Bill Text: OR SB515 | 2013 | Regular Session | Introduced

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Bill Title: Relating to health insurance rate review.

Spectrum: Committee Bill

Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB515 Detail]

Download: Oregon-2013-SB515-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 1298

                         Senate Bill 515

Sponsored by COMMITTEE ON GENERAL GOVERNMENT, CONSUMER AND SMALL
  BUSINESS PROTECTION

                             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.

  Authorizes Director of Department of Consumer and Business
Services to conduct public meeting on insurer's request for
approval of premium rates for individual or small employer health
benefit plan.
  Requires director to conduct public meeting on rate request if
filing proposes seven percent or greater increase in rates and
affects 1,000 or more policyholders. Requires director to certify
intervenor that meets specified criteria for purposes of
proceedings. Authorizes director to conduct public hearing and
requires public hearing on request of certified
intervenor. Provides that insurer has burden of proving that rate
filing satisfies requirements. Requires that director act on rate
filing by 90th day after beginning of public comment period or
filing is deemed disapproved.

                        A BILL FOR AN ACT
Relating to health insurance rate review; amending ORS 742.003,
  743.018, 743.019 and 743.020.
  Whereas the State of Oregon, through its regulation of health
insurance, has an obligation to balance the needs of individual
and small group policyholders and the needs of insurers; now,
therefore,
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 - }
 { + 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 2. 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 may conduct a public meeting, in
accordance with the provisions of ORS 192.610 to 192.690, on any
filing with respect to an individual or small employer health
benefit plan submitted under subsection (1) of this section.
  (3)(a) The director shall conduct a public meeting, in
accordance with the provisions of ORS 192.610 to 192.690, on any
filing with respect to an individual or small employer health
benefit plan submitted under subsection (1) of this section if:
  (A) The filing proposes an average annual increase to the
premium rates charged by the insurer of seven percent or greater;
and
  (B) The rate increase affects 1,000 or more policyholders.
  (b) The purpose of a public meeting conducted under this
subsection is to obtain additional information necessary for the
director to determine if the proposed premium rates meet the
requirements of ORS 743.018 (4) and that there are no grounds for
disapproval under ORS 742.005. An actuary for the insurer or
other representative of the insurer who is knowledgeable about
the details of the filing must appear at the public meeting to
answer questions.
  (4) The director shall certify any of the following individuals
or groups to formally participate in any proceedings under this
section as intervenors:
  (a) A group of 10 or more policyholders who will be affected by
the premium rates in the filing and who jointly apply, in
writing, to intervene.
  (b) An association with 10 or more members who are
policyholders who will be affected by the premium rates in the
filing and who jointly apply, in writing, to intervene.
  (c) An office of health insurance consumer assistance or
ombudsman described in 42 U.S.C. 300gg-93 or similar consumer
assistance organization or ombudsman.
  (5) A certified intervenor shall have access to all information
described in ORS 743.018 (3), 743.737 (10) and 743.760 (10) to
the same extent as and subject to no greater restrictions on
access than are imposed on the department. An insurer must
respond to any requests for information from the director or a
certified intervenor no later than the 20th day after the
beginning of the public comment period on the filing.
  (6) No later than 10 days after the close of the public comment
period and with at least 10 days' advance notice to the insurer,
the director may, or upon the request of a certified intervenor
shall, conduct a public hearing. At any public hearing held under
this subsection, the insurer shall have the burden of proving
that the proposed premium rates meet the requirements of ORS
743.018 (4) and that there are no grounds for disapproval under
ORS 742.005. + }
    { - (2) - }  { +  (7) + } 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 - }  { + 90 days after the beginning + } of the
public comment period  { + if the insurer has provided all
necessary information to the director + }.  The notice shall
comply with the requirements of ORS 183.415.  { + If the director
does not approve or modify a rate filing by the 90th day after
the beginning of the public comment period, the rate filing shall
be deemed disapproved.
  (8) The director shall give written notice of the approval,
modification or disapproval of a rate filing to:
  (a) Any certified intervenors in the proceedings; and
  (b) Any person that submitted public comments during the public
comment period for the filing.
  (9) A certified intervenor shall be reimbursed by the insurer
for reasonable expenses incurred for expert testimony presented
at proceedings under this section, not to exceed $10,000 for each
filing. + }
  SECTION 3. ORS 743.020 is amended to read:
  743.020. An insurer licensed by the Department of Consumer and
Business Services shall include   { - in - }  { +  with + } any
 { - rate filing under ORS 743.018 - }   { + schedule or table of
premium rates filed for approval by the Director of the
Department of Consumer and Business Services  + }with respect to
individual and small employer health   { - insurance policies - }
 { + benefit plans, as defined in ORS 743.730, + } a statement of
administrative expenses in the form and manner prescribed by the
department by rule. The statement must include, but is not
limited to:
  (1) A statement of administrative expenses on a per member per
month basis; and
  (2) An explanation of the basis for any proposed premium rate
increases or decreases.
  SECTION 4. 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 in ORS 743.019 with respect to rate
filings, + } 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 - }  { +  approval
or disapproval + } to the insurer proposing to deliver
 { - such - }  { +  the + } form and when a form is disapproved
the notice shall   { - show wherein such - }  { +  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.
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