Form 440-4872 - Standards For Filing Individual And Small Group Health Benefit Plan Rates - Oregon Department Of Consumer And Business Service Page 11
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14GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS
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Reference
Description of review standards requirements
Answers
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quantitative and specific.
Quantify savings from the reduction of “bad debt” due to ACA
coverage expansion. Show where this savings is reflected in the trend
and/or rate development.
Mathematical development of the pricing trend used in the
Development of Rate Change
Historical monthly average allowed claim costs for at least the
immediately preceding three years when applicable
o This information based on allocated costs if the insurer’s
structure doesn’t include claims cost
o Both un-normalized and normalized monthly average claim
costs for same period. Claims should be normalized for
applicable premium rating factors
o Explanation of normalization method used and discussion of
impact on trend
Notes:
Carriers may not include a trend margin, or fluctuation factor in the
development of trend.
Effective 1/1/2015, underwriting wear-off no longer applies to
individual health plans.
STATEMENT OF
OAR 836-053-
Please refer to provided template.
Yes
N/A
ADMINISTRATIVE
0473 (2)(h)
EXPENSES
A document labeled STATEMENT OF ADMINISTRATIVE EXPENSES
including:
(Exhibit 5)
A chart illustrating a breakdown of the insurer’s administrative
expenses including:
o 5 years of historical data tying to financials
o Projected expenses for the filing effective date
A detailed breakdown of fees and taxes
Target margin for the projected period
Total retention for the base period and projected period
Reports retention on a percentage of premium basis broken down by
operating expenses, commissions, state assessments and tax, and
profit
Reports retention on a per member per month (PMPM) basis
440-4872 (4/4/13 INS)
11
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