Bill Text: OR HB3033 | 2011 | Regular Session | Introduced
Bill Title: Relating to Oregon Medical Insurance Pool assessment.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Failed) 2011-06-30 - In committee upon adjournment. [HB3033 Detail]
Download: Oregon-2011-HB3033-Introduced.html
76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 3219
House Bill 3033
Sponsored by Representative DEMBROW
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Reduces Oregon Medical Insurance Pool assessment for
reinsurers.
A BILL FOR AN ACT
Relating to Oregon Medical Insurance Pool assessment; amending
ORS 735.614.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 735.614 is amended to read:
735.614. (1) If the Oregon Medical Insurance Pool Board
determines at any time that funds in the Oregon Medical Insurance
Pool Account are or will become insufficient for payment of
expenses of the pool in a timely manner, the board shall
determine the amount of funds needed and shall impose and collect
assessments against insurers, as provided in this section, in the
amount of the funds determined to be needed.
(2) Each insurer's assessment shall be determined by
multiplying the total amount { - to be assessed - } { + of
funds needed under subsection (1) of this section + } by a
fraction { - , - } { + . + } The numerator of { - which - }
{ + the fraction + } equals the { + sum of that insurer's
total + } number of Oregon { - insureds and certificate holders
insured or reinsured by each insurer, and - } { + covered
lives, excluding those that are reinsured, plus 10 percent of the
number of that insurer's Oregon covered lives that are
reinsured. + } The denominator of { - which - } { + the
fraction + } equals the { + sum of the + } total { + number of
Oregon covered lives insured by all insurers in this state,
excluding the covered lives that are reinsured, plus 10 percent
of the total number of Oregon covered lives that are reinsured by
all insurers in this state. The number of covered lives shall be
determined as of March 31 of each year. + } { - of all Oregon
insureds and certificate holders insured or reinsured by all
insurers, all determined as of March 31 each year. - }
(3) The board shall ensure that each { - insured and
certificate holder - } { + covered life + } is counted only
once with respect to any assessment. For that purpose, the board
shall require each insurer that obtains reinsurance for its
{ - insureds and certificate holders - } { + covered lives + }
to include in its count { - of insureds and certificate holders
all insureds and certificate holders whose coverage is - } { +
all of the covered lives that are + } reinsured in whole or part.
The board shall allow an insurer { - who - } { + that + } is
a reinsurer to exclude from its { - number of insureds
those - } { + count all of the covered lives + } that have been
counted by the primary insurer or the primary reinsurer for the
purpose of determining { - its - } { + the amount of the
primary insurer's or primary reinsurer's + } assessment under
this subsection.
(4) All insurers authorized to transact medical insurance in
Oregon and that insure persons residing in Oregon are subject to
the assessment under this section. Insureds under the following
types of coverage, as defined by rule by the board, are
{ - excluded - } { + not counted as covered lives + } in the
calculation of the assessment:
(a) Medicaid;
(b) State Children's Health Insurance Program;
(c) Medicare;
(d) Disability income insurance;
(e) Hospital only insurance;
(f) Dental insurance;
(g) Vision only insurance;
(h) Accident only insurance;
(i) Automobile insurance;
(j) Specific disease insurance;
(k) Medical supplemental plans;
(L) TRICARE;
(m) CHAMPUS;
(n) Prescription drug only plans;
(o) Long term care insurance; and
(p) Federal Employees Health Benefits Program.
(5) If assessments exceed the amounts actually needed, the
excess shall be held and invested and, with the earnings and
interest, used by the board to offset future net losses or to
reduce pool premiums. For purposes of this subsection, 'future
net losses' includes reserves for claims incurred but not
reported.
(6) Each insurer's proportion of participation in the pool
shall be determined by the board based on annual statements and
other reports deemed necessary by the board and filed by the
insurer with the board. The board may use any reasonable method
of estimating the number of { - insureds and certificate
holders - } { + covered lives + } of an insurer if the specific
number is unknown. With respect to insurers that are reinsurers,
the board may use any reasonable method of estimating the number
of { - persons insured by - } { + covered lives for + } each
reinsurer.
(7) The board may abate or defer, in whole or in part, the
assessment of an insurer if, in the opinion of the board, payment
of the assessment would endanger the ability of the insurer to
fulfill the insurer's contractual obligations. In the event an
assessment against an insurer is abated or deferred in whole or
in part, the amount by which the assessment is abated or deferred
may be assessed against the other insurers in a manner consistent
with the basis for assessments set forth in this section. The
insurer receiving the abatement or deferment shall remain liable
to the board for the deficiency for four years.
(8) The board shall abate or defer assessments authorized by
this section if a court orders that assessments cannot be made
applicable to reinsurers. However, if a court orders that
assessments cannot be made applicable to reinsurers, the board
may continue to assess insurers to the end of the biennium in
which the determination is made { + using the number of covered
lives that are not reinsured on a statewide basis and for each
insurer subject to the assessment + }.
(9) Subject to the approval of the Director of the Oregon
Health Authority, the board may develop a program for adjusting
the assessment of an insurer in the individual health benefits
market based on that insurer's contribution to reducing the
enrollment in the Oregon Medical Insurance Pool. When developing
the program, the board may consider, but is not limited to, the
following factors:
(a) The insurer's level of participation;
(b) Level of health benefit plan coverage offered; and
(c) Assumption of risk in the individual health benefits
market.
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