Laws and Rules

Proposed rules

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These proposed new and amended rules establish the Oregon benchmark health benefit plan and standard plans for plan years beginning on and after January 1, 2017. Because the plan selected is a 2014 plan, the plan alone does not reflect current state and federal minimum requirements. Therefore, the proposed rules also include provisions to supplement the selected plan so that the plan complies with state and federal law. The proposed rules clarify existing state and federal requirements adopted since 2014 and make conforming amendments to rules related to coverage of mental or nervous conditions.

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic Impact of the rule on business.

Filed: December 15, 2015

Public hearing: January 26, 2016, 1:30 p.m.

Last day for public comment: February 3, 2016, 5 p.m.

Documents

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These proposed rules are necessary to reflect changes in state law that impact current rules and require new rules. The proposed rules include provisions defining "small employer" and establishing eligible employees and counting methodology to determine whether an employer is a small employer or a large employer. These proposed 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 proposed rules also repeal a previously adopted temporary rule that allowed transitional plans and provided guidance to insurers who proposed to issue the transitional plans. The proposed rules also eliminate provisions related to individual transitional plans which end on December 31, 2015, because those provisions will no longer be necessary.

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 1 percent assessment on health insurers are repealed because the assessment is no longer imposed by Oregon statutes.

Finally, the proposed rules eliminate obsolete references to 2014 special enrollment periods, the Oregon Health Insurance Exchange Corporation and the use of health statements for underwriting purposes.

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic impact of the rule on business.

Filed: December 14, 2015

Public hearing: January 28, 2016, 1:30 p.m.

Last day for public comment: February 4, 2016, 5 p.m.

Documents

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These proposed rules make changes to rules to which forms are included as exhibits to the rules. The changes are necessary to reflect statutory changes made in 2013 and 2015 related to enterprise risk reporting and holding companies. The forms were updated in a temporary rule to allow insurers to submit requisite documents on the correct forms. This rulemaking will change the language of the rule to allow the division to make changes to the rules without rulemaking. Rather than being an exhibit to the rule, the forms will be available on the DCBS website at the Division of Financial Regulation webpage. Failure to update the rule will require additional time should future changes to the forms be necessary resulting in delay of company transactions.

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic impact of the rule on business.

Filed: January 14, 2016

Public hearing: February 24, 2016, 1:30 p.m.

Last day for public comment: February 24, 2016, 5 p.m.

Documents

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Where to send comments on proposed rules

Division of Financial Regulation
ins.rules@oregon.gov​​​​

Rulemaking advisory committees

Key links

Oregon Revised Statutes

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