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
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Rules relating to a 1 percent assessment on health insurers are repealed because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.