Form 440-4872 - Standards For Filing Individual And Small Group Health Benefit Plan Rates - Oregon Department Of Consumer And Business Service Page 9
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14GENERAL REQUIREMENTS FOR ALL SMALL GROUP AND INDIVIDUAL HBP RATE FILINGS
Category
Reference
Description of review standards requirements
Answers
Page #
BASE RATE
including :
Detailed calculation of how the proposed rate or rate change was
(Exhibit 1)
determined:
o Base period data appropriate for risk pool
o All adjustments from base period claims to projected claims
o Addition of all expenses and margin to costs
o All adjustments from base period premiums to current
premiums
o Calculation of final required premium and rate increase
o Loss ratio demonstrations
Sufficient detail to allow division to review and determine reasonability
and actuarial soundness of assumptions, calculations, and estimates
o Distinguish between data, assumptions, and calculations
o Provide calculated aggregate and PMPM values
o Provide all formulas
Cross-reference supporting exhibits: Trend (Exhibit 4), Admin (Exhibit
5)
COVERED
OAR 836-053-
A document labeled COVERED BENEFIT OR PLAN DESIGN CHANGES
Yes
N/A
BENEFIT OR
that:
0473 (2)(e)
PLAN DESIGN
Explains benefit and administrative changes with rating impact,
CHANGES
including:
o Covered benefit level changes
o Member cost-sharing changes
(Exhibit 2)
o Elimination of plans
o Implementation of new plan designs
o Provider network changes
o New utilization or prior authorization programs
o Changes to eligibility requirements
o Changes to exclusions
o Any other change in the plan offerings that impacts costs or
coverage provided
o Complete description of plan changes made due to federal
healthcare reform including the total premium percentage
increase attributed to these changes and a specific breakdown
that shows the benefit change and percentage of rate increase
for each benefit
o Percentage rating impact for each item, as well as the total
440-4872 (4/4/13 INS)
9
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