Current through Register Vol. 63, No. 12, December 1, 2024
(1) Unless data submitted to the Director
under OAR 836-060-0043 justify a higher
rate in the Director's opinion, credit health insurance premium rates for the
insured portion of an indebtedness repayable in equal monthly installments,
where the insured portion of the indebtedness decreases uniformly by the amount
of the monthly installment paid, shall not exceed the rates ("prima facie"
rates) set forth in subsections (a) and (b) of this section. Subsections (c),
(d) and (e) of this section prescribe the corresponding "prima facie" premium
rates for other types of credit health insurance benefits. The prima facie
premium rates are as follows:
(a) As set
forth in Tables 1 and 2, if premiums are payable on a single premium basis for
the duration of the coverage;
(b)
As set forth in Tables 1 and 2, if premiums are payable on a monthly
outstanding insured indebtedness basis for a closed-end loan;
(c) The actuarial equivalent of the rates
specified in subsections (a) and (b) of this section, if the coverage provided
is a constant maximum indemnity for a given period of time;
(d) An appropriate combination of the premium
rate for a constant maximum indemnity for a given period of time and the
premium rate for a maximum indemnity which decreases in even amounts per month,
if the coverage provided starts as a constant maximum indemnity for a given
period of time after which the maximum indemnity begins to decrease in even
amounts per month;
(e) For credit
health insurance on an open-end credit account, per $1,000 of outstanding
insured indebtedness, the following rates shall apply to the following minimum
benefit plans:
(A) 14-day nonretroactive plan
-- $1.66-$1.49 if underwritten;
(B)
30-day nonretroactive plan -- $1.40-$1.26 if underwritten;
(C) 14-day retroactive plan -- $1.89-$1.70 if
underwritten;
(D) 30-day
retroactive plan -- $1.74-$1.57 if underwritten;
(f) For other benefits, except for benefits
described in section (2)(g) of this rule, rates shall be actuarially consistent
with the rates specified in this section;
(g) For critical period credit health
coverage, maximum rates shall be computed by using the conversion ratios based
on the 1974 Basic Tables of Credit A & H Claim Costs published by National
Association of Insurance Commissioners, NAIC Proceedings, 1975 Volume 1, pp.
676-691, and the extension as published in 1970 Volume 1, pp. 332-333. The
factors are published in Exhibit 2.
(2) The premium rates in section (1) of this
rule shall apply to credit health insurance policies issued without
underwriting or with underwriting for conditions with a high potential of
resulting in permanent disablement, and offered to all eligible debtors. Such
policies:
(a) Shall not contain a provision
excluding or denying a claim for disability resulting from preexisting
conditions except for those conditions for which the insured debtor received
medical diagnosis or treatment within six months preceding the effective date
of the debtor's coverage and which caused loss that commences within six months
immediately following the effective date of coverage. For purposes of this
subsection:
(A) Except as provided in
paragraph (B) of this subsection, the effective date of insurance coverage
applicable to an indebtedness is the date on which the individual policy or
certificate of coverage was first issued; and
(B) An individual policy for an open-end plan
or a certificate of coverage under a group policy for an open-end plan may
provide that the effective date of coverage of a specific advance or charge,
for the amount in excess of the first $3,000 of account balance, is the date of
the specific advance or charge;
(b) Shall not contain any other provision
that excludes or restricts liability in the event of disability caused in a
specified manner, except that the policy may contain provisions excluding or
restricting coverage in the event of normal pregnancy and intentionally
self-inflicted injuries;
(c) May
contain an "actively at work test" only if the test applies solely when
coverage is issued. Such a test shall not require that the debtor be employed
more than 30 hours per week or deny coverage because the debtor is unemployed
solely due to seasonal layoff;
(d)
Shall not contain age restrictions other than age restrictions only making
ineligible for coverage debtors 66 or over at the time the indebtedness is
incurred and may provide that all insurance will terminate upon attainment by
the debtor of a specified age not less than 66 years;
(e) Shall contain a daily benefit equal in
amount to one-thirtieth of the monthly benefit payable under the policy for the
indebtedness;
(f) Shall contain a
definition of "disability" providing that during the first 18 months of
disability the insured shall be unable to perform the duties of the insured's
occupation at the time the disability occurred, and thereafter the duties of
any occupation for which the insured is reasonably fitted by education,
training, or experience. This subsection shall not apply to lump-sum disability
coverage;
(g) May contain other
additional benefits to policyholders and their debtors, such as dismemberment,
partial disability and other benefits of small economic value to the consumer,
but an insurer shall not pass on the charge for such coverage to the debtor so
as to increase the total rate to exceed the rate established by this rule;
and
(h) Shall not contain a
requirement of regular physician care unless the care is medically necessary
for determination of continued disability.
(3) The rates under section (1)(e) of this
rule may be used as a composite rate for a benefit pay-off duration not to
exceed 48 months. The percentage of monthly benefit must include accruing
interest and charges. For durations greater than 48 months, rates filed must
include actuarial development and adjustments consistent with this
basis.
Exhibits and Tables referenced are available from the
agency.
Stat. Auth.: ORS
731.244
Stats. Implemented: ORS
742.003 & ORS
742.005(6)(c)
