Proposed rules

Proposed rules

Rules affected: OAR 836-053-0013

Need for Rules:
ORS 743B.130 requires the Department of Consumer and Business Services (DCBS) to prescribe by rule the form, level of coverage, and benefit design for bronze and silver health benefit plans that must be offered by insurance carriers. These plans must meet federal requirements issued by the Department of Health and Human Services (HHS). Each year, HHS updates the actuarial value (AV) calculator used for determining coverage levels. Changes may include costs, plan designs, populations, developments in the function and operation of the AV calculator, and other actuarially relevant factors.

As a result of changes made to the federal AV calculator for 2021, the AV for the standard bronze and silver plans prescribed in OAR 836-053-0013 exceeded federal requirements. Failure to update the rule would result in DCBS requiring carriers to submit plans that are illegal with respect to federal law.

DCBS convened a Rulemaking Advisory Committee (RAC) that met on January 28, 2020. Representatives from consumer advocacy groups, insurers, and business groups participated in the RAC. Representatives from the agent community were invited but did not participate.

Filed: February 27, 2020

Public hearing: March 31, 2020, 11 a.m.

Last day for public comment: March 31, 2020, 5 p.m.

Documents

• Notice of proposed rulemaking

​Proposed rules

Rules affected: OAR 836-150-0040

Need for Rules:
These rules permanently adopt a change to the coinsurance rate that was used to calculate payments from the Oregon Reinsurance Program for the 2018 benefit year. The Division of Financial Regulation (DFR) previously issued a temporary rule that increased the program’s coinsurance rate for 2018 from 50 percent to 59.2 percent. This rule makes that change permanent. The higher coinsurance rate ensures that payments made by the Oregon Reinsurance Program for the 2018 benefit year align with the program’s total anticipated budget for 2018 of $90 million. The rules are necessary to ensure that the program achieves its statutory purposes of stabilizing rates and premiums for individual health benefit plans and providing greater financial certainty to consumers of health insurance in this state.

DFR previously convened a Reinsurance Rules Advisory Committee (RAC) consisting of health insurers and consumer advocates. The division solicited comment from the RAC on these rules via email.

Filed: February 26, 2020

Public hearing: March 31, 2020, 1 p.m.

Last day for public comment: March 31, 2020, 5 p.m.

Documents

• Notice of proposed rulemaking