OAR 409-065-0005
Definitions

The following definitions apply to OAR 409-065-0000 (Purpose) to 409-065-0030 (Data Access and Disclosure):
(1) “Accident policy” means an insurance policy that provides benefits only for a loss due to accidental bodily injury.
(2) “Authority” means the Oregon Health Authority.
(3) “DCBS” means the Oregon Department of Consumer and Business Services.
(4) “Dental-only insurance” means an insurance policy that provides benefits only for dental services.
(5) “Disability policy” means an insurance policy that provides benefits for losses due to a covered illness or disability.
(6) “Health benefit plan” has the meaning provided in ORS 743B.005 (Definitions).
(7) “Health care” has the meaning provided in ORS 442.385 (Definitions).
(8) “Health insurance” has the meaning provided in ORS 731.162 (“Health insurance”).
(9) “Hospital indemnity policy” means an insurance policy that provides benefits only for covered hospital stays.

(10)

“Long-term care insurance” has the meaning provided in ORS 743.652 (Definitions for ORS 743.650 to 743.665).

(11)

“Mandatory Reporter” means any payer or licensed third party administrator with a mean total lives of 1,000 or more across all lines of business, as calculated by the Authority.

(12)

“Medicare supplemental insurance” means a group or individual insurance policy or a subscriber contract, other than a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act (42 U.S.C. section 1395 et seq.) or an issued policy under a demonstration project specified in 42 U.S.C. section 1395ss(g)(1) that is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare.

(13)

“Payer” has the meaning provided in ORS 442.385 (Definitions).

(14)

“Specific disease policy” means an insurance policy that provides benefits only for a loss due to a covered disease.

(15)

“Stand-alone prescription drug plan” means an insurance policy that provides benefits only for prescription drugs.

(16)

“Stop-loss plan” means insurance against the risk of economic loss assumed under a less than fully-insured employee health benefit plan as provided in ORS 742.065 (Insurance against risk of loss assumed under less than fully insured employee health benefit plan).

(17)

“Third-party administrator (TPA)” means any person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts or settles claims on, residents of Oregon or residents of another state from offices in Oregon, in connection with life insurance or health insurance coverage; or any person or entity who must otherwise be licensed under ORS 744.702 (Third party administrator license).

(18)

“Vision policy” means a health benefits plan covering only vision health care.

(19)

“Voluntary reporter” means a payer or third-party administrator that does not meet the requirements to be considered a Mandatory Reporter and elects to submit cost growth target data on a voluntary basis.

Source: Rule 409-065-0005 — Definitions, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=409-065-0005.

Last Updated

Jun. 24, 2021

Rule 409-065-0005’s source at or​.us