Oregon Revised Statutes Chapter 743 § 743.652 — Definitions for ORS 743.650 to 743.665

Definitions for ORS 743.650 to 743.665. As used in ORS 743.650 to 743.665, unless the context requires otherwise: (1) “Applicant” means: (a) In the case of an individual long term care insurance policy, the person who seeks to contract for benefits; and (b) In the case of a group long term care insurance policy, the proposed certificate holder. (2) “Benefit trigger” means a contractual provision in a long term care insurance policy that conditions the payment of benefits on an insured’s inability to perform activities of daily living or on an insured’s cognitive impairment. For qualified long term care insurance, the “benefit trigger” is the determination that an insured is a chronically ill individual, as defined in section 7702B(c) of the Internal Revenue Code. (3) “Certificate” means any certificate issued under a group long term care insurance policy, if the policy has been delivered or issued for delivery in this state. (4) “Group long term care insurance” means a long term care insurance policy that is delivered or issued for delivery in this state and issued to: (a) One or more employers or labor organizations, or to a trust or to the trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations; (b) Any professional, trade or occupational association for its members or former or retired members, or combination thereof, if such association: (A) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and (B) Has been maintained in good faith for purposes other than obtaining insurance; (c)(A) An association or a trust or the trustee of a fund established, created or maintained for the benefit of members of one or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations shall file evidence with the director that the association or associations have been organized and maintained in good faith for purposes other than that of obtaining insurance; have been in active existence for at least one year; and have a constitution and bylaws that provide that: (i) The association or associations hold regular meetings not less than annually to further purposes of the members; (ii) Except for credit unions, the association or associations collect dues or solicit contributions from members; and (iii) The members have voting privileges and representation on the governing board and committees; and (B) Sixty days after the filing, the association or associations shall be considered to satisfy the organizational requirements, unless the director makes a finding that the association or associations do not satisfy those organizational requirements; or (d) A group other than as described in paragraphs (a), (b) and (c) of this subsection, subject to a finding by the director that: (A) The issuance of the group policy is not contrary to the best interest of the public; (B) The issuance of the group policy would result in economies of acquisition or administration; and (C) The benefits are reasonable in relation to the premiums charged. (5) “Long term care insurance” means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than 24 consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis; for one or more necessary or medically necessary services, including but not limited to nursing, diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care services, provided in a setting other than an acute care unit of a hospital. “Long term care insurance” includes group and individual annuities and life insurance policies or riders that provide directly or supplement long term care insurance. “Long term care insurance” also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity, and qualified long term care insurance contracts. Long term care insurance may be issued by insurers; fraternal benefit societies; nonprofit health, hospital and medical service corporations; prepaid health plans; or health maintenance organizations, health care service contractors or any similar organization to the extent they are otherwise authorized to issue life or health insurance. “Long term care insurance” does not include any insurance policy that is offered primarily to provide basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income or related asset protection coverage, catastrophic coverage