Division 052

OAR Chapter 836

Division 052 Exhibits, appendixes, forms, attachments

836-052-0143
Attachment 1 (Medicare Supplement Guaranteed Issue Replacement Matrix)

• For plan years before 2020
• For plan Years Beginning January 1, 2020

836-052-0145
Exhibit 1

836-052-0160
Exhibit 1
Appendix C

836-052-0165
Exhibit 1

836-052-0185
Exhibit 1

836-052-0531
Exhibit 1 – Form 440-4776
Exhibit 2 – Form 440-4772
Exhibit 3 – Form 440-4773
Exhibit 4 – Form 440-4769

836-052-0556
Exhibit 1
Exhibit 2

836-052-0576
Exhibit 1

836-052-0626 (formerly 836-052-0615)
Exhibit 1
Exhibit 2

836-052-0636
LTC Claims Denial Reporting Form – Form 440-2500
Long-Term Care Insurance Replacement & Lapse Reporting Form – Form 440-2735

836-052-0726
Exhibit 1
Exhibit 2

836-052-0746
Table – 836-052-0746(4)(c)
Table - 836-052-0746(4)(d)

836-052-0776
LTC Outline of Coverage – Form 440-2571