Or. Admin. Code § 836-053-1060

Current through Register Vol. 63, No. 10, October 1, 2024

Section 836-053-1060 - Definitions

For purposes of grievance procedures under OAR 836-053-1000 to 836-053-1200, and ORS 743.804:

(1) "Complaint" means an expression of dissatisfaction directly to an insurer that is about a specific problem encountered by an enrollee or about a decision by an insurer or by an insurance producer acting on behalf of the insurer and that includes a request for action to resolve the problem or change the decision. "Complaint" does not include an inquiry as that term is defined in this rule.

(2) "Inquiry" means a written request for information or clarification about any subject matter related to the enrollee's health benefit plan.

Or. Admin. Code § 836-053-1060

ID 1-1998, f. & cert. ef. 1-15-98; ID 8-2005, f. 5-18-05, cert. ef. 8-1-05; ID 23-2011, f. & cert. ef. 12-19-11

Stat. Auth.: ORS 731.244 & 743.819

Stats. Implemented: ORS 743.801 & 743.804