§734.790(2) Except as limited by ORS 734.750 to 734.890 , the association shall provide coverage to the persons specified in subsection (1) of this section for direct nongroup life or health insurance policies or annuity contracts, for certificates under direct group policies or contracts, and for supplemental contracts to any of these, in each case issued by member insurers. Amended effective 5/27/2011.
§734.790(3)(a) That portion of any policy or contract not guaranteed by the member insurer or under which the risk is borne by the policyholder or contract owner. (b) Any policy or contract or part thereof assumed by the impaired or insolvent insurer under a contract of reinsurance, other than reinsurance for which assumption certificates have been issued. (c) Any policy or contract issued by a health care service contractor complying with ORS 750.005 to 750.095. (d) Any policy or contract issued by a fraternal benefit society. (e) Any portion of a policy or contract to the extent that the interest rate on which the policy or contract is based , or to the extent that the interest rate, crediting rate or similar factor determined by use of an index or other external reference stated in the policy or contract for the purpose of calculating returns or changes in value: (A) Exceeds, when averaged over the period of four years prior to the date on which the member insurer becomes either an impaired or insolvent insurer under ORS 734.750 to 734.890, whichever occurs first, a rate of interest determined by subtracting four percentage points from Moody's Corporate Bond Yield Average averaged for that same four-year period or for a lesser period if the policy or contract was issued less than four years before the member insurer becomes either an impaired or insolvent insurer under ORS 734.750 to 734.890, whichever occurred first; and (B) Exceeds, on and after the date on which the member insurer becomes either an impaired or insolvent insurer under ORS 734.750 to 734.890, whichever occurs first, the rate of interest determined by subtracting three percentage points from Moody's Corporate Bond Yield Average as most recently available. (f) Any portion of a policy or contract issued to a plan or program of an employer, association or similar entity to provide life insurance health insurance or annuity benefits to its employees or members to the extent that the plan or program is self-funded or uninsured, including benefits payable by an employer, association or similar entity under any of the following: (A) A multiple employer welfare arrangement as defined in section 3(40)(29 U.S.C. 1002(40)) of the Employee Retirement Income Security Act of 1974, as amended. (B) A minimum premium group insurance plan. (C) A stop-loss group insurance plan. (D) An administrative services only contract. (g) Any portion of a policy or contract to the extent that it provides dividends or experience rating credits or voting rights, or provides that any fees or allowances be paid to any person, including the policyholder or contract owner, in connection with the service to or administration of the policy or contract. (h) Any policy or contract issued in this state by a member insurer at a time that it the insurer did not have a certificate of authority to issue the policy or contract in this state. (i) Any unallocated annuity contract issued to or in connection with an employee benefit plan protected under the federal Pension Benefit Guaranty Corporation , regardless of whether the federal Pension Benefit Guaranty Corporation has yet become liable to make any payments with respect to the benefit plan. (j) Any portion of any unallocated annuity contract that is not issued to or in connection with a government retirement plan referred to in subsection (1) of this section, or a government lottery. (k) Any coverage issued by the Oregon Medical Insurance Pool. (l) Any portion of a policy or contract to the extent that the assessments required by ORS 734.815 with respect to the policy or contract are preempted by federal or state law. (m) An obligation that does not arise under the express written terms of the policy or contract issued by the insurer to the policyholder or contract owner, including but not limited to: (A) Claims based on marketing materials; (B) Claims based on side letters, riders or other documents that were issued by the insurer without meeting applicable policy or contract form filing or approval requirements; (C) Misrepresentations of, or regarding, policy or contract benefits; (D) Extracontractual claims, including but not limited to claims related to bad faith in the payment of claims, punitive or exemplary damages or attorney fees or costs; or (E) A claim for penalties or consequential or incidental damages. (n) A contractual agreement that establishes the member insurer's obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee that in either case is not an affiliate of the member insurer. (o) Any portion of a policy or contract to the extent that portion provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but the changes in value have not been credited to the policy or contract, or as to which the policyholder's or contract owner's rights are subject to forfeiture, as of the date on which the member insurer becomes either an impaired or insolvent insurer, whichever occurs first. If the interest or changes in value in a policy or contract are credited less frequently than annually, for purposes of determining the values that have been credited and are not subject to forfeiture under this paragraph, the interest or change in value that is determined by using the procedures specified in the policy or contract shall be credited as if the contractual date of crediting interest or changing value was the date of the impairment or insolvency, whichever is earlier, and may not be subject to forfeiture. (p) Any policy or contract providing any hospital, medical, prescription drug or other health care benefits under Part C or Part D of subchapter XVIII, chapter 7, Title 42 of the United States Code, or any regulations issued under those provisions. Amended effective 5/27/2011.
§734.790(1)(b). Yes. Covers nonresidents only if the following conditions are met: (A) The insurer that issued the policy or contract must be a member insurer. (B) The state in which the person resides must have an association similar to the Oregon Life and Health Insurance Guaranty Association. (C) The person must not be eligible for coverage by an association in the state in which the person resides, as described in subparagraph (B) of this paragraph , due to the fact that the insurer was not authorized to transact insurance or licensed in that state at the time specified in the state's guaranty association law. Amended effective 5/27/2011.
§734.810(1) If a domestic member insurer is an impaired insurer. Amended effective 5/27/2011.
§734.810(2) If a member insurer is an insolvent insurer.
No separate provision.
§734.760(6) “Impaired insurer” means a member insurer that is subject to an order of rehabilitation under ORS 734.063 or an order of conservation under ORS 734.200 after September 13, 1975. “Impaired insurer” does not include an insolvent insurer. Amended effective 5/27/2011.
§734.760(7) “Insolvent insurer” means a member insurer that, after September 13, 1975, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency. Amended effective 5/27/2011.
§ 734.760(9)(a) “Member insurer” means any insurer currently authorized to transact in this state any kind of insurance to which ORS 734.750 to 734.890 apply , regardless of whether the insurer's authorization to transact insurance was, in the past, suspended, revoked, not renewed or voluntarily withdrawn. (b) “Member insurer” does not include: (A) A hospital or medical service organization, whether for-profit or nonprofit; (B) A health maintenance organization; (C) A fraternal benefit society; (D) A mandatory state pooling plan; (E) A mutual assessment company or other person that operates on an assessment basis; (F) An insurance exchange; or (G) An organization that has a certificate of authority limited to the issuance of charitable gift annuities under ORS 731.038. Amended effective 5/27/2011.
§734.815(5). Two percent (2%) of premiums in state for policies covered by each account.
§734.815(2). Two classes of assessments: Class A for administrative costs, legal costs and other general expenses whether or not related to a particular impaired or insolvent insurer; and Class B to carry out the powers and duties of the association with regard to an impaired or insolvent insurer.