Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-0065 - Rating for Grandfathered Small Group Plans

Current through Register Vol. 63, No. 7, July 1, 2024
The following provisions relating to rating apply to
				grandfathered health benefit plans offered to small employers:
(1) A small employer carrier shall file a
			 single geographic average rate for each grandfathered health benefit plan that
			 is offered to small employers within a geographic area and for each category of
			 family composition. The geographic average rate must be determined on a pooled
			 basis and the pool shall include all of the carrier's grandfathered business in
			 the small employer market.
(2)
			 There shall be one rating class for each small employer carrier. All
			 grandfathered small employer health benefit plans of the carrier shall be rated
			 in that class. A rating of a grandfathered health benefit plan is subject to
			 adjustments reflecting the level of benefits provided and differences in family
			 composition and age.
(3) The
			 variation in geographic average rates among different grandfathered small
			 employer health benefit plans offered by a carrier must be based solely on
			 objective differences in plan design or coverage. The variation shall not
			 include differences based on the risk characteristics or claims experience of
			 the actual or expected enrollees in a particular plan, except that a carrier
			 may make further adjustment at renewal to reflect the expected claims
			 experience of the covered small employer; however, this adjustment may not
			 exceed five percent of the annual premium otherwise payable by the small
			 employer, is not cumulative year to year, and may be based only on the
			 carrier's claims experience with the small employer. A variation based on the
			 level of contribution by the small employer or on the level of participation by
			 eligible employees, or on both, must be actuarially sound.
(4) A small employer carrier shall file its
			 geographic average rates for grandfathered small employer health benefit plans
			 in accordance with the rate filing requirements of OAR 836-053-0910.
(5) A small employer carrier shall assess
			 administrative expenses in a uniform manner to all grandfathered small employer
			 health benefit plans. Administrative expenses shall be expressed as a
			 percentage of premium and the percentage may not vary with the size of the
			 small employer.
(6) Grandfathered
			 small employer plans shall be rated within the following geographic areas
			 comprising counties as follows:
(a) Area 1
			 shall include: Clackamas, Multnomah, Washington and Yamhill.
(b) Area 2 shall include: Benton, Lane and
			 Linn.
(c) Area 3 shall include:
			 Marion and Polk.
(d) Area 4 shall
			 include: Deschutes, Klamath and Lake.
(e) Area 5 shall include: Clatsop, Columbia,
			 Coos, Curry, Lincoln and Tillamook.
(f) Area 6 shall include: Baker, Crook,
			 Gilliam, Grant, Harney, Hood River, Jefferson, Malheur, Morrow, Sherman,
			 Umatilla, Union, Wallowa, Wasco and Wheeler.
(g) Area 7 shall include: Douglas, Jackson
			 and Josephine.