ORS 743.019¹
Procedure for review of proposed rates for health benefit plans
  • rules

(1) When an insurer files a schedule or table of premium rates for individual or small employer health benefit plans under ORS 743.018 (Filing of rates for life and health insurance), 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 department shall post all of the comments received to the department’s website without delay.

(2) After the close of the public comment period described in subsection (1) of this section, the department shall issue a preliminary decision to approve, disapprove or modify a rate filing. The department shall notify the insurer of, and make available to the public, the preliminary decision, including:

(a) An explanation of the findings and rationale that are the basis for the preliminary decision; and

(b) Any actuarial or other analyses, calculations or evaluations relied upon by the department in arriving at the preliminary decision.

(3) The department shall provide the insurer or any person adversely affected or aggrieved by the preliminary decision the opportunity to meet with the department to discuss and respond to the preliminary decision. However, an insurer or other person may not substitute new facts or data for the facts or data submitted by the insurer in the filing. The meeting shall:

(a) Include a department employee who reviewed the rate filing; and

(b) Comply with the requirements of ORS 192.610 (Definitions for ORS 192.610 to 192.690) to 192.690 (Exceptions to ORS 192.610 to 192.690).

(4)(a) The department shall issue a proposed order, no later than 30 days after the department issues a preliminary decision under subsection (2) of this section, to approve, disapprove or modify the rate filing based on the information submitted during the public comment period.

(b) In issuing the proposed order, the department may not consider new facts or data that are offered as a substitute for the facts or data submitted by the insurer in the filing.

(c) The department shall mail the proposed order to the insurer and post the proposed order to the department’s website.

(d) The proposed order must include:

(A) An explanation of the findings and rationale that are the basis for the proposed order, including any actuarial or other analyses, calculations or evaluations relied upon by the department in its findings or rationale; and

(B) Notice of the right of the insurer or any person adversely affected or aggrieved by the proposed order to request a review by the Director of the Department of Consumer and Business Services, in accordance with subsection (6) of this section, no later than 10 days after the date that the proposed order was issued.

(5) If the insurer or person adversely affected or aggrieved by the proposed order does not timely request a review of the proposed order by the director, the director shall issue a final order as described in subsection (6)(d) of this section.

(6) If the insurer or a person adversely affected or aggrieved by the proposed order timely requests a review by the director of the proposed order:

(a) The requester may not substitute new facts or data for the facts and data that were submitted by the insurer in the filing, but may provide a brief, memorandum or analysis based on the evidence contained in the filing or received and considered by the department during the public comment period;

(b) The director may not delegate the decision-making authority for the request for review to any other individual;

(c) The director shall issue a final order no later than 30 days after the request for review is received by the director; and

(d) The final order shall include:

(A) An explanation of the findings and rationale that are the basis for the final order; and

(B) Notice of the right to a contested case hearing in accordance with ORS chapter 183.

(7)(a) If, following the issuance of a final order under subsection (6)(c) of this section but before the effective date of the premium rates approved by the final order, an event occurs that materially affects the director’s decision to approve the rates, the director may open a new public comment period for a period of time that the director determines is necessary to receive comments concerning the event. Based upon the event and the public comments received, the director shall affirm the final order by providing a written explanation of the basis for affirming the final order or issue a new proposed order, as described in subsection (4) of this section.

(b) In the consideration of public comments or the event described in paragraph (a) of this subsection or in issuing any new proposed order, the director:

(A) May not consider new facts or data that are offered as a substitute for the facts or data submitted by the insurer in the original filing.

(B) May consider supplemental facts or data reasonably related to the event described in paragraph (a) of this subsection.

(8) Subsections (2) to (7) of this section do not require the department to perform any actuarial or other analyses, calculations or evaluations.

(9) The department may adopt rules modifying the procedures described in subsections (2) to (7) of this section, but only to the extent necessary to comply with 42 U.S.C. 300gg-94. [2009 c.595 §28; 2013 c.681 §36; 2015 c.88 §3; 2019 c.441 §1]

1 Legislative Counsel Committee, CHAPTER 743—Health and Life Insurance, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors743.­html (2019) (last ac­cessed May 16, 2020).
 
2 OregonLaws.org contains the con­tents of Volume 21 of the ORS, inserted along­side the per­tin­ent statutes. See the preface to the ORS An­no­ta­tions for more information.
 
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent. Currency Information