What plans do you regulate?
The Division of Financial Regulation regulates rates for small employer and individual health insurance plans. Small employers are those with 50 or fewer employees. Individual health plans are for the self-employed and others who are not covered through an employer and buy a plan on their own. This can be for one person or a family. The state does not regulate rates for large employers or public entities, such as a school district or the State of Oregon.
What is the timeline for reviewing 2016 proposed rates?
Insurers must file proposed rates by April 30, 2015, to sell small employer and individual health insurance plans for 2016. The division will post filings and tables comparing proposed rates by May 4. The division will make decisions on proposed rates by the beginning of July.
What is the difference between grandfathered plans and non-grandfathered plans?
You can find proposed rates for both grandfathered plans (GF) and non-grandfathered plans (NGF) on this website.
Grandfathered plans existed before the Affordable Care Act passed (March 23, 2010) and may not offer all of the consumer protections of ACA-compliant plans.
Non-grandfathered plans came into existence after the Affordable Care Act passed (March 23, 2010). There are two types of non-grandfathered plans:
- ACA-compliant plans. These plans were first offered in 2014 and meet all of the requirements of the Affordable Care Act. For example, they cover required benefits and have limits on out-of-pocket costs.
- Transitional plans. These plans were issued after the Affordable Care Act was passed, but before Jan. 1, 2014, when all of the law’s requirements took effect. Senate Bill 1582 allows insurers to continue coverage under these plans through 2015. In most cases, transitional plans do not cover many of the benefits that ACA-compliant plans offer.
How does rate review affect my premium?
Rate review approves a "base rate" for insurance company health plans plus the factors that determine the actual rate you pay. Your personal cost for health insurance may be more or less than the base rate. It depends on your age, how many family members are on the plan, where you live, and whether you use tobacco.
How can I shop for insurance?
Once rates are approved and open enrollment is under way, you can:
- Contact an insurance company.
- Go to healthcare.gov. Compare plans from multiple companies and see if you qualify for financial help.
- Contact an insurance agent.
How can I participate in rate review?
Click on the "new rate requests" tab after June 10 to find links to company rate requests. You will also find links to how you can comment about a rate request. Click on the "public hearings" button to see when rate hearings will be streamed live. You can also sign up for e-notify. We will email you when an insurance company files for new rates and when we post rate decisions.
How are health insurance rates set?
Rates must cover the cost of benefits plus the insurance company’s costs to operate without being overpriced.
What protects me from overpricing?
Companies must pay rebates to individual and small-group policyholders if they fail to spend at least 80 percent of premiums on medical care and quality improvement versus administrative costs. They must spend at least 85 percent of premiums on these activities in the large group market or pay a rebate. The division does not approve rate requests that anticipate rebates.
How can I afford coverage?
Many people qualify for financial help to pay the costs of private insurance sold through the federal exchange. Learn more at healthcare.gov.
Who can I contact if I have questions about rate review?
Contact our consumer rate liaison, Ethan Baldwin, at 503-947-7660 or email email@example.com.