OAR 836-052-0508
Definitions
(1)
The following have the meanings given those terms in ORS 743.652 (Definitions for ORS 743.650 to 743.665):(a)
“Applicant;”(b)
“Benefit trigger;”(c)
“Certificate;”(d)
“Group long term care insurance;”(e)
“Long term care insurance;”(f)
“Policy;” and(g)
“Qualified long term care insurance.”(2)
The following definitions apply:(a)
“Independent review organization” means an organization qualified under OAR 836-052-0768 (Appealing An Insurer’s Determination That The Benefit Trigger Is Not Met)(5) that conducts independent reviews of long term care benefit trigger decisions.(b)
“Licensed health care professional” means an individual qualified by education and experience in an appropriate field, to determine, by record review, an insured’s actual functional or cognitive impairment.(c)
“Qualified actuary” means a member in good standing of the American Academy of Actuaries.(d)
“Similar policy forms” means all of the long term care insurance policies and certificates issued by an insurer in the same long term care benefit classification as the policy form being considered. Certificates of groups that meet the definition of ORS 743.652 (Definitions for ORS 743.650 to 743.665)(3)(a) are not considered similar to certificates or policies otherwise issued as long term care insurance, but are similar to other comparable certificates with the same long term care benefit classifications.
Source:
Rule 836-052-0508 — Definitions, https://secure.sos.state.or.us/oard/view.action?ruleNumber=836-052-0508
.