OAR 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.