75th OREGON LEGISLATIVE ASSEMBLY--2010 Special 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 118

                        Senate Bill 1029

Sponsored by Senators SHIELDS, EDWARDS, Representatives
  GREENLICK, HOLVEY; Senators BATES, ROSENBAUM, Representatives
  FREDERICK, KAHL, KOTEK, NATHANSON, RILEY (Presession filed.)

                             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.

  Requires Director of Department of Consumer and Business
Services to order insurer to pay attorney fees and costs to
consumer representative that contests health insurance premium
rate filing and substantially contributes to final order of
director. Requires director to determine if premium rates
proposed by insurer for health benefit plans for small employers
and individual health benefit plans satisfy specified criteria.
  Removes authority of director to exempt from public disclosure
rate filing materials of health benefit plan carriers.
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to health insurance premium rates; creating new
  provisions; amending ORS 743.018 and section 30, chapter 595,
  Oregon Laws 2009; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + The Director of the Department of Consumer and
Business Services shall order an insurer to pay the reasonable
attorney fees and costs of any person that requests a hearing
under ORS 731.240 to contest health insurance premium rates filed
in accordance with ORS 743.018 if the director finds that the
person:
  (1) Represents the interests of insureds who are subject to the
rates; and
  (2) Has made a substantial contribution to the adoption of any
final order by the director with respect to the rate filing. + }
  SECTION 2. ORS 743.018, as amended by section 31, chapter 595,
Oregon Laws 2009, 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 - }   { + to + }
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 { +  and this
section + }.

  (2)   { - Except as provided in ORS 743.737 and 743.760 and
subsection (3) of this section, - }   { + All materials submitted
as part of + } 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 - }  { +  no later than three days after + } 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 - }
 { +  shall + } 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)  { + The director by order shall approve, disapprove
or, + } 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) 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 3. Section 30, chapter 595, Oregon Laws 2009, is
amended to read:
   { +  Sec. 30. + }   { - Sections 28 and 29 of this 2009
Act - }  { +  ORS 743.019 and 743.020  + }and the amendments to
ORS 743.018 by   { - section 31 of this 2009 Act - }
 { + section 2 of this 2010 Act + } apply to rate filings
submitted to the Department of Consumer and Business Services on
or after April 1, 2010.
  SECTION 4.  { + This 2010 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2010 Act takes effect on its
passage. + }
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