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2011 Legislative Summary
Health care reform once again dominated the agenda. One of the
major bills passed by the 2011 Legislature conforms the Oregon
Insurance Code to the federal Patient Protection and Affordable
Care Act. Another bill created an Oregon Health Insurance Exchange
Corporation as contemplated in the federal law. And a third major
bill requires health insurers to offer certain levels of benefit
plans if they want to sell insurance in the individual or small
group market, whether or not the plans are offered through the
Exchange. The Department of Consumer and Business Services will
continue to work with the Oregon Health Authority and the Oregon
Health Insurance Exchange to implement these and other health
care-related bills.
The Insurance Division saw a number of the division's legislative
initiatives passed that enhance consumer protections and streamline
division regulatory processes. The division has new authority
to register medical retainer practices, enhancements to the state's
version of COBRA that allows continuation of health insurance
after termination of group coverage, increases to life and health
insurance guaranty fund benefits, consumer protections against
inappropriate health benefit plan rescissions, cancellations and
non-renewals, and prompt payment and independent review requirements
for long-term care insurance. In addition, legislation added Oregon
as a member of the Interstate Insurance Product Regulation Compact
that allows the department to participate in a national organization
that reviews and approves life, annuities, disability and long-term
care insurance products.
The division summary covers key insurance-related bills that
passed the Legislature with links to the bills.
Property and Casualty Insurance
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The Insurance Code requires that providers of PIP benefits charge
a person who receives PIP benefits (or that person's insurer)
the lesser of: (1) an amount that does not exceed the amount the
provider charges the general public, or (2) an amount that does
not exceed the Workers' Compensation fee schedules. Prior to April1,
2011, ambulance providers could charge a person or their insurer
100 percent of their usual fee as ambulance services were not
covered by the Workers' Compensation fee schedules. Rulemaking
required insurers to pay 80 percent of the provider's usual fee
when the service is not covered by the fee schedules. As a result,
ambulance providers experienced a reduction in payments from insurers.
SB 372 decouples the payment of PIP benefits for ambulance services
from the Workers' Compensation fee schedules, and allows ambulance
providers to once again charge 100 percent of their usual fee.
- Effective Date: Sept. 1, 2011
The Insurance Code allows an insured to obtain an independent
appraisal by a disinterested party of damage to a vehicle if the
insurer and the insured disagree about the policy coverage for
physical damage, and if the policy includes a provision allowing
the insured to seek an independent appraisal. This bill amends
the law to require that a person conducting an independent appraisal
be a competent and disinterested person. In addition, the appraisal
must be conducted by a person who has been issued a vehicle appraiser
certificate under the Oregon Vehicle Code, or has been issued
a vehicle appraiser certificate or license by another state or
government body.
- Effective Date: Jan. 1, 2012
- Applicability: Motor vehicle liability insurance policies
issued or renewed on or after Jan. 1, 2012
The 2003 Legislature enacted HB 3630 to subsidize medical professional
liability insurance costs for rural doctors and directed the State
Accident Insurance Fund Corporation to establish a reinsurance
program for medical professional liability insurance policies
issued to rural doctors. This program succeeded in providing medical
professional liability insurance rate relief to rural doctors,
and in 2007, the legislature enacted SB 183 to extend and modify
the program. This program expired at the end of calendar year
2011.
SB 608 requires the Oregon Health Authority (OHA) to establish
a new program to provide subsidies for medical professional liability
insurance premiums paid by rural health practitioners. This bill
establishes the Rural Medical Liability Subsidy Fund in the State
Treasury, separate from the General Fund. The Subsidy Fund is
to pay premium subsidies to applicable practitioners (both doctors
and nurse practitioners).
- Effective Date: June 28, 2011
- Operative Date: Jan. 1, 2012
This bill voids any provision in a construction agreement if
the provision requires a party or the party's surety or insurer
to waive a right of subrogation, indemnity, or contribution for
amounts paid by reason of death or bodily injury, or damage to
property, caused in whole or in part by the negligence of another
person. SB 961 does not apply to such a provision in an insurance
policy issued for certain very large projects defined in the Insurance
Code or to such a provision that applies to proceeds of a property
insurance policy. Exemptions apply allowing waivers of subrogation,
indemnity, or contribution in a personal property lease or rental
agreement, a real property lease or rental agreement between a
landlord and tenant, and in a construction agreement in which
one of the parties is a railroad.
- Effective Date: June 23, 2011
This bill removes the sunset provision of SB 256, passed by the
2007 Legislature, and allows parties in an uninsured motorist
coverage dispute, when the parties agree to arbitration, to continue
using arbitration to resolve the dispute.
- Effective Date: Jan. 1, 2012
Surplus Lines Provisions
This bill conforms Oregon's surplus lines insurance laws to certain
provisions of the federal Dodd-Frank Wall Street Reform and Consumer
Protection Act that became effective July 21, 2011. The Dodd-Frank
Act contemplates that each state will adopt nationwide uniform
requirements to share premium taxes on multi-state surplus lines
policy transactions. HB 2679 allows Oregon to collect a tax on
100 percent of the premium on a multi-state surplus lines policy
if Oregon is the "home state" of an insured. The bill
also allows the Director of the Department of Consumer and Business
Services, after receiving express legislative approval, to enter
into a compact or otherwise establish procedures with other states
to allocate premium taxes on multi-state surplus lines policies.
The bill gives Oregon the authority to collect premium taxes on
independently procured surplus lines policies. HB 2679 amends
Oregon's current requirements that an insurance producer first
must determine whether the insurance is available from an admitted
insurer before writing surplus lines insurance (called a "diligent
search"), and broadens the diligent search federal exemption
under Dodd-Frank to include a larger group of commercial purchasers.
The bill also simplifies and streamlines the calculation of the
tax that helps fund the office of the State Fire Marshal, and
increases the minimum capital and surplus requirements for surplus
lines insurers.
Health Insurance Provisions
HB 2679 was also used as the vehicle for two health insurance
related amendments that are unrelated to surplus lines insurance.
The bill amends ORS 743.912 and 743.917 and clarifies that the
statute applies to health benefit plans. The bill prohibits health
insurers from requesting refunds of payments made to a provider
more than the earlier of the date specified in a contract between
the provider and the health insurer or 18 months after the date
of original payment except in cases of fraud, abuse of billing,
coordination of benefits, and certain third-party liability situations.
Except in cases of fraud and coordination of benefits, the bill
prohibits a health care provider from requesting additional payment
from a health insurer more than the earlier of the last day of
the period specified by the contract with the insurer or 18 months
after the date the claim was denied or payment was made. The bill
also prohibits a health insurer from considering a provider's
claim untimely if the claim is made no later than 12 months after
a different insurer denied the claim in whole or in part; or requested
a refund of an erroneous payment.
HB 2679 also requires insurers offering health benefit plans
that provide coverage of prescription eye drops to provide coverage
for one early refill of a prescription for eye drops to treat
glaucoma if (1) the refill is requested by an insured less than
30 days after the later of (a) the date the original prescription
was dispensed, and (b) the date the last refill was dispensed;
(2) the prescriber indicates on the original prescription that
a specific number of refills will be needed; (3) the refill does
not exceed the number indicated; and (4) the prescription hasn't
been refilled more than once during the 30-day period prior to
the request for an early refill.
- Effective Date: Jan. 1, 2012
- Applicability: There are two provisions in the bill
related to applicability:
- The health insurance provisions related to payments to providers
apply to contracts between insurers and providers in effect
on or after Jan. 1, 2012.
- The health insurance provisions related to prescription eye
drops apply to policies or certificates issued or renewed on
or after Jan. 1, 2012.
This bill is modeled after a California law and allows motor
vehicle owners to participate in vehicle sharing program where
the owner's vehicle could be used for non-commercial purposes
for a fee. The bill eliminates the concern that the owner's personal
motor vehicle liability insurer will cancel, void, terminate,
rescind, or non-renew an existing policy solely because the owner
participates in a personal vehicle sharing program. A business
conducting a personal vehicle sharing program is required to provide
coverage for the vehicle and assume all liability of the vehicle
owner. The vehicle owner's personal motor vehicle liability insurer
may exclude all coverage under the policy while the vehicle is
under the control of the personal vehicle sharing program. The
personal vehicle sharing program must provide proof of compliance
with the insurance requirements to the vehicle owner and comply
with other record-keeping requirements.
- Effective Date: Jan. 1, 2012
- Applicability: Insurance policies issued or renewed
on or after Jan. 1, 2012.
This bill relates to portable electronics insurance coverage
for the repair or replacement of portable electronics devices
such as a cell phone or electronic tablet. A vendor (e.g., Verizon,
Best Buy) who purchases this coverage from an insurer or insurance
producer is prohibited from issuing, selling, or offering this
insurance coverage to their customers without obtaining a limited
insurance producer license issued by the Department of Consumer
and Business Services (DCBS). This bill also allows the employees,
agents, or authorized representatives of the vendor to sell this
insurance coverage without being individually licensed, but they
must receive training developed by the insurer or insurance producer
before they are able to issue, sell, or offer portable electronics
insurance. All acts of the employees, agents, or authorized representatives
are deemed to be the acts of the vendor. The bill requires the
vendor to comply with certain written disclosure requirements
to prospective customers and includes civil penalties for violations
of the law. Portable electronics insurance coverage does not apply
to service contracts governed by ORS 646A.150 to 646A.172, a warranty,
a maintenance agreement as defined in ORS 646A.152, or a policy
of insurance covering the obligations of a vendor or a portable
electronics manufacturer under a warranty. A vendor must apply
for the limited insurance producer license no later than 90 days
after the operative date.
- Effective Date: June 16, 2011
- Operative Date: Jan. 1, 2012
This bill exempts an individual from obtaining an adjuster's
license if that individual, supervised by a licensed adjuster
or insurance producer, merely collects and furnishes claim information
and conducts data entry into an automated claims adjudication
system. An automated claims adjudication system is defined as
a preprogrammed computer system designed for the collection, data
entry, calculation, and final resolution of portable electronics
insurance claims. The system must comply with all requirements
of the Insurance Code. A licensed adjuster or insurance producer
is prohibited from supervising more than 25 individuals exempted
from the adjuster's license requirement. The bill excludes portable
electronics that are covered under the service contract statutes
(ORS 646A.150 to 646A.172), warranties, maintenance agreements
as defined in ORS 646A.152, or an insurance policy that covers
the obligations of a vendor or a portable electronics manufacturer
under a warranty.
- Effective Date: Jan. 1, 2012
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