Bill Text: OR HB4105 | 2012 | Regular Session | Introduced
Bill Title: Relating to health insurance.
Spectrum: Partisan Bill (Republican 7-0)
Status: (Failed) 2012-03-05 - In committee upon adjournment. [HB4105 Detail]
Download: Oregon-2012-HB4105-Introduced.html
76th OREGON LEGISLATIVE ASSEMBLY--2012 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 39
House Bill 4105
Sponsored by Representative ESQUIVEL; Representatives BREWER,
CAMERON, PARRISH, G SMITH, THATCHER, WINGARD (Presession
filed.)
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Exempts from application of insurance code sale of policies or
certificates of health insurance in this state by insurers
licensed to transact insurance in another state.
A BILL FOR AN ACT
Relating to health insurance; creating new provisions; and
amending ORS 731.036.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 731.036 is amended to read:
731.036. Except as provided in ORS 743.061 or as specifically
provided by law, the Insurance Code does not apply to any of the
following to the extent of the subject matter of the exemption:
(1) A bail bondsman, other than a corporate surety and its
agents.
(2) A fraternal benefit society that has maintained lodges in
this state and other states for 50 years prior to January 1,
1961, and for which a certificate of authority was not required
on that date.
(3) A religious organization providing insurance benefits only
to its employees, if the organization is in existence and exempt
from taxation under section 501(c)(3) of the federal Internal
Revenue Code on September 13, 1975.
(4) Public bodies, as defined in ORS 30.260, that either
individually or jointly establish a self-insurance program for
tort liability in accordance with ORS 30.282.
(5) Public bodies, as defined in ORS 30.260, that either
individually or jointly establish a self-insurance program for
property damage in accordance with ORS 30.282.
(6) Cities, counties, school districts, community college
districts, community college service districts or districts, as
defined in ORS 198.010 and 198.180, that either individually or
jointly insure for health insurance coverage, excluding
disability insurance, their employees or retired employees, or
their dependents, or students engaged in school activities, or
combination of employees and dependents, with or without employee
or student contributions, if all of the following conditions are
met:
(a) The individual or jointly self-insured program meets the
following minimum requirements:
(A) In the case of a school district, community college
district or community college service district, the number of
covered employees and dependents and retired employees and
dependents aggregates at least 500 individuals;
(B) In the case of an individual public body program other than
a school district, community college district or community
college service district, the number of covered employees and
dependents and retired employees and dependents aggregates at
least 500 individuals; and
(C) In the case of a joint program of two or more public
bodies, the number of covered employees and dependents and
retired employees and dependents aggregates at least 1,000
individuals;
(b) The individual or jointly self-insured health insurance
program includes all coverages and benefits required of group
health insurance policies under ORS chapters 743 and 743A;
(c) The individual or jointly self-insured program must have
program documents that define program benefits and
administration;
(d) Enrollees must be provided copies of summary plan
descriptions including:
(A) Written general information about services provided, access
to services, charges and scheduling applicable to each enrollee's
coverage;
(B) The program's grievance and appeal process; and
(C) Other group health plan enrollee rights, disclosure or
written procedure requirements established under ORS chapters 743
and 743A;
(e) The financial administration of an individual or jointly
self-insured program must include the following requirements:
(A) Program contributions and reserves must be held in separate
accounts and used for the exclusive benefit of the program;
(B) The program must maintain adequate reserves. Reserves may
be invested in accordance with the provisions of ORS chapter 293.
Reserve adequacy must be calculated annually with proper
actuarial calculations including the following:
(i) Known claims, paid and outstanding;
(ii) A history of incurred but not reported claims;
(iii) Claims handling expenses;
(iv) Unearned contributions; and
(v) A claims trend factor; and
(C) The program must maintain adequate reinsurance against the
risk of economic loss in accordance with the provisions of ORS
742.065 unless the program has received written approval for an
alternative arrangement for protection against economic loss from
the Director of the Department of Consumer and Business Services;
(f) The individual or jointly self-insured program must have
sufficient personnel to service the employee benefit program or
must contract with a third party administrator licensed under ORS
chapter 744 as a third party administrator to provide such
services;
(g) The individual or jointly self-insured program shall be
subject to assessment in accordance with ORS 735.614 and former
enrollees shall be eligible for portability coverage in
accordance with ORS 735.616;
(h) The public body, or the program administrator in the case
of a joint insurance program of two or more public bodies, files
with the Director of the Department of Consumer and Business
Services copies of all documents creating and governing the
program, all forms used to communicate the coverage to
beneficiaries, the schedule of payments established to support
the program and, annually, a financial report showing the total
incurred cost of the program for the preceding year. A copy of
the annual audit required by ORS 297.425 may be used to satisfy
the financial report filing requirement; and
(i) Each public body in a joint insurance program is liable
only to its own employees and no others for benefits under the
program in the event, and to the extent, that no further funds,
including funds from insurance policies obtained by the pool, are
available in the joint insurance pool.
(7) All ambulance services.
(8) A person providing any of the services described in this
subsection. The exemption under this subsection does not apply to
an authorized insurer providing such services under an insurance
policy. This subsection applies to the following services:
(a) Towing service.
(b) Emergency road service, which means adjustment, repair or
replacement of the equipment, tires or mechanical parts of a
motor vehicle in order to permit the motor vehicle to be operated
under its own power.
(c) Transportation and arrangements for the transportation of
human remains, including all necessary and appropriate
preparations for and actual transportation provided to return a
decedent's remains from the decedent's place of death to a
location designated by a person with valid legal authority under
ORS 97.130.
(9)(a) A person described in this subsection who, in an
agreement to lease or to finance the purchase of a motor vehicle,
agrees to waive for no additional charge the amount specified in
paragraph (b) of this subsection upon total loss of the motor
vehicle because of physical damage, theft or other occurrence, as
specified in the agreement. The exemption established in this
subsection applies to the following persons:
(A) The seller of the motor vehicle, if the sale is made
pursuant to a motor vehicle retail installment contract.
(B) The lessor of the motor vehicle.
(C) The lender who finances the purchase of the motor vehicle.
(D) The assignee of a person described in this paragraph.
(b) The amount waived pursuant to the agreement shall be the
difference, or portion thereof, between the amount received by
the seller, lessor, lender or assignee, as applicable, that
represents the actual cash value of the motor vehicle at the date
of loss, and the amount owed under the agreement.
(10) A self-insurance program for tort liability or property
damage that is established by two or more affordable housing
entities and that complies with the same requirements that public
bodies must meet under ORS 30.282 (6). As used in this
subsection:
(a) 'Affordable housing' means housing projects in which some
of the dwelling units may be purchased or rented, with or without
government assistance, on a basis that is affordable to
individuals of low income.
(b) 'Affordable housing entity' means any of the following:
(A) A housing authority created under the laws of this state or
another jurisdiction and any agency or instrumentality of a
housing authority, including but not limited to a legal entity
created to conduct a self-insurance program for housing
authorities that complies with ORS 30.282 (6).
(B) A nonprofit corporation that is engaged in providing
affordable housing.
(C) A partnership or limited liability company that is engaged
in providing affordable housing and that is affiliated with a
housing authority described in subparagraph (A) of this paragraph
or a nonprofit corporation described in subparagraph (B) of this
paragraph if the housing authority or nonprofit corporation:
(i) Has, or has the right to acquire, a financial or ownership
interest in the partnership or limited liability company;
(ii) Has the power to direct the management or policies of the
partnership or limited liability company;
(iii) Has entered into a contract to lease, manage or operate
the affordable housing owned by the partnership or limited
liability company; or
(iv) Has any other material relationship with the partnership
or limited liability company.
(11) A community-based health care initiative approved by the
Administrator of the Office for Oregon Health Policy and Research
under ORS 735.723 operating a community-based health care
improvement program approved by the administrator.
(12) Except as provided in ORS 735.500 and 735.510, a person
certified by the Department of Consumer and Business Services to
operate a retainer medical practice.
{ + (13) A foreign insurer that is licensed in another state
to transact insurance, with respect to the sale by the insurer in
this state of a policy or certificate of health insurance that is
otherwise subject to ORS chapter 743A. + }
SECTION 2. { + The amendments to ORS 731.036 by section 1 of
this 2012 Act apply to the offering of a policy or certificate of
health insurance by a foreign insurer on or after the effective
date of this 2012 Act. + }
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