OAR 836-050-0115
Permitted Modifications to Uniform Forms

(1)

An insurer may add to the face of the form its own identification and similar information, including insurer name and logo and policy identification by color coding or otherwise. The captions may be supplemented by instructions that merely facilitate the completion of the form.

(2)

An insurer may add to the back of the form or, for Exhibit 2, to any blank area on the face of the form, an item whose purpose is the certification of the status of the patient as a person in the insured group or as a member of the family or dependent of a person in the insured group. In the case of a claim form required by a state agency, the back of the form may also contain such provider certification and acknowledgment language as is required or permitted by law.

(3)

No alteration may be made to the format of the face of the form. No addition to the form may impose any additional requirement on any person, except for the certification item permitted by section (2) of this rule.

(4)

An insurer may screen the portions of the uniform claim form that it does not require to be completed, if the screening is done in such a way as to leave these portions usable by others.

[ED. NOTE: Exhibits referenced are available from the agency.]

Source: Rule 836-050-0115 — Permitted Modifications to Uniform Forms, https://secure.sos.state.or.us/oard/view.action?ruleNumber=836-050-0115 (accessed May 26, 2025).

836–050–0000
Purpose, Statutory Authority and Implementation 836–050–0010
Notice of Transfer 836–050–0020
Notice of Rejection 836–050–0105
Statutory Authority 836–050–0110
Uniform Claim Forms 836–050–0115
Permitted Modifications to Uniform Forms 836–050–0120
Effective Date 836–050–0150
Advance Payments 836–050–0200
Purpose, Scope and Definitions 836–050–0205
Authority 836–050–0207
Unfair Trade Practices 836–050–0210
General Exclusions 836–050–0215
Pre-existing Condition Exclusions 836–050–0230
Purpose, Scope and Definitions 836–050–0235
Rulemaking Authority 836–050–0237
Unfair Trade Practices 836–050–0240
General Principles 836–050–0245
Medical and Lifestyle Application Questions and Underwriting Standards 836–050–0250
Testing for HIV Infection 836–050–0255
Inquiries Regarding Past Test Results 836–050–0275
Credit Unions as Associations 836–050–0280
Credit Unions as Association 836–050–0300
Purpose, Authority, Application 836–050–0305
Criteria for orders

May 26, 2025

Rule 836-050-0115's source at or.us

Stay Connected

Join thousands of people who receive monthly site updates.

Get Legal Help

The Oregon State Bar runs a service for finding an attorney in good standing. Initial consultations are usually free or discounted: Lawyer Referral Service

Committed to Public Service

We will always provide free access to the current law. In addition, we provide special support for non-profit, educational, and government users. Through social entrepreneurship, we’re lowering the cost of legal services and increasing citizen access.

Navigate

California:	Codes
Colorado:	C.R.S.
Nevada:	NRS
New York:	Laws
Oregon:	OAR, ORS
Texas:	Statutes
World:	Rome Statute, International Dictionary

Location: https://oregon.public.law/rules/oar_836-050-0115

Original Source: Rule 836-050-0115 — Permitted Modifications to Uniform Forms, https://secure.sos.state.or.us/oard/view.action?ruleNumber=836-050-0115 (last accessed May 10, 2025).