2021 Oregon Revised Statutes
Chapter 743 - Health and Life Insurance
Section 743.405 - General requirements for health insurance policies.


(1) The policy must include a statement of the entire money and other considerations due.
(2) The policy must state the time at which the insurance takes effect and terminates.
(3) The policy may purport to insure only one person, unless an adult member of a family applies for coverage of family members or other dependents.
(4) The policy may not be issued individually to an individual in a group of persons described in ORS 731.098 for the purpose of separating the individual from health insurance benefits offered or provided in connection with a group health benefit plan.
(5)(a) Except as provided in ORS 743.498, the style, arrangement and overall appearance of the policy may not give undue prominence to any portion of the text, and every printed portion of the text of the policy and of any indorsements or attached papers shall be plainly printed in lightfaced type of a style in general use, the size of which shall be uniform and not less than 12-point type.
(b) As used in this subsection, "text" includes all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and captions and subcaptions.
(6) The policy must state the exceptions and reductions of indemnity. Except those required by ORS 743.411 to 743.477, exceptions and reductions shall be printed at the insurer’s option either included with the applicable benefit provision or under an appropriate caption such as EXCEPTIONS, or EXCEPTIONS AND REDUCTIONS. However, if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction must be included with the applicable benefit provision.
(7) Each form constituting the policy, including riders and indorsements, must be identified by a form number in the lower left-hand corner of the first page of the policy.
(8) The policy may not contain provisions purporting to make any portion of the charter, rules, constitution or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of or reference to a statement of rates or classification of risks, or short rate table filed with the Director of the Department of Consumer and Business Services. [Formerly 741.120; 1999 c.987 §5; 2009 c.11 §94; 2011 c.9 §91; 2011 c.500 §6; 2013 c.681 §12]

Structure 2021 Oregon Revised Statutes

2021 Oregon Revised Statutes

Volume : 18 - Financial Institutions, Insurance

Chapter 743 - Health and Life Insurance

Section 743.004 - Submission of information by carriers offering health benefit plans.

Section 743.005 - Protection of health information report.

Section 743.007 - Data reporting.

Section 743.008 - Reporting requirements; rules.

Section 743.009

Section 743.010 - Health insurance policy and health benefit plan forms; expenditures on primary care; rules.

Section 743.015 - Filing and approval of credit life and credit health insurance forms; filing of rates.

Section 743.018 - Filing of rates for life and health insurance; rules.

Section 743.019 - Procedure for review of proposed rates for health benefit plans; rules.

Section 743.020 - Rate filing to include statement of administrative expenses; rules.

Section 743.022 - Premium rates for individual health benefit plans.

Section 743.023 - Electronic administration; discounted rates; requirements.

Section 743.025 - Rate filing to include prescription drug cost information; reports to Legislative Assembly.

Section 743.029 - Uniform standards for health care financial and administrative transactions; rules.

Section 743.031 - Stakeholder work group to recommend uniform standards.

Section 743.034 - Coordination with Oregon Health Authority concerning uniform standards; Department of Human Services to be subject to standards.

Section 743.035 - Uniform prior authorization form for prescription drug benefits; consultation with Oregon Health Authority; rules.

Section 743.038 - Consent of individual required for life and health insurance; exceptions.

Section 743.039 - Alteration of application for life or health insurance.

Section 743.040 - Personal insurance, insurable interest and beneficiaries.

Section 743.044 - Life insurance for benefit of charity.

Section 743.046 - Exemption of proceeds of individual life insurance other than annuities.

Section 743.047 - Exemption of proceeds of group life insurance.

Section 743.049 - Exemption of proceeds of annuity policies; assignability of rights.

Section 743.101 - Purpose.

Section 743.104 - Scope of ORS 743.100 to 743.109.

Section 743.106 - Reading ease standards for life and health insurance policies.

Section 743.107 - When director may authorize lower standards.

Section 743.154 - Acceleration of death benefits; rules.

Section 743.168 - Incontestability.

Section 743.171 - Incontestability and limitation of liability after reinstatement.

Section 743.183 - Dividends.

Section 743.186 - Policy loan.

Section 743.187 - Maximum interest rate on policy loan; adjustable interest rate.

Section 743.192 - Payment of claim; payment of interest upon failure to pay proceeds.

Section 743.204 - Standard Nonforfeiture Law for Life Insurance; applicability.

Section 743.207 - Required provisions relating to nonforfeiture.

Section 743.210 - Determination of cash surrender values; applicability to certain policies.

Section 743.215 - Calculation of adjusted premiums.

Section 743.216 - Adjusted premiums; applicability.

Section 743.218 - Requirements for determination of future premium amounts or minimum values.

Section 743.219 - Supplemental rules for calculating nonforfeiture benefits.

Section 743.221 - Cash surrender values upon default in premium payment.

Section 743.222 - Policy benefits and premiums that shall be disregarded in calculating cash surrender values and paid-up nonforfeiture benefits.

Section 743.225 - Prohibited provisions.

Section 743.228 - Acts of corporate insured or beneficiary with respect to policy.

Section 743.230 - Variable life policy provisions.

Section 743.231 - "Profit-sharing policy" defined.

Section 743.234 - "Charter policy" or "founders policy" defined.

Section 743.243 - Restrictions on form of coupon policy.

Section 743.247 - Notice to variable life insurance policyholders.

Section 743.268 - Advancement of policy loans.

Section 743.271 - Periodic stipulated payments on variable annuities.

Section 743.272 - Computing benefits.

Section 743.273 - Standard provisions of reversionary annuities.

Section 743.275 - Standard Nonforfeiture Law for Individual Deferred Annuities; application.

Section 743.278 - Required provisions in annuity policies; exception.

Section 743.284 - Computation of benefits.

Section 743.287 - Commencement of annuity payments at optional maturity dates; calculation of benefits.

Section 743.293 - Minimum forfeiture amounts for annuity policies; rules.

Section 743.295 - Effect of certain life insurance and disability benefits on minimum nonforfeiture amounts.

Section 743.298 - Penalties, fees or charges; rules.

Section 743.303 - Requirements for issuance of group life insurance policies.

Section 743.306 - Required provisions in group life insurance policies.

Section 743.327 - Payments under policy; payment of interest upon failure to pay proceeds.

Section 743.333 - Termination of individual coverage.

Section 743.336 - Termination of policy or class of insured persons.

Section 743.348 - Certain sales practices prohibited.

Section 743.351 - Eligibility of association to be group life policyholder; rules.

Section 743.354 - Requirements for certain group life policies issued to trustees of certain funds; rules.

Section 743.356 - Continuing coverage upon replacement of group life policy.

Section 743.358 - Borrowing by certificate holders under group life policy.

Section 743.360 - Alternative group life insurance coverage.

Section 743.371 - Definitions for credit life and credit health insurance provisions.

Section 743.372 - Applicability of credit life and credit health insurance provisions.

Section 743.373 - Forms of credit life and credit health insurance.

Section 743.374 - Limits on amount of credit life insurance.

Section 743.376 - Duration of credit life and credit health insurance.

Section 743.377 - Credit life and credit health insurance policy or group certificate; contents; delivery of policy, certificate or copy of application.

Section 743.378 - Charges and refunds to debtor.

Section 743.380 - Claim report and payment.

Section 743.402 - Exceptions to individual health insurance policy requirements.

Section 743.405 - General requirements for health insurance policies.

Section 743.406 - Required provisions in group health insurance policies.

Section 743.414 - Time limit on certain defenses; incontestability.

Section 743.416 - Due date for first premium payment.

Section 743.417 - Grace period for subsequent premium payments; cancellation and nonrenewal.

Section 743.420 - Reinstatement.

Section 743.423 - Notice of claim.

Section 743.435 - Payment of claims.

Section 743.444 - Change of beneficiary.

Section 743.456 - Other insurance in same insurer.

Section 743.459 - Insurance with other insurers; expense incurred benefits.

Section 743.462 - Insurance with other insurers; other than expense incurred benefits.

Section 743.465 - Relation of earnings to insurance.

Section 743.472 - Permissible reasons for cancellation or refusal to renew.

Section 743.495 - Use of terms "noncancelable" or "guaranteed renewable"; synonymous terms.

Section 743.498 - Statement in policy of cancelability or renewability.

Section 743.521 - Leased workers; offering group health insurance.

Section 743.522 - Additional groups designated by director.

Section 743.523 - Certain sales practices prohibited.

Section 743.524 - Eligibility of association to be group health policyholder; rules.

Section 743.526 - Determination of whether trustees are policyholders; consequences; rules.

Section 743.535 - Health benefit coverage for guaranteed association.

Section 743.536 - "Blanket health insurance" defined.

Section 743.550 - Student health insurance.

Section 743.551 - Student health benefit plans; rules.

Section 743.650 - Long Term Care Insurance Act; purpose; application.

Section 743.652 - Definitions for ORS 743.650 to 743.665.

Section 743.655 - Rules; disclosure; contents of policy.

Section 743.656 - Eligibility for benefits; providers required to be covered.

Section 743.658 - Notice of lapse or termination; rules.

Section 743.662 - Rescission of policy and denial of claims.

Section 743.664 - Offer of nonforfeiture benefit; rules.

Section 743.680 - Definitions for ORS 743.680 to 743.689.

Section 743.682 - Application of ORS 743.680 to 743.689.

Section 743.683 - Policy contents; standards for benefit and claims payments; rules.

Section 743.684 - Filing of policy; loss ratio standards; insurance producer compensation.

Section 743.685 - Outline of coverage; information brochure; rules.

Section 743.787 - Definitions for ORS 743.788.

Section 743.788 - Prescription drug identification card.

Section 743.824 - Cash dividends for healthy behaviors.

Section 743.826 - Requirements for catastrophic plans.