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.
Statutory/Other Authority
ORS 731.244 & 743.819
Statutes/Other Implemented
ORS 743.801 & 743.804
History
ID 12-2013, f. 12-31-13, cert. ef. 1-1-14
ID 23-2011, f. & cert. ef. 12-19-11
ID 8-2005, f. 5-18-05, cert. ef. 8-1-05
ID 1-1998, f. & cert. ef. 1-15-98