Or. Admin. Code § 836-075-0045

Current through Register Vol. 63, No. 12, December 1, 2024

Section 836-075-0045 - Format and Instructions for Report Required by ORS 743.818

(1) As used in this rule:

(a) "Covered lives" means Oregon residents who are employees, dependents of employees, or individuals otherwise eligible for an individual, student health, association, group or self-insured group health benefit plan or other benefit plan for which reporting is required and who are enrolled for coverage under the terms of the plan as of the close of the calendar quarter.

(b) "Third party administrator" means a third party administrator licensed under ORS 744.702.

(c) "Zip code" means the 5-digit code:

(A) Of the employee or individual policyholder's Oregon residence;

(B) Of an Oregon employer group covered by a stop loss policy; or

(C) In circumstances for which an Oregon zip code does not exist, the placeholder code established by the director of the Department of Consumer and Business Services and set forth on the website of the Division of Financial Regulation of the Department of Consumer and Business Services at dfr.oregon.gov.

(2) At quarterly intervals covering each year, a third party administrator must submit information pertaining to covered lives through the reporting system of the Division of Financial Regulation in the format established by the director and in accordance with instructions set forth on the website of the Division of Financial Regulation at dfr.oregon.gov. The third party administrator must submit the required information on or before:

(a) May 1 for the first calendar quarter.

(b) August 1 for the second calendar quarter.

(c) November 1 for the third calendar quarter.

(d) February 1 for the fourth calendar quarter.

(3) A third party administrator claiming exemption from reporting must request an exemption through the reporting system of the Division of Financial Regulation on or before the due date for the calendar quarter for which reporting is first due.

(4) A third party administrator submitting information pertaining to covered lives or requesting an exemption from reporting is subject to the electronic reporting or response requirements of OAR 836-011-0005.

Or. Admin. Code § 836-075-0045

ID 12-2013, f. 12-31-13, cert. ef. 1-1-14; ID 44-2023, minor correction filed 07/24/2023, effective 7/24/2023

Statutory/Other Authority: ORS 731.244, 743.745 & ORS 743.818

Statutes/Other Implemented: ORS 743.818