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Medicare supplement

Filing requirements

  1. NAIC Transmittal Form, instructions, and Product Code matrices for completing transmittal forms
  2. Instructions for the Filing Description on the Transmittal (cover letter)
  3. Certificate of Compliance: Word | PDF
  4. Product standards for policies issued prior to June 2010: Word | PDF Product standards for 2010 policies: Word | PDF
  5. Readability Certification
  6. Appendix A with Actuarial Memorandum: Word | PDF

Annual Medicare Supplement Refund Calculation Report

Insurers that offer Medicare Supplement policies are required under OAR 836-052-0145(2)(a) to submit a Medicare Supplement Refund Calculation Report by May 31 each year. The reports should not be submitted via SERFF.

The division offers electronic submission if the following guidelines are followed:

  • Reports will be submitted via email to dcbs.ratesforms@oregon.gov.
  • Secure emails requiring a password for us to access the email will not be accepted.
  • Reports should be in .pdf format. We cannot accept .zip files.
  • No one pdf should be over 3MB.
  • All .pdf's should be compressed for size.
  • Reports should be separated by type.
    • Individual and group must be separate.
    • Pre-Standard plans are separate from all others.
    • For 1990 and 2010 plans, separate by plan, but pool each 1990 plan with its corresponding 2010 plan:
      • Plan A
      • Plan B
      • Plan C
      • But pool F high deductible with regular F plan.
      • Also pool J high deductible with regular J plan.

Any questions can be directed to Elizabeth McMahon at 503-947-7001 or email: elizabeth.a.mcmahon@oregon.gov

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