Form 440-4872 - Standards For Filing Individual And Small Group Health Benefit Plan Rates - Oregon Department Of Consumer And Business Service Page 6
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14GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS
Category
Reference
Description of review standards requirements
Answers
Page #
RATE TABLES
OAR 836-053-
A document labeled RATE TABLES AND FACTORS that includes:
Yes
N/A
AND FACTORS
0473 (2)(b)
Introduction:
Indicate whether the rate changes are the same for all policies
If the rate change is not uniform for all policies, clear explanation of
how the rate changes apply to different policies
o Identify the rate factors that are changing
o Refer to table demonstrating a meaningful distribution of rate
changes(Exhibit 4)
Clear instructions, including a calculation, so that any member or
group can determine the rates for each benefit plan, each age
bracket, each geographic area, each rate tier, and all other variables
used to determine rates
Cross-reference supporting exhibits: Benefit changes (Exhibit 2),
Plan Relativities(Exhibit 6)
Identify any rating factors that are not used to develop rates
Rate Tables:
Rate tables containing, at a minimum, the base rates for each
available plan
Geographic Average Rate (GAR) table containing family type,
geographic area, and average of highest and lowest rates resulting
from the application of other rating factors
(Small Group only) Rates may vary quarterly based on trend
Rate Factors:
Tables for all factors not already included in the rate tables:
o Age
o Tobacco
o Family/Rating Tier
o Geographic Area
The following factors are no longer allowed for plans issued on or
after 2014
o Contribution
o Participation
o Wellness program participation
o Duration of in-force coverage
o Experience adjustments
440-4872 (4/4/13 INS)
6
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