Form 440-4872 - Standards For Filing Individual And Small Group Health Benefit Plan Rates - Oregon Department Of Consumer And Business Service Page 4
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14GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS
Category
Reference
Description of review standards requirements
Answers
Page #
When determining reasonability of rates, Oregon does not recognize
federal credibility standards in calculation of the Federal MLR
Fees and Assessments (General):
Fees must reflect an average total cost over the plan year
Insurer’s Fee:
This fee is not considered a deduction for tax purposes
The unique tax implications should be added to margin, since they do
not reflect explicit costs associated with the health benefit plans
Actuarial Value (AV) Calculator:
All plans, both inside and outside the exchange must meet the
de minimis range (within 2%) for one of the 4 metal tiers: bronze,
silver, gold, platinum
Actuarial value is determined based on Essential Health Benefits
only
Where appropriate, the AV calculator should determine the
objective differences between plans
Where the AV calculator is not appropriate, pricing must be
consistent across all plans
Reinsurance (Federal and State Supplemental):
HEALTHCARE
Federal regulations
Yes
N/A
REFORM
Use parameters and assessment provided by federal and state
ELEMENTS
regulators
Claims adjustments on individual filings must be consistent with
The “3 Rs”
average market risk
Embedded pediatric dental qualifies for reinsurance
Stand alone dental does not qualify for reinsurance
Risk Adjustment:
Carrier projected claims must be adjusted to reflect average
experience for the market
Risk Corridor:
Health benefit plans should not be priced to anticipate an impact of the
risk corridor program
FILING
OAR 836-053-
The document labeled FILING DESCRIPTION is submitted in the form of a
Yes
N/A
DESCRIPTION
cover letter summarizing the reasons for rate change and includes:
0473 (2)(a)
Filing Information:
440-4872 (4/4/13 INS)
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