Adopt: 836-053-0015, 836-053-1500, 836-053-1505, 836-053-1510
Amend: 836-010-0013, 836-052-1000, 836-053-0010, 836-053-0021,
836-053-0030, 836-053-0050, 836-053-0066, 836-053-0230, 836-053-0410, 836 -053-0431,
836-053-0465, 836-053-0472, 836-053-0510, 836-053-0825, 836-053-0830, 836-053-0835
Repeal: 836-053-0014(T), 836-053-0015(T), 836-053-1500(T),
836-053-1505(T), 836-053-1510(T), 836-009-0020, 836-009-0025, 836-009-0030,
836 -009-0035, 836-009-0040
These rules reflect changes in state and federal laws and statutes that impact
current rules and require new rules. The rules include provisions defining "small
employer" and establishing eligible employees and the counting methodology
an insurer must use to determine whether an employer is a small employer or
a large employer. These rules are necessary to implement requirements of Senate
Bill 231 (2015 Session) to establish the definition of "prominent carrier"
and to prescribe the primary care services for which costs must be reported
to the Department of Consumer and Business Services (DCBS) by prominent carriers.
These rules define "prominent carrier" based on annual premium income
and clarify the data to be reported to DCBS.
Because federal legislation eliminates the need for expanded transitional plans
for small employer groups that have 51-100 employees, these rules also repeal
a previously adopted temporary rule that allowed small group transitional plans
and provided guidance to insurers who proposed to issue the transitional plans
to certain small employers. The rules also eliminate provisions related to individual
transitional plans which ended on December 31, 2015, because those provisions
will no longer be necessary and update exhibits related to transitional plans.
The rules specify the intent of the DCBS to not enforce provisions of a state
mandate related to prosthetics and orthotics that sunset by operation of the
state law. Other federal statutes may impose similar coverage requirements.
The rules clarify that an insurer may not rescind a policy or certificate on
the basis of statements related to pediatric dental coverage.
Rules relating to a one percent assessment on health insurers are repealed
because the assessment is no longer imposed by Oregon statutes.
Finally, the rules eliminate obsolete references to 2014 special enrollment
periods, the Oregon Health Insurance Exchange Corporation, the use of health
statements for underwriting purposes and make technical changes to reflect the
merger of two DCBS divisions, the Insurance Division and the Division of Finance
and Corporate Securities, into a single division, the Division of Financial
Adopted: April 8, 2016
Effective: April 8, 2016