ORS 742.005
Grounds for disapproval of policy forms


The Director of the Department of Consumer and Business Services shall disapprove any form requiring the director’s approval:

(1)

If the director finds it does not comply with the law;

(2)

If the director finds it contains any provision, including statement of premium, or has any label, description of its contents, title, heading, backing or other indication of its provisions, which is unintelligible, uncertain, ambiguous or abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued;

(3)

If, in the director’s judgment, its use would be prejudicial to the interests of the insurer’s policyholders;

(4)

If the director finds it contains provisions which are unjust, unfair or inequitable;

(5)

If the director finds sales presentation material disapproved by the director pursuant to ORS 742.009 (Regulation of sales material) is being used with respect to the form; or

(6)

If, with respect to any of the following forms, the director finds the benefits provided therein are not reasonable in relation to the premium charged:

(a)

Individual health insurance policy forms, including benefit certificates issued by fraternal benefit societies and individual policies issued by health care service contractors, but excluding policies referred to in ORS 743.402 (Exceptions to individual health insurance policy requirements) as exempt from the application of ORS 743.405 (General requirements for health insurance policies) to 743.498 (Statement in policy of cancelability or renewability) and 743A.160 (Alcoholism treatment);

(b)

Small employer group health benefit plan forms for small employers as that term is defined in ORS 743B.005 (Definitions), including small employer group policies issued by health care service contractors; or

(c)

Credit life and credit health insurance forms subject to ORS 743.371 (Definitions for credit life and credit health insurance provisions) to 743.380 (Claim report and payment). [Formerly 743.009; 1991 c.182 §1; 1999 c.987 §4; 2017 c.206 §15]

Source
Last accessed
May. 15, 2020