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Oregon Bulletin

May 1, 2012

Department of Consumer and Business Services, Insurance Division, Chapter 836

Rule Caption: Notification Requirements for Carriers Regarding State Continuation of Health Insurance.

Adm. Order No.: ID 6-2012(Temp)

Filed with Sec. of State: 3-27-2012

Certified to be Effective: 4-15-12 thru 10-10-12

Notice Publication Date:

Rules Adopted: 836-053-0863

Rules Suspended: 836-053-0862

Subject: This rulemaking suspends rules adopted by the Department of Consumer and Business Services (DCBS) related to state continuation of health insurance. The suspended rules include material required by federal law (American Recovery and Reinvestment Act) that is no longer applicable to state continuation. During the 2012 Legislative Session, the governing statute was amended to reflect new requirements for the notice that carriers must provide for persons eligible for state continuation of health insurance. The changes required by that legislation are incorporated in the new rule, OAR 736-053-0863(T). DCBS anticipates further changes may be necessary to reflect federal guidance related to the Affordable Care Act. These temporary rules provide the requirements for carriers until permanent rules can be adopted that reflect all changes to the notice requirements under both the state continuation and portability program. OAR 836-053-0862 will be suspended until permanent rules are adopted by DCBS, at which time the rule will be repealed.

Rules Coordinator: Sue Munson—(503) 947-7272

836-053-0862

Notifications

(1) For purposes of the notice required by ORS 743.610(10):

(a) An insurer may provide a single notice under ORS 743.610(10) to a covered person and a qualified beneficiary when:

(A) The notice is addressed to the covered person or qualified beneficiary at the last known address of the covered person or qualified beneficiary;

(B) The covered person and qualified beneficiary are eligible for state continuation coverage by virtue of the same qualifying event; and

(C) The covered person and qualified beneficiary have the same last known mailing address.

(b) An insurer that does not require a covered person or qualified beneficiary to complete a form to request continuation of coverage need not include a form in the notice. However, the insurer must provide sufficient instructions to inform the covered person or qualified beneficiary how to apply for continuation of coverage.

(c) An insurer is not required to include premium rates in the notice. However, an insurer that does not provide premium rates for continuation of coverage in the notice must instruct the covered person or qualified beneficiary how and from whom the premium rates can be obtained.

(d) The requirement to provide written notice under ORS 743.610(1) may be triggered either by the notification of a qualifying event received from the covered person or qualified beneficiary under ORS 743.610(5) or notice of the qualifying event submitted to the insurer by the group policy holder.

(e) The enrollment information required to be in the notice under ORS 743.610(10) may instruct the covered person or qualified beneficiary to contact the employer or group for information about additional coverage for which the covered person or qualified beneficiary may be eligible.

(f) The explanation of appeal rights required to be included in the notice under ORS 743.610(1) may be provided by a statement that continuation coverage constitutes continued coverage under the group policy and that the covered person or qualified beneficiary has the same rights to appeal or grieve a decision by the insurer on a medical claim that exists under the group policy unless the group policy has been replaced with coverage that provides different appeal or grievance rights.

(2) Notice provided under ORS 743.610 must include the following information: “Oregon Insurance Division, (503) 947-7984 or (888) 877-4894.”

Stat. Auth.: ORS 731.244, 743.601 & 743.610
Stats. Implemented: ORS 743.601 & 743.610
Hist.: ID 23-2011, f. & cert. ef. 12-19-11; Suspended by ID 6-2012(Temp), f. 3-27-12, cert. ef. 4-15-12 thru 10-10-12

836-053-0863

Notifications

(1) For purposes of the notice required by ORS 743.610(10), an insurer must use the notice set forth on the website for the Insurance Division of the Department of Consumer and Business Services at www.insurance.oregon.gov. An insurer:

(a) May incorporate the notice into another document provided that the notice remains prominent.

(b) May modify the font of the document but the font must be at least 12 point.

(c) May add headings, logos and other company identifiers.

(d) Must modify the notice to include the correct insurer or employee-specific information as indicated in the brackets.

(2) An insurer may provide a single notice under ORS 743.610(10) to a covered person and a qualified beneficiary when:

(a) The notice is addressed to the covered person or qualified beneficiary at the last known address of the covered person or qualified beneficiary;

(b) The covered person and qualified beneficiary are eligible for state continuation coverage by virtue of the same qualifying event; and

(c) The covered person and qualified beneficiary have the same last known mailing address.

(3) The requirement to provide written notice under ORS 743.610(1) may be triggered either by the notification of a qualifying event received from the covered person or qualified beneficiary under ORS 743.610(5) or notice of the qualifying event submitted to the insurer by the group policy holder.

Stat. Auth.: ORS 731.244 & 743.610
Stats. Implemented: ORS 743.610
Hist.: ID 6-2012(Temp), f. 3-27-12, cert. ef. 4-15-12 thru 10-10-12


 

Rule Caption: Adoption of Attorney General’s 2012 Model Rules of Procedure for Insurance Division.

Adm. Order No.: ID 7-2012

Filed with Sec. of State: 3-27-2012

Certified to be Effective: 3-27-12

Notice Publication Date:

Rules Amended: 836-005-0107

Subject: This rulemaking adopts the Oregon Attorney General’s Model Rules of Procedure under the Administrative Procedures Act dated January 31, 2012.

Rules Coordinator: Sue Munson—(503) 947-7272

836-005-0107

Model Rules of Procedure Governing Rulemaking

The Model Rules of Procedure, OAR 137-001-0005 to 137-005-0070, in effect on January 31, 2012, as promulgated by the Attorney General of the State of Oregon under the Administrative Procedures Act, are adopted as the rules of procedure for the Insurance Division.

[ED. NOTE: The full text of the Attorney General’s Model Rules of Pro?cedures is available from the Office of the Attorney General or the Insurance Division.]

Stat. Auth.: ORS 183.341
Stats. Implemented: ORS 183.025, 183.090 & 183.310 - 183.550
Hist.: IC 2-1981, f. & ef. 11-20-81; IC 7-1983, f. & ef. 9-28-83; IC 3-1986, f. & ef. 3-5-86; IC 16-1988, f. & cert. ef. 10-12-88; ID 19-1990, f. & cert. ef. 12-13-90; ID 3-1992, f. & cert. ef. 2-13-92; ID 2-1994, f. & cert. ef. 3-23-94; ID 8-1995, f. & cert. ef. 12-8-95; ID 7-1998, f. & cert. ef. 4-15-98; ID 10-2000, f. & cert. ef. 11-3-00; ID 3-2002, f. & cert. ef. 1-24-02; ID 3-2004, f. & cert. ef. 5-7-04; ID 8-2006, f. & cert. ef. 4-27-06; ID 7-2012, f. & cert. ef. 3-27-12


 

Rule Caption: Annual Update of Rule Relating to Health Insurance Coverage of Prosthetic and Orthotic Devices.

Adm. Order No.: ID 8-2012

Filed with Sec. of State: 4-5-2012

Certified to be Effective: 4-5-12

Notice Publication Date: 1-1-2012

Rules Amended: 836-052-1000

Subject: This rulemaking adopts the annual update to the Insurance Division rule listing the prosthetic and orthotic devices that must be covered by group and individual health insurance policies. The rulemaking implements ORS 743A.144, which requires all such policies that provide coverage for hospital, medical or surgical expenses to include coverage for prosthetic and orthotic devices This statute also requires the Director to adopt and annually update the list of covered prosthetic and orthotic devices.

Rules Coordinator: Sue Munson—(503) 947-7272

836-052-1000

Prosthetic and Orthotic Devices

(1) This rule is adopted under the authority of ORS 731.244 and 743A.144, for the purpose of implementing 743A.144.

(2) The list of prosthetic and orthotic devices and supplies in the Medicare fee schedule for Durable Medical Equipment, Prosthetics, Orthotics and Supplies is adopted for the purpose of listing the prosthetic and orthotic devices and supplies for which coverage is required by ORS 743A.144, insofar as the list is consistent with 743A.144. The list is limited to those rigid or semi rigid devices used for supporting a weak or deformed leg, foot, arm, hand, back or neck, or restricting or eliminating motion in a diseased or injured leg, foot, arm, hand, back or neck or an artificial limb device or appliance designed to replace in whole or in part an arm or a leg that the Centers for Medicare and Medicaid Services (CMS) has designated in the 4-digit L Codes of Healthcare Common Procedure Coding System (HCPC) Level II, which is accessible by selecting the link for the 2012 Alpha-Numeric HCPCS File at: https://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp.

(3) Under ORS 743A.144(4), benefits payable under a policy may not be subject to internal or separate limits or caps other than the policy lifetime maximum benefits as they apply to the coverage for prosthetic and orthotic devices required by ORS 743A.144.

(4) A managed care plan to which ORS 743A.144(6) applies is a health insurance policy that requires an enrollee to use a closed network of providers managed, owned, under contract with or employed by the insurer in order to receive benefits under the plan.

Stat. Auth: ORS 731.244 & 743A.144
Stats. Implemented: ORS 743A.144
Hist.: ID 12-2007, f. 12-18-07, cert. ef. 1-1-08; ID 12-2009, f. & cert. ef. 12-18-09; ID 8-2011, f. & cert. ef. 2-23-11; ID 8-2012, f. & cert. ef. 4-5-12

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2011.

2.) Copyright 2012 Oregon Secretary of State: Terms and Conditions of Use

Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

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