Or. Admin. Code § 836-052-0508

Current through Register Vol. 63, No. 12, December 1, 2024

Section 836-052-0508 - Definitions

For the purpose of OAR 836-052-0500 to 836-052-0790:

(1) The following have the meanings given those terms in ORS 743.652:

(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(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(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.

Or. Admin. Code § 836-052-0508

ID 10-2007, f. 12-3-07, cert. ef. 1-1-08; ID 3-2012, f. & cert. ef. 2-14-12

Stat. Auth.: ORS 731.244, 742.023, 743.013, 743.655, 743.685 & 746.240, OL 2007 Ch. 9, 9a

Stats. Implemented: ORS 742.003, 742.005, 743.650, 743.655 & 743.656