Form 440-4872 - Standards For Filing Individual And Small Group Health Benefit Plan Rates - Oregon Department Of Consumer And Business Service Page 7
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS
Category
Reference
Description of review standards requirements
Answers
Page #
Identify each rate factor that is changing as a result of this filing
o Include the previous rate factors
o Calculate the rate impact for each change
ACTUARIAL
This is the primary supporting document for the filing and should satisfy both
Yes
N/A
OAR 836-053-
MEMORANDUM
state and federal memorandum requirements. All other supporting
0473 (2)(c)
documentation should be provided as Exhibits to accompany the
memorandum.
A document labeled ACTUARIAL MEMORANDUM that includes:
Company’s Identifying Information:
Company Legal Name
State: Oregon
HIOS Issuer ID
Market: Individual or Small Group
Effective Date
Company Contact Information:
Name and contact information of the filer
Name and contact information for secondary contact
Introduction:
Identify the benefit plans impacted by the rate change request
Overview of the filing
o Identify the base rate increase, as calculated in the
Development of Rate Change exhibit. (Exhibit 1)
o Quantify the impact of all rate factor changes and whether
those changes are revenue neutral, as identified in the Rate
Table and Factors exhibit
o Quantify any impacts of the changes to the benefit plan, as
described in the Covered Benefit Design Changes (Exhibit 2)
o Demonstrate the calculation of the average annual rate change
(Exhibit 3)
Fill out and include Summary of Filed Rating Assumptions (see
template) in Actuarial Memorandum.
Discussion:
Description of any changes in rating methodology, supported by
sufficient detail to permit the division to evaluate the effect on rates
440-4872 (4/4/13 INS)
7
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Odh 206 Oklahoma Standard Authorization To Use Or Share Protected Health Information (phi) - Oklahoma State Department Of Health
Legal
Form Dss-1432 - Application For Disaster Food And Nutrition Services - North Carolina Division Of Social Services
Legal
Form De 428c - Suggested Format For Filing A Written Protest To The De 428t - Employment Development Department Of California
Legal
Form 8843 Draft - Statement For Exempt Individuals And Individuals With A Medical Condition - 2016
Financial
Related Categories
Parent category: Legal