ORS 743.652
Definitions for ORS 743.650 to 743.665


As used in ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements), unless the context requires otherwise:

(1)

“Applicant” means:

(a)

In the case of an individual long term care insurance policy, the person who seeks to contract for benefits; and

(b)

In the case of a group long term care insurance policy, the proposed certificate holder.

(2)

“Benefit trigger” means a contractual provision in a long term care insurance policy that conditions the payment of benefits on an insured’s inability to perform activities of daily living or on an insured’s cognitive impairment. For qualified long term care insurance, the “benefit trigger” is the determination that an insured is a chronically ill individual, as defined in section 7702B(c) of the Internal Revenue Code.

(3)

“Certificate” means any certificate issued under a group long term care insurance policy, if the policy has been delivered or issued for delivery in this state.

(4)

“Group long term care insurance” means a long term care insurance policy that is delivered or issued for delivery in this state and issued to:

(a)

One or more employers or labor organizations, or to a trust or to the trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations;

(b)

Any professional, trade or occupational association for its members or former or retired members, or combination thereof, if such association:

(A)

Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and

(B)

Has been maintained in good faith for purposes other than obtaining insurance;

(c)

Intentionally left blank —Ed.

(A)

An association or a trust or the trustee of a fund established, created or maintained for the benefit of members of one or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations shall file evidence with the director that the association or associations have been organized and maintained in good faith for purposes other than that of obtaining insurance; have been in active existence for at least one year; and have a constitution and bylaws that provide that:
(i)
The association or associations hold regular meetings not less than annually to further purposes of the members;
(ii)
Except for credit unions, the association or associations collect dues or solicit contributions from members; and
(iii)
The members have voting privileges and representation on the governing board and committees; and

(B)

Sixty days after the filing, the association or associations shall be considered to satisfy the organizational requirements, unless the director makes a finding that the association or associations do not satisfy those organizational requirements; or

(d)

A group other than as described in paragraphs (a), (b) and (c) of this subsection, subject to a finding by the director that:

(A)

The issuance of the group policy is not contrary to the best interest of the public;

(B)

The issuance of the group policy would result in economies of acquisition or administration; and

(C)

The benefits are reasonable in relation to the premiums charged.

(5)

“Long term care insurance” means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than 24 consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis; for one or more necessary or medically necessary services, including but not limited to nursing, diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care services, provided in a setting other than an acute care unit of a hospital. “Long term care insurance” includes group and individual annuities and life insurance policies or riders that provide directly or supplement long term care insurance. “Long term care insurance” also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity, and qualified long term care insurance contracts. Long term care insurance may be issued by insurers; fraternal benefit societies; nonprofit health, hospital and medical service corporations; prepaid health plans; or health maintenance organizations, health care service contractors or any similar organization to the extent they are otherwise authorized to issue life or health insurance. “Long term care insurance” does not include any insurance policy that is offered primarily to provide basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income or related asset protection coverage, catastrophic coverage, accident only coverage, specified disease or specified accident coverage or limited benefit coverage. With regard to life insurance, “long term care insurance” does not include life insurance policies that accelerate the death benefit specifically for one or more of the qualifying events of terminal illness, medical conditions requiring extraordinary medical intervention or permanent institutional confinement, and that provide the option of a lump-sum payment for those benefits and when neither the benefits nor the eligibility for the benefits is conditioned upon the receipt of long term care. Notwithstanding any other provision of ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements), any product advertised, marketed or offered as long term care insurance is subject to ORS 743.650 (Long Term Care Insurance Act) to 743.665 (Prompt pay requirements).

(6)

“Policy” means any policy, contract, subscriber agreement, rider or indorsement delivered or issued for delivery in this state by an insurer; fraternal benefit society; nonprofit health, hospital or medical service corporation; prepaid health plan; or health maintenance organization, health care service contractor or any similar organization.

(7)

“Qualified long term care insurance” means:

(a)

The portion of a life insurance contract that provides long term care insurance coverage by rider or as part of the contract and that satisfies the requirements of section 7702B(b) and (e) of the Internal Revenue Code; or

(b)

Individual or group long term care insurance as defined in this section that meets all of the following requirements of section 7702B(b) of the Internal Revenue Code:

(A)

The only insurance protection provided under the contract is coverage of qualified long term care services. A contract shall not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate.

(B)

The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act, or would be reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subparagraph do not apply to expenses that are reimbursable under Title XVIII of the Social Security Act only as a secondary payer. A contract does not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate.

(C)

The contract is guaranteed renewable within the meaning of section 7702B(b)(1)(C) of the Internal Revenue Code.

(D)

The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subparagraph (E) of this paragraph.

(E)

All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract.

(F)

The contract meets the consumer protection provisions set forth in section 7702B(g) of the Internal Revenue Code. [1989 c.1022 §4; 1993 c.744 §30; 1995 c.79 §364; 2007 c.486 §2; 2011 c.69 §3; 2016 c.11 §3]

Source: Section 743.652 — Definitions for ORS 743.650 to 743.665, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743.­html.

743.004
Submission of information by carriers offering health benefit plans
743.005
Protection of health information report
743.007
Data reporting
743.008
Reporting requirements
743.010
Health insurance policy and health benefit plan forms
743.015
Filing and approval of credit life and credit health insurance forms
743.018
Filing of rates for life and health insurance
743.019
Procedure for review of proposed rates for health benefit plans
743.020
Rate filing to include statement of administrative expenses
743.022
Premium rates for individual health benefit plans
743.023
Electronic administration
743.025
Rate filing to include prescription drug cost information
743.028
Uniform health insurance claim forms
743.029
Uniform standards for health care financial and administrative transactions
743.031
Stakeholder work group to recommend uniform standards
743.034
Coordination with Oregon Health Authority concerning uniform standards
743.035
Uniform prior authorization form for prescription drug benefits
743.038
Consent of individual required for life and health insurance
743.039
Alteration of application for life or health insurance
743.040
Personal insurance, insurable interest and beneficiaries
743.041
Payment discharges insurer
743.043
Assignment of policies
743.044
Life insurance for benefit of charity
743.046
Exemption of proceeds of individual life insurance other than annuities
743.047
Exemption of proceeds of group life insurance
743.049
Exemption of proceeds of annuity policies
743.050
Exemption of proceeds of health insurance
743.053
Prohibition on requirement that death or dismemberment occur in less than 180 days after accident
743.100
Short title
743.101
Purpose
743.103
Definitions for ORS 743.100 to 743.109
743.104
Scope of ORS 743.100 to 743.109
743.106
Reading ease standards for life and health insurance policies
743.107
When director may authorize lower standards
743.109
Approval of certain policy forms containing specified provisions
743.150
Scope of ORS 743.150, 743.153 and 743.156
743.153
Statement of benefits
743.154
Acceleration of death benefits
743.156
Statement of premium
743.159
Scope of ORS 743.162 to 743.243
743.162
Payment of premium
743.165
Grace period
743.168
Incontestability
743.171
Incontestability and limitation of liability after reinstatement
743.174
Entire contract
743.177
Statements of insured
743.180
Misstatement of age
743.183
Dividends
743.186
Policy loan
743.187
Maximum interest rate on policy loan
743.189
Reinstatement
743.192
Payment of claim
743.195
Installment payments
743.198
Title
743.201
Beneficiary of industrial policies
743.204
Standard Nonforfeiture Law for Life Insurance
743.207
Required provisions relating to nonforfeiture
743.210
Determination of cash surrender values
743.213
Determination of paid-up nonforfeiture benefits
743.215
Calculation of adjusted premiums
743.216
Adjusted premiums
743.218
Requirements for determination of future premium amounts or minimum values
743.219
Supplemental rules for calculating nonforfeiture benefits
743.221
Cash surrender values upon default in premium payment
743.222
Policy benefits and premiums that shall be disregarded in calculating cash surrender values and paid-up nonforfeiture benefits
743.225
Prohibited provisions
743.228
Acts of corporate insured or beneficiary with respect to policy
743.230
Variable life policy provisions
743.231
“Profit-sharing policy” defined
743.234
“Charter policy” or “founders policy” defined
743.237
“Coupon policy” defined
743.240
Profit-sharing, charter or founders policies prohibited
743.243
Restrictions on form of coupon policy
743.245
Variable life insurance policy provisions
743.247
Notice to variable life insurance policyholders
743.252
Scope of ORS 743.255 to 743.273
743.255
Grace period for annuities
743.258
Incontestability
743.261
Entire contract
743.264
Misstatement of age or sex
743.267
Dividends
743.268
Advancement of policy loans
743.269
Periodic payments for period certain
743.270
Reinstatement
743.271
Periodic stipulated payments on variable annuities
743.272
Computing benefits
743.273
Standard provisions of reversionary annuities
743.275
Standard Nonforfeiture Law for Individual Deferred Annuities
743.278
Required provisions in annuity policies
743.284
Computation of benefits
743.287
Commencement of annuity payments at optional maturity dates
743.290
Notice of nonpayment of certain benefits to be included in annuity policy
743.293
Minimum forfeiture amounts for annuity policies
743.295
Effect of certain life insurance and disability benefits on minimum nonforfeiture amounts
743.298
Penalties, fees or charges
743.303
Requirements for issuance of group life insurance policies
743.306
Required provisions in group life insurance policies
743.309
Nonforfeiture provisions
743.312
Grace period
743.315
Incontestability
743.318
Application
743.321
Evidence of insurability
743.324
Misstatement of age
743.327
Payments under policy
743.330
Issuance of certificates
743.333
Termination of individual coverage
743.336
Termination of policy or class of insured persons
743.339
Death during period for conversion to individual policy
743.342
Statement furnished to insured under credit life insurance policy
743.345
Assignability of group life policies
743.348
Certain sales practices prohibited
743.351
Eligibility of association to be group life policyholder
743.354
Requirements for certain group life policies issued to trustees of certain funds
743.356
Continuing coverage upon replacement of group life policy
743.358
Borrowing by certificate holders under group life policy
743.360
Alternative group life insurance coverage
743.371
Definitions for credit life and credit health insurance provisions
743.372
Applicability of credit life and credit health insurance provisions
743.373
Forms of credit life and credit health insurance
743.374
Limits on amount of credit life insurance
743.375
Limit on amount of credit health insurance
743.376
Duration of credit life and credit health insurance
743.377
Credit life and credit health insurance policy or group certificate
743.378
Charges and refunds to debtor
743.379
Status of remuneration to creditor
743.380
Claim report and payment
743.402
Exceptions to individual health insurance policy requirements
743.405
General requirements for health insurance policies
743.406
Required provisions in group health insurance policies
743.408
Mandatory provisions
743.411
Entire contract
743.414
Time limit on certain defenses
743.416
Due date for first premium payment
743.417
Grace period for subsequent premium payments
743.420
Reinstatement
743.423
Notice of claim
743.426
Claim forms
743.429
Proofs of loss
743.432
Time of payment of claims
743.435
Payment of claims
743.438
Physical examinations and autopsy
743.441
Legal actions
743.444
Change of beneficiary
743.447
Optional provisions
743.450
Change of occupation
743.453
Misstatement of age
743.456
Other insurance in same insurer
743.459
Insurance with other insurers
743.462
Insurance with other insurers
743.465
Relation of earnings to insurance
743.468
Unpaid premium
743.471
Cancellation
743.472
Permissible reasons for cancellation or refusal to renew
743.474
Conformity with state statutes
743.477
Illegal occupation
743.483
Arrangement of provisions
743.486
Scope of term “insured” in statutory policy provisions
743.489
Extension of coverage beyond policy period
743.492
Policy return and premium refund provision
743.495
Use of terms “noncancelable” or “guaranteed renewable”
743.498
Statement in policy of cancelability or renewability
743.521
Leased workers
743.522
Additional groups designated by director
743.523
Certain sales practices prohibited
743.524
Eligibility of association to be group health policyholder
743.526
Determination of whether trustees are policyholders
743.535
Health benefit coverage for guaranteed association
743.536
“Blanket health insurance” defined
743.537
Required provisions for blanket health insurance policies
743.540
Application and certificates not required for blanket health insurance policies
743.543
Payment of benefits under blanket health insurance policies
743.546
Exemption of policy form approval for blanket health insurance policies
743.550
Student health insurance
743.551
Student health benefit plans
743.650
Long Term Care Insurance Act
743.652
Definitions for ORS 743.650 to 743.665
743.653
Prohibition on certain policies
743.655
Rules
743.656
Eligibility for benefits
743.658
Notice of lapse or termination
743.662
Rescission of policy and denial of claims
743.664
Offer of nonforfeiture benefit
743.665
Prompt pay requirements
743.680
Definitions for ORS 743.680 to 743.689
743.682
Application of ORS 743.680 to 743.689
743.683
Policy contents
743.684
Filing of policy
743.685
Outline of coverage
743.686
Right to return of policy
743.687
Advertising
743.688
Rules
743.689
Director’s authority upon violation of ORS 743.680 to 743.689
743.787
Definitions for ORS 743.788
743.788
Prescription drug identification card
743.790
Rules for prescription drug identification cards
743.824
Cash dividends for healthy behaviors
743.826
Requirements for catastrophic plans
Green check means up to date. Up to date