Required Filing of Associations, Union Trusts, Trusts, and Discretionary
The purpose of this Notification is to ensure that all insurers are aware
of the filing requirements for associations, union trustees, trusts, and discretionary
groups. Laws relating to this topic were amended in the 2007 regular session
of the Legislative Assembly (HB 3321). See
ch. 752, Oregon Laws 2007.
For purposes of this Notification:
"Association" means an association as that term is used
in the definition of "group health insurance" in ORS 743.522 and includes a trust, trustees of labor unions,
discretionary groups or multiple employer welfare association. "Association"
also means an association as that term is used in the definition of "group
life insurance" in ORS 743.351, and includes a trust as defined in ORS
743.354, or discretionary group as defined in ORS 743.360.
Filing of Associations, Generally
The Division is requiring insurers to file all associations, even those previously
filed and approved to ensure compliance with HB 3321. All associations must
be submitted for approval as a group policyholder before any policies and/or
certificates may be issued to or coverage renewed to an association or to
its members residing in Oregon. The Division must receive these filings no
later than January 1, 2009.
In order to expedite review of the associations, we ask insurers to file
these associations without the policy forms. The Insurance Division will assign
a unique number (OID#) to each association that is filed, prior to determination
of whether or not it qualifies as a group policyholder authorized to offer
coverage to its Oregon members. The OID# will be assigned at the time the
entity is filed for approval to be a group policyholder. Assignment of the
OID # does not necessarily mean that it has been approved.
Insurers will be required to use this OID number when submitting the reports
mandated by OAR
836-053-1400 due on or before April 1, 2009. Even those associations which
were previously filed for approval will need to have an OID# assigned in order
to meet the mandated reporting requirements.
The Division will continue to track all associations authorized to be group
policyholders in the State of Oregon. Although this information was previously
accessible via our external Web site, at this time the internal database used
for this purpose is not available on the Web. Please contact us by phone at
(503) 947-7983 or by email DCBS.Ratesforms@state.or.us.
to learn whether an association has been filed and approved in Oregon and
to obtain the OID number assigned to it.
Life and Blanket Health
HB 3321 did not directly impact associations that offer life and blanket
health products. However, in order for the Division to determine whether an
association is offering health benefit plans to small employer groups and
to verify whether those small employer groups are being rated correctly, it
is necessary to make changes to our life and blanket health filing requirements.
We are updating the transmittals for Life and Blanket Health to be used for
these filings. Until these revision of these transmittals are complete, continue
to use the old transmittals. These filings must include the bylaws and/or
constitution, membership application, and the insurance enrollment form so
that the Division can ensure compliance with the Oregon Revised Statutes.
Health (except Blanket Health)
All insurers offering any health insurance coverage through associations
are required to file the association using the new transmittal, form 440-2441A.
The filing documents must include:
- an explanation of how the entity is rated (as one large group or groups
with small employer groups rated separately); and
- all form numbers that have been filed with the Division that will be
offered through the entity and an indication of whether the forms are negotiated
or submitted for prior approval.
Any policy or forms used by the association that have already been approved
do not need to be resubmitted for approval. If the forms have not been filed
and approved, the entire policy (include the certificate, group application,
enrollment form, and any riders) must be resubmitted for prior approval. Negotiated
forms with unique form numbers do not need to be filed, however the forms
numbers must be reported to the division by use of the transmittal. The application
for membership into the association must be included with the filing. Filings
that are considered incomplete will be disapproved without review. Policies
that have been reviewed and approved previously do not require re-filing.
The new transmittal is available at: Group Health – Associations and Trust