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Rate regulation

The division reviews and approves health insurance rates in the individual and small group markets. Health insurance rates are not regulated for large groups with 51 or more employees. In this market, competition plays a more significant role in keeping rates reasonable. In addition, large groups tend to be more sophisticated purchasers of insurance and or use insurance brokers.

In Oregon, health insurance rate filings must include actuarial documentation. Oregon law (ORS 742.005) provides that rate filings will be denied if the filings are deemed "prejudicial to the interests of the insured's policyholders," if the filings contain "provisions which are unjust, unfair, or inequitable," or, most significantly, if the "benefits … are not reasonable in relation to the premium charged."

Division actuaries rely on these laws to answer two basic questions about each rate filing: Is the aggregate rate request justified? Is the request fairly allocated among the ratepayers?

Below are the key factors the division uses to determine if the overall rate request is actuarially justified:

Click on a factor to see information.

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