Required provisions in group health insurance policies
A group health insurance policy shall contain in substance the following provisions:
(1) A provision that, in the absence of fraud, all statements made by applicants, the policyholder or an insured person shall be deemed representations and not warranties, and that no statement made for the purpose of effecting insurance shall avoid the insurance or reduce benefits unless contained in a written instrument signed by the policyholder or the insured person, a copy of which has been furnished to the policyholder or to the person or the beneficiary of the person.
(2) A provision that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group a statement in summary form of the essential features of the insurance coverage of the employee or member, to whom the insurance benefits are payable, and the applicable rights and conditions set forth in ORS 743B.340 (When group health insurance policies to continue in effect upon payment of premium by insured individual), 743B.341 (Continuation of benefits after termination of group health insurance policy) and 743B.343 (Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older) to 743B.347 (Continuation of coverage under group policy upon termination of membership in group health insurance policy). If dependents are included in the coverage, only one statement need be issued for each family unit.
(3) A provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy. [Formerly 743.528]
Note: 743.406 (Required provisions in group health insurance policies) was made a part of ORS chapter 743 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.
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