Form 440-4872 - Standards For Filing Individual And Small Group Health Benefit Plan Rates - Oregon Department Of Consumer And Business Service Page 8
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14GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS
Category
Reference
Description of review standards requirements
Answers
Page #
Discussion of all assumptions and calculations pertinent to the
proposed rate
o (Small Group only) If rates vary more frequently than annually,
provided information to justify such variation in rates
o Provide justification and need for assumptions, identifying
relevant sources if the assumption is data driven
o Tie together the administrative costs presented in the
Development of Rate Change (Exhibit 1) and Statement of
Administrative Expenses (Exhibit 5)
o Consideration of credibility of calculations and data
Demonstrate how projected claims on Exhibit 1 tie to the Index Rate
shown on the URRT.
Demonstrate starting with the Index rate how the rates for each plan is
calculated utilizing network/area, pricing relativity, age factors and
admin only.
We expect use of HHS guidance or generally accepted actuarial
principles
Mandates:
Identify all mandated state and federal changes to the filing including,
but not limited to:
o New benefits (EHB), including effective dates and pricing
methodology
o New fees, including implementation and justification
o “3 R’s”: Reinsurance, Risk Adjustment, Risk Corridor
o Exchange impacts: fees, reallocation impacts
o Impact of cost sharing subsidies on plan pricing
o Guaranteed issue
Certification:
Identify that the filing is consistent with the company’s internal
business plans
Confirm all calculations are based on generally accepted actuarial
rating principles for rating blocks of business
Signature of and date that a qualified actuary reviewed the rate filing
DEVELOPMENT
OAR 836-053-
Please refer to provided template.
Yes
N/A
OF RATE
0473 (2)(d)
CHANGE OR
A document labeled DEVELOPMENT OF RATE CHANGE OR BASE RATE
440-4872 (4/4/13 INS)
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