Bill Text: OR SB413 | 2013 | Regular Session | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

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

Spectrum: Partisan Bill (Democrat 16-0)

Status: (Enrolled - Dead) 2013-07-08 - In conference committee upon adjournment. [SB413 Detail]

Download: Oregon-2013-SB413-Engrossed.html

---

     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 1299

                           A-Engrossed

                         Senate Bill 413
                 Ordered by the Senate March 28
           Including Senate Amendments dated March 28

Sponsored by Senator SHIELDS; Senator EDWARDS (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.

   { +  Requires insurer offering health benefit plans to provide
annual notice to policyholders and certificate holders of
specified information about Department of Consumer and Business
Services' rate review process and consumer advocacy unit. + }
  Limits public comment period for premium rate filings by
individual, portability or small employer health insurers to
health benefit plans offered by those insurers.
    { - Requires, if rate filing represents specified premium
rate increase, insurer to send notice to affected policyholders
and persons who requested notification. - }
  Requires Director of Department of Consumer and Business
Services to post to website of Department of Consumer and
Business Services detailed explanation for approval of any health
insurance rate filing that increases rates. Makes consideration
of certain criteria related to approval of such rate increases
mandatory.
   { +  Declares emergency, effective October 1, 2013. + }

                        A BILL FOR AN ACT
Relating to health insurance rate review; creating new
  provisions; amending ORS 742.003, 743.018 and 743.019; and
  declaring an emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. Section 2 of this 2013 Act is added to and made a
part of the Insurance Code.
  SECTION 2.  { + (1) At least annually, an insurer offering
health benefit plans, as defined in ORS 743.730, to individuals
and small employers shall send a notice to each individual and
small employer policyholder and certificate holder that contains:
  (a) Information about how the policyholder or certificate
holder may receive notice from the Department of Consumer and
Business Services about rate filings and public hearings on rate
filings.
  (b) The department's website address and the toll-free
telephone number of the department's consumer advocacy unit.
  (2) An insurer may satisfy the requirements of this section by:
  (a) Including the information, in a prominent manner, in a
mailing or an electronic communication of other insurance-related
information to the policyholder or certificate holder, including
but not limited to a policy renewal notice or enrollment
confirmation; or
  (b) Sending a separate notice that need not include information
related to the policy or certificate. + }
  SECTION 3. ORS 743.019 is amended to read:
  743.019. (1) When an insurer files  { + for approval by the
Director of the Department of Consumer and Business Services + }
a schedule or table of premium rates for  { + an + } individual,
portability or small employer health   { - insurance under ORS
743.018 - }  { +  benefit plan as defined in ORS 743.730 + }, the
director   { - of the Department of Consumer and Business
Services - }  shall open a 30-day public comment period on the
rate filing that begins on the date the insurer files the
schedule or table of premium rates. The director shall post all
comments to the website of the Department of Consumer and
Business Services without delay.
  (2) The director shall give written notice to an insurer
approving or disapproving a rate filing or, with the written
consent of the insurer, modifying a rate filing submitted under
ORS 743.018 no later than 10 business days after the close of the
public comment period. The notice shall comply with the
requirements of ORS 183.415.
   { +  (3) If the director approves a rate filing that increases
rates above the rates previously approved by the director for an
individual or small employer health benefit plan, the director
shall make available on the department's website a detailed
explanation of how the increased rates:
  (a) Meet standards described in ORS 743.018 (4) and (5); and
  (b) Are not subject to disapproval under ORS 742.005. + }
  SECTION 4. 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 - }
 { +  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) 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 5. ORS 742.003 is amended to read:
  742.003. (1) Except where otherwise provided by law, no basic
policy form, or application form where written application is
required and is to be made a part of the policy, or rider,
indorsement or renewal certificate form shall be delivered or
issued for delivery in this state until the form has been filed
with and approved by the Director of the Department of Consumer
and Business Services. This section does not apply to:
  (a) Forms of unique character which are designed for and used
with respect to insurance upon a particular risk or subject;
  (b) Forms issued at the request of a particular life or health
insurance policy owner or certificate holder and which relate to
the manner of distribution of benefits or to the reservation of
rights and benefits thereunder;
  (c) Forms of group life or health insurance policies, or both,
that have been agreed upon as a result of negotiations between
the policyholder and the insurer; or
  (d) Forms complying with specific requirements regarding
delivery or issuance for delivery in this state established by
the director by rule.
  (2)  { + Except as provided for rate filings under ORS
743.019, + } the director shall within 30 days after the filing
of any   { - such - } form approve or disapprove the form. The
director shall give written notice of   { - such action - }  { +
the approval or disapproval + } to the insurer proposing to
deliver   { - such - }  { +  the + } form and when a form is
disapproved the notice shall   { - show wherein such form - }
 { +  explain why the form + } does not comply with the law.
  (3) The 30-day period referred to in subsection (2) of this
section may be extended by the director for an additional period
not to exceed 30 days if the director gives written notice within
the first 30-day period to the insurer proposing to deliver the
form that the director needs   { - such - }  additional time for
the consideration of   { - such - }  { +  the + } form.
  (4) The director may at any time request an insurer to furnish
the director a copy of any form exempted under subsection (1) of
this section.
  SECTION 6.  { + 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 October 1,
2013. + }
                         ----------