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A health policy contract or form refers to the documents that describe the benefits of a health insurance policy (as opposed to the rates that address the charge for those benefits). The division reviews all individual and group health policy forms to ensure they include all the required policy language and provisions necessary to constitute a complete insurance policy. This includes the mandated benefits required by Oregon law and by the Affordable Care Act.
The division disapproves forms that do not comply with the law or that contain provisions that are unjust, unfair, or inequitable. While insurance policies for large groups of 51 or more are not subject to rate regulation by the division, insurers must file policy forms for approval and provide all mandated health benefits for all group insurance plans. An exception to the filing requirement for group health forms exists for policies that are negotiated and unique to a particular group. These forms, however, must still include benefit mandates and comply with insurance regulations.
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