Current through Register Vol. 63, No. 9, September 1, 2024
(1) The
notice required by ORS
743B.310(2) to
the individual whose coverage is rescinded must be in writing and include all
of the following:
(a) Clear identification of
the alleged fraudulent act, practice or omission or the intentional
misrepresentation of material fact underlying the rescission.
(b) An explanation as to why the act,
practice or omission was fraudulent or was an intentional misrepresentation of
a material fact.
(c) A statement
informing the individual of any right the individual has to file a grievance or
to request a review of the decision to rescind coverage.
(d) A description of the health carrier's
grievance procedures, including any time limits applicable to those procedures
if such procedures are available to the individual.
(e) A statement explaining that complaints
relating to the notice of rescission required by ORS
743B.310(2) may
be made with the Department of Consumer and Business Services by writing to the
departement at PO Box 14480, Salem, OR 97309-0405; by calling 503-947-7984 or
toll-free 888-877-4894; online at dfr.oregon.gov; or by electronic mail to
DFR.InsuranceHelp@dcbs.oregon.gov. The statement shall also explain at such
complaints to the Department of Consumer and Business Services do not
constitute grievances under the health benefit plan or health insurance policy
and may not preserve an enrollee's rights under the plan or policy.
(f) The toll-free customer service number of
the insurer.
(g) The effective date
of the rescission and the date back to which the coverage will be
rescinded.
(2) Subject
to ORS 743.777, a health carrier may
provide the notice required under ORS
743B.310(2) for
individual health insurance either by first class mail or
electronically.
(3)
(a) On or before June 30 of each calendar
year, an insurer must submit an electronic notice for the preceding calendar
year in the format prescribed by the director of the Department of Consumer and
Business Services and in accordance with instructions set forth on the website
of the Division of Financial Regulation of the Department of Consumer and
Business Services at dfr.oregon.gov. The notice required by ORS
743B.310(4)
must include information related to rescission of individual health benefit
plans and individual health insurance policies including but not limited to the
total number of:
(A) Fully rescinded
individual health benefit plans and individual health insurance
policies;
(B) Partially rescinded
individual health benefit plans and health insurance policies;
(C) Individual health benefit plans and
individual health insurance policies in force on December 31 of the report
year; and
(D) Enrollees affected by
full or partial rescission of an individual health benefit plan or individual
health insurance policy.
(b) The notice required under this section
may be combined with the notice required under OAR
836-053-0825 and OAR
836-053-0835.
(4) A health carrier may not
rescind coverage for fraud if an individual fails to accurately comply with the
requirement to provide reasonable assurance that pediatric dental coverage is
separately provided.
Statutory/Other Authority: ORS
731.244 & ORS
743B.310
Statutes/Other Implemented: ORS
743B.310 & ORS
743B.003
