Bill Text: OR HB3037 | 2013 | Regular Session | Introduced

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Bill Title: Relating to health insurance; declaring an emergency.

Sponsorship: Partisan Bill (Democrat 6)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [HB3037 Detail]

Download: Oregon-2013-HB3037-Introduced.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 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 2083

                         House Bill 3037

Sponsored by Representative FREDERICK; Representatives BARTON,
  BOONE, DOHERTY, GREENLICK, WILLIAMSON

                             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.

  Prohibits Director of Department of Consumer and Business
Services from approving rate filing for health benefit plan that
reimburses serious adverse events. Defines 'serious adverse
event. '
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to health insurance; creating new provisions; amending
  ORS 743.018; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 743.018 is amended to read:
  743.018. (1) Except for group life and health insurance, and
except as provided in ORS 743.015, every insurer shall file with
the Director of the Department of Consumer and Business Services
all schedules and tables of premium rates for life and health
insurance to be used on risks in this state, and shall file any
amendments to or corrections of such schedules and tables.
Premium rates are subject to approval, disapproval or withdrawal
of approval by the director as provided in ORS 742.003, 742.005
and 742.007.
  (2) Except as provided in ORS 743.737 and 743.760 and
subsection (3) of this section, a rate filing by a carrier for
any of the following health benefit plans subject to ORS 743.730
to 743.773 shall be available for public inspection immediately
upon submission of the filing to the director:
  (a) Health benefit plans for small employers.
  (b) Portability health benefit plans.
  (c) Individual health benefit plans.
  (3) The director may by rule:
  (a) Specify all information a carrier must submit as part of a
rate filing under this section; and
  (b) Identify the information submitted that will be exempt from
disclosure under this section because the information constitutes
a trade secret and would, if disclosed, harm competition.
  (4) The director, after conducting an actuarial review of the
rate filing, may approve a proposed premium rate for a health
benefit plan for small employers or for an individual health
benefit plan if, in the director's discretion, the proposed rates
are:
  (a) Actuarially sound;
  (b) Reasonable and not excessive, inadequate or unfairly
discriminatory; and
  (c) Based upon reasonable administrative expenses.
  (5) In order to determine whether the proposed premium rates
for a health benefit plan for small employers or for an
individual health benefit plan are reasonable and not excessive,
inadequate or unfairly discriminatory, the director may consider:
  (a) The insurer's financial position, including but not limited
to profitability, surplus, reserves and investment savings.
  (b) Historical and projected administrative costs and medical
and hospital expenses.
  (c) Historical and projected loss ratio between the amounts
spent on medical services and earned premiums.
  (d) Any anticipated change in the number of enrollees if the
proposed premium rate is approved.
  (e) Changes to covered benefits or health benefit plan design.
  (f) Changes in the insurer's health care cost containment and
quality improvement efforts since the insurer's last rate filing
for the same category of health benefit plan.
  (g) Whether the proposed change in the premium rate is
necessary to maintain the insurer's solvency or to maintain rate
stability and prevent excessive rate increases in the future.
  (h) Any public comments received under ORS 743.019 pertaining
to the standards set forth in subsection (4) of this section and
this subsection.
   { +  (6)(a) The director may not approve a proposed premium
rate for any health benefit plan as defined in ORS 743.730 unless
the carrier submitting the rate filing certifies that, in the
carrier's contracts with providers and other business
arrangements, the carrier does not reimburse for serious adverse
events and does not allow the provider to bill an insured for a
serious adverse event.
  (b) As used in this subsection, 'serious adverse event ' means
a health care service that is not covered by Medicare because the
service is related to a health care acquired condition. + }
    { - (6) - }  { +  (7) + } With the written consent of the
insurer, the director may modify a schedule or table of premium
rates filed in accordance with subsection (1) of this section.
    { - (7) - }  { +  (8) + } The requirements of this section do
not supersede other provisions of law that require insurers,
health care service contractors or multiple employer welfare
arrangements providing health insurance to file schedules or
tables of premium rates or proposed premium rates with the
director or to seek the director's approval of rates or changes
to rates.
  SECTION 2.  { + The amendments to ORS 743.018 by section 1 of
this 2013 Act apply to rate filings for periods of coverage that
begin on or after the effective date of this 2013 Act. + }
  SECTION 3.  { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
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