744 §§14,15; 2011 c.70 §23]
Note:
735.700 to 735.710 were enacted into law by the Legislative Assembly but were
not added to or made a part of ORS chapter 735 or any series therein by
legislative action. See Preface to Oregon Revised Statutes for further
explanation.
735.701 Office of Private Health
Partnerships. (1) The Office of Private Health
Partnerships is established in the Oregon Health Authority.
(2)
The office shall carry out the duties described under ORS 414.826, 414.841 to
414.864 and 735.700 to 735.710. [2005 c.744 §2; 2009 c.595 §1123; 2009 c.867 §49]
Note:
735.701 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 735 or any series therein by legislative action.
See Preface to Oregon Revised Statutes for further explanation.
735.702 Duties of office.
To increase access to health insurance and health care, the Office of Private
Health Partnerships shall provide:
(1)
Information about health benefit plans and the premiums charged for those plans
to self-employed individuals and employers in Oregon;
(2)
Direct assistance to health insurance producers and health insurance consumers
regarding health benefit plans; and
(3)
A central source for information about resources for health care and health
insurance. [Formerly 653.715; 2003 c.364 §96; 2003 c.742 §§2,7; 2005 c.744 §§16,17;
2011 c.70 §24]
Note: See
note under 735.700.
735.703 Administrator.
(1) The Office of Private Health Partnerships is under the supervision and
control of an administrator, who is responsible for the performance of the
duties, functions and powers of the office.
(2)
The Governor shall appoint the Administrator of the Office of Private Health
Partnerships, who holds office at the pleasure of the Governor.
(3)
The administrator shall be paid a salary as provided by law or, if not so
provided, as prescribed by the Governor.
(4)
For purposes of administration, subject to the approval of the Governor, the
administrator may organize and reorganize the office as the administrator
considers necessary to properly conduct the work of the office. [2005 c.744 §3]
Note:
735.703 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 735 or any series therein by legislative action.
See Preface to Oregon Revised Statutes for further explanation.
735.704
[Formerly 653.725; repealed by 2005 c.744 §41]
735.705 Appointment of deputy director,
officers and employees. (1) The Administrator of the
Office of Private Health Partnerships shall, by written order filed with the
Secretary of State, appoint a deputy director. The deputy director serves at
the pleasure of the administrator, has authority to act for the administrator
in the absence of the administrator and is subject to the control of the
administrator at all times.
(2)
Subject to any applicable provisions of ORS chapter 240, the administrator
shall appoint all subordinate officers and employees of the Office of Private
Health Partnerships, prescribe their duties and fix their compensation. [2005
c.744 §4]
Note:
735.705 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 735 or any series therein by legislative action.
See Preface to Oregon Revised Statutes for further explanation.
735.706 [2001
c.716 §16; 2005 c.744 §18; 2009 c.595 §1124; repealed by 2009 c.595 §1204]
735.707 Rules.
In accordance with applicable provisions of ORS chapter 183, the Administrator
of the Office of Private Health Partnerships may adopt rules necessary for the
administration of the laws that the Office of Private Health Partnerships is
charged with administering. [2005 c.744 §5]
Note:
735.707 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 735 or any series therein by legislative action.
See Preface to Oregon Revised Statutes for further explanation.
735.708
[Formerly 653.735; repealed by 2005 c.744 §41]
735.709 Appointment of advisory
committees. (1) To aid and advise the Administrator
of the Office of Private Health Partnerships in the performance of the
functions of the Office of Private Health Partnerships, the administrator may
establish advisory committees that the administrator considers necessary. These
committees may be continuing or temporary. The administrator shall determine
the representation, membership, terms and organization of the committees and
shall appoint their members. The administrator is an ex officio member of each
committee.
(2)
Members appointed to the committees shall represent business, labor, employers,
insurance carriers or producers and consumers.
(3)
Members of the committees are not entitled to compensation, but at the discretion
of the administrator may be reimbursed from funds available to the office for
actual and necessary travel and other expenses incurred in the performance of
their official duties in the manner and amount provided in ORS 292.495. [2005
c.744 §10]
Note:
735.709 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 735 or any series therein by legislative action.
See Preface to Oregon Revised Statutes for further explanation.
735.710 Additional duties of office;
rules. (1) In carrying out its duties under
ORS 414.841 to 414.864 and 735.700 to 735.710, the Office of Private Health
Partnerships may:
(a)
Enter into contracts for administration of ORS 414.841 to 414.864 and 735.700
to 735.710, including collection of premiums and paying carriers.
(b)
Retain consultants and employ staff.
(c)
Enter into contracts with carriers or health care providers for health benefit
plans for individuals and employers, including contracts where final payment
may be reduced if usage is below a level fixed in the contract.
(d)
Perform other duties to provide low-cost health benefit plans of types likely
to be purchased by individuals and employers.
(2)
The office shall establish procedures by rule for the publication or release of
aggregate data relating to:
(a)
Applicants for enrollment and persons enrolled in the Family Health Insurance
Assistance Program;
(b)
Health benefit plans for individuals and employers offered by the office; and
(c)
Other programs operated by the office.
(3)
With respect to health benefit plans contracted for or certified by the office
under ORS 414.841 to 414.864 or 735.700 to 735.710, the office:
(a)
Shall contract for or certify health benefit plans best designed to meet the
needs and provide for the welfare of individuals, employees and employers.
(b)
May approve more than one carrier for each type of plan contracted for or
certified, but the number of carriers shall be held to a number consistent with
adequate service to enrollees.
(c)
May approve premium rates for health benefit plans for individuals and
employers and may establish contributions to be paid by employers toward the
premiums incurred on behalf of covered employees.
(d)
Shall, where appropriate for a contracted and offered health benefit plan,
provide options under which an employee may arrange coverage for family members
of the employee.
(e)
May provide an option of additional coverage for employees and family members
at an additional cost or premium.
(f)
Shall, by rule, establish a method for all enrollees to transfer enrollment
from one health benefit plan to another.
(g)
May require coverage of fewer health care services or benefits than is
otherwise required by state law.
(h)
Shall require health benefit plans certified by the office for the Family
Health Insurance Assistance Program or offered in the private health option
under ORS 414.826 to provide a sufficient level of benefits to be eligible for
a subsidy under ORS 414.844.
(4)
The office may employ whatever means are reasonably necessary to carry out the
purposes of ORS 414.841 to 414.864 and 735.700 to 735.710. Such authority
includes but is not limited to authority to seek clarification, amendment,
modification, suspension or termination of any agreement, contract or
certification that in the office’s judgment requires such action. [Formerly
653.745; 2003 c.742 §§3,8; 2005 c.238 §§3,4; 2005 c.262 §§3,4; 2005 c.727 §§3,4;
2005 c.744 §§19,20; 2011 c.70 §25]
Note: See
note under 735.700.
735.711 [2007
c.619 §3; repealed by 2011 c.720 §228]
735.712 Office to encourage health
insurance coverage among small employers. (1)
The Office of Private Health Partnerships shall encourage increased health
insurance coverage among small employers:
(a)
By providing information, benefit comparisons, premium comparisons and
technical assistance on obtaining employee benefits and on incentives
including, but not limited to, information on the pretax health benefit options
allowed under section 125 of the United States Internal Revenue Code; and
(b)
By using other means necessary to market health benefit plan coverage to small
employers.
(2)
The office shall provide information about other resources for accessing health
care and shall assist consumers in accessing those resources. [Formerly
653.747; 2005 c.744 §21]
Note:
735.712 was enacted into law by the Legislative Assembly but was not added to
or made a part of ORS chapter 735 or any series therein by legislative action.
See Preface to Oregon Revised Statutes for further explanation.
735.714 [2003
c.742 §12; 2005 c.744 §22; repealed by 2011 c.70 §26]
735.720
[Formerly 653.800; 2003 c.684 §8; 2005 c.727 §§5,5a; 2005 c.744 §§23d,23e,23g;
2007 c.70 §317; renumbered 414.841 in 2009]
COMMUNITY-BASED HEALTH CARE INITIATIVES
735.721 Definitions for ORS 735.721 to
735.727. As used in ORS 735.721 to 735.727:
(1)
“Community” means the area of geographically contiguous political subdivisions
as determined by the Office for Oregon Health Policy and Research in
collaboration with the board of directors of a community-based health care
initiative.
(2)
“Qualified employee” means an individual who:
(a)
Is employed by a qualified employer;
(b)
Resides or works within a community;
(c)
Does not have health insurance; and
(d)
Does not qualify for publicly funded health care.
(3)
“Qualified employer” means an employer that:
(a)
Employs 1 to 50 employees;
(b)
Pays a median wage to its employees that is equal to or below an amount that is
300 percent of the federal poverty guidelines;
(c)
For 12 months prior to enrollment in a community-based health care improvement
program, or for the duration of the employer’s operation if the employer has
been in operation less than 12 months, has not provided to employees
employer-based health insurance coverage for which the employer contributes at
least 50 percent of the cost of premiums;
(d)
Offers community-based health care services through a community-based health
care improvement program to all qualified employees and their dependents regardless
of health status;
(e)
Agrees to participate in a community-based health care improvement program for
at least 12 months; and
(f)
Agrees to provide information that is deemed necessary by the community-based
health care initiative to determine eligibility, assess dues and pay claims. [2009
c.470 §1]
Note:
735.721 to 735.727 were enacted into law by the Legislative Assembly but were
not added to or made a part of ORS chapter 735 or any series therein by
legislative action. See Preface to Oregon Revised Statutes for further
explanation.
735.722
[Formerly 653.805; 2003 c.128 §1; 2003 c.683 §4; 2003 c.784 §12; 2005 c.238 §6;
2005 c.262 §6; 2005 c.727 §6; 2005 c.744 §24a; 2009 c.595 §1125; renumbered
414.842 in 2009]
735.723 Requirements for approval; rules.
(1) The Administrator of the Office for Oregon Health Policy and Research shall
adopt rules for the approval of one community-based health care initiative per
community that meets the requirements under subsection (2) of this section and
of a community-based health care improvement program that meets the
requirements under subsection (3) of this section. The office may not approve
community-based health care initiatives for more than three communities during
the period beginning with June 23, 2009, and ending June 30, 2013.
(2)
An approved community-based health care initiative shall:
(a)
Be a nonprofit corporation governed by a board of directors that includes, but
is not limited to, representatives of participating health care providers and
qualified employers. At least 80 percent of the board members must be residents
of the community.
(b)
Contract with health care providers that offer health care services in the
community to provide services to enrollees in the program.
(c)
Recruit qualified employers to enroll in the program.
(d)
Establish an operational structure for:
(A)
Assisting employees of qualified employers or their dependents to enroll in
state medical assistance programs if appropriate;
(B)
Enrolling qualified employees and their dependents in the community-based
health care improvement program;
(C)
Billing and collecting dues from qualified employers and qualified employees;
and
(D)
Reimbursing participating health care providers for services to enrollees.
(e)
Establish a set of health care services that are covered in the community-based
health care improvement program, cost-sharing requirements and incentives to
encourage the utilization of primary care, wellness and chronic disease
management services.
(f)
Maintain a liquid reserve account in an amount sufficient to pay all claims
that have been incurred but not yet charged for a period of at least two
months.
(g)
Provide to each qualified employee enrolled in the program a clear and concise
written statement that describes the community-based health care improvement
program and that includes:
(A)
The health care services that are covered;
(B)
Any exclusions or limitations on coverage of health care services, including
any requirements for prior authorization;
(C)
Copayments, coinsurance, deductibles and any other cost-sharing requirements;
(D)
A list of participating health care providers;
(E)
The complaint process described in subsection (3)(b) of this section; and
(F)
The conditions under which the program or coverage through the program may be
terminated.
(h)
Comply with the requirements of ORS 735.725 and 735.727.
(3)
An approved community-based health care improvement program shall:
(a)
Reimburse the cost of the set of health care services established by the initiative
and provided in the community to qualified employers, qualified employees and
their dependents.
(b)
Include an enrollee complaint process that ensures the resolution of complaints
within 45 days. [2009 c.470 §2]
Note: See
note under 735.721.
735.724
[Formerly 653.810; 2003 c.128 §2; 2003 c.683 §1; 2005 c.238 §7; 2005 c.262 §7;
2005 c.727 §7; 2005 c.744 §25; renumbered 414.844 in 2009]
735.725 Enrollment requirements.
(1) A community-based health care initiative may limit enrollment in a community-based
health care improvement program. If enrollment is limited, the initiative must
establish a waiting list.
(2)
Except as provided in this section, an initiative may not restrict or deny
enrollment in the program except for nonpayment of dues, fraud or
misrepresentation.
(3)
As a condition for enrolling a qualified employer and maintaining the employer’s
enrollment in the program, an initiative may require a minimum percentage of
participation by qualified employees of an employer. [2009 c.470 §3]
Note: See
note under 735.721.
735.726
[Formerly 653.815; 2005 c.744 §26; renumbered 414.846 in 2009]
735.727 Annual report to Legislative
Assembly. A community-based health care
initiative approved by the Administrator of the Office for Oregon Health Policy
and Research must report to the Legislative Assembly no later than October 1 of
each year. The report must contain at a minimum the following information:
(1)
The financial status of the community-based health care improvement program,
including the dues, the costs per enrollee per month, the total amount of
claims paid, the total amount of dues collected and the administrative
expenses;
(2)
A description of the set of health care services covered by the program and an
analysis of service utilization;
(3)
The number of qualified employers, qualified employees and dependents enrolled;
(4)
The number and scope of practice of participating health care providers;
(5)
Recommendations for improving the program and establishing programs in other
geographical regions of the state; and
(6)
Any other information requested by the administrator or the Legislative
Assembly. [2009 c.470 §4]
Note: See
note under 735.721.
735.728
[Formerly 653.820; 2005 c.744 §27; renumbered 414.848 in 2009]
735.730 [Formerly
653.825; 2005 c.744 §28; renumbered 414.851 in 2009]
735.731 [2003
c.683 §3; 2003 c.735 §12; 2005 c.744 §29; renumbered 414.852 in 2009]
735.732
[Formerly 653.830; 2005 c.744 §30; renumbered 414.854 in 2009]
735.733 [2003
c.684 §11; 2005 c.744 §31; renumbered 414.856 in 2009]
735.734
[Formerly 653.835; 2005 c.744 §32; 2009 c.595 §1126; renumbered 414.858 in
2009]
735.736
[Formerly 653.840; 2005 c.744 §33; renumbered 414.861 in 2009]
735.738
[Formerly 653.845; 2005 c.238 §8; 2005 c.727 §8; renumbered 414.862 in 2009]
735.740
[Formerly 653.850; 2003 c.684 §9; 2005 c.744 §34; 2007 c.71 §238; renumbered
414.864 in 2009]
735.750 [2003
c.684 §1; 2005 c.744 §35; renumbered 414.866 in 2009]
735.752 [2003
c.684 §2; renumbered 414.868 in 2009]
735.754 [2003
c.684 §3; 2005 c.744 §36; 2009 c.595 §1127; renumbered 414.870 in 2009]
735.756 [2003
c.684 §4; 2009 c.595 §1128; renumbered 414.872 in 2009]
735.990 [1987
c.774 §135; repealed by 1991 c.810 §29]
_______________