Procedure for review of proposed rates for health insurance
- • rules
(1) When an insurer files a schedule or table of premium rates for individual or small employer health insurance 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) The department shall make 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 decision; and
(b) Any actuarial or other analyses, calculations or evaluations relied upon by the department in arriving at the 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
(4)(a) The department may approve a modified rate filing only with the written consent of the insurer. An insurer’s consent to the modified rate filing does not preclude the insurer from contesting the modified rate filing by requesting a reconsideration under subsection (6) of this section or by requesting a contested case hearing.
(b) If the modified rate filing is reversed as a result of a reconsideration or contested case hearing, the rate filing, as approved in the reconsideration or final order in a contested case, may take effect on or after the date of the reconsideration or final order, in accordance with rules adopted by the department.
(5)(a) The department shall issue an order, no later than 30 days after the close of the public comment period described in subsection (1) of this section, approving, disapproving or modifying the rate filing based on the information submitted during the public comment period. However, 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. The order shall be mailed to the insurer and posted to the department’s website.
(b) The order must include:
(A) An explanation of the findings and rationale that are the basis for the 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 order to contest the order by requesting:
(i) An expedited reconsideration in accordance with subsection (6) of this section; or
(ii) A contested case hearing in accordance with ORS chapter 183.
(6) If an insurer or a person adversely affected or aggrieved by an order approving, disapproving or modifying a rate filing submits to the department a request for reconsideration no later than 10 days after the date the order is issued under subsection (5) of this section:
(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 of the Department of Consumer and Business Services may not delegate the decision-making authority for the reconsideration request to any other individual;
(c) The director shall issue a decision on the request for reconsideration no later than 30 days after the request is received by the department; and
(d) The decision shall include:
(A) An explanation of the findings and rationale that are the basis for the decision; and
(B) Notice of the right to a contested case hearing in accordance with ORS chapter 183.
(7) Subsections (2) and (5) of this section do not require the department to perform any actuarial or other analyses, calculations or evaluations.
(8) The department may adopt rules modifying the procedures described in subsections (2) to (6) 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]
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