Or. Admin. Code § 836-053-0014

Current through Register Vol. 63, No. 12, December 1, 2024

Section 836-053-0014 - Standards and Process for Shortened Period of Market Prohibition

(1) In order to be eligible for consideration by the director for a shortened period of prohibition under ORS 743B.012, 743B.104 or 743B.126, a carrier must have met at least one of the following conditions upon exiting:

(a) The director determines that the continued operation of the insurer transacting insurance in this state is hazardous to the policyholders, its creditors or the general public ORS 731.385 and OAR 836-013-0100 through OAR 836-013-0120; or

(b) The domestic health care service contractor does not exceed Company Action Level risk-based capital requirements under OAR 836-011-0515(1)(a)(B).

(2) A carrier seeking consideration for a shortened period of prohibition under ORS 743B.012, 743B.104 or 743B.126, must submit a formal, written request no later than August 1, two years prior to the plan year the carrier intends to offer its products in a market.

(3) The request for reentry must be in writing and include:

(a) The chief executive officer or president's signature; and

(b) Reason(s) for the request, including reasons why the carrier elected to discontinue offering plans in such market;

(c) The intent of the carrier in resuming to offer health benefit plans in this state; and

(d) Perceived harm to the market if the carrier is not permitted to enter in a shortened timeframe.

(4) The department must provide notice to the public by August 15th of the year that the request was made, indicating that a carrier intends to reenter the market under a shortened period of prohibition and post to its website the letter submitted by the carrier.

(5) If the department does not receive the required materials identified in section (6) by the due date it will consider the carrier's intentions to reenter the market to be withdrawn.

(6) After submission of a formal request for reentry, a carrier must provide required materials to be submitted for consideration for a shortened period of prohibition by no later than November 1, two years prior to the plan year the carrier intends to offer its products in the market. The required materials shall be confidential pursuant to ORS 192.501(2) and ORS 731.752 and must include the following:

(a) An actuarial certification memorandum that includes:

(A) Requested service areas for reentry;

(B) Previous service areas;

(C) Plans to be offered;

(D) Previously offered plans;

(E) Projected membership count;

(F) Expected distribution of membership count across intended plan offerings and service areas;

(G) Scenario testing for:

(i) Expected membership;

(ii) Lower than expected membership;

(iii) Higher than expected membership;

(iv) Catastrophically higher than expected membership; and

(b) Five year projection of all revenues and expenses for each market the carrier intends to reenter.

(7) Within seven business days after receiving a formal request and supporting documentation for reentry, the director must determine whether the application is complete.

(a) If the director determines that the request is not complete, the director must notify the insurer in writing that the request is deficient and allow the insurer up to five business days from date of notification to provide the missing information or materials.

(b) If the director determines the request is complete, the director will open a 30-day public comment period.

(8) By January 15, one year prior to the plan year the carrier intends to offer its products in the market, the director must issue a decision approving or disapproving a shortened period of prohibition under ORS 743B.012, 743B.104 or 743B.126. A decision of approval to reenter the market under a shortened timeframe is contingent upon approval of rates in accordance with ORS 743.018 and section (9) of this rule and that are consistent with the information in the applications materials submitted under sections (3) and (6) of this rule.

(9) After a carrier is approved for reentry into the market it exited, the carrier shall; subject to applicable law:

(a) Submit rates in accordance with OAR 836-053-0473 through OAR 836-053-0475; and

(b) Participate in areas of the state that were identified in section (6)(a)(A) and which the director has identified in section (8).

Or. Admin. Code § 836-053-0014

ID 15-2017, temporary adopt filed 12/22/2017, effective 01/01/2018 through 06/19/2018; ID 10-2018, adopt filed 06/15/2018, effective 6/19/2018; ID 1-2024, minor correction filed 01/04/2024, effective 1/4/2024

Statutory/Other Authority: ORS 743B.012, 743B.104, 743B.126 & 2017 Or Laws, ch 260, sec 4-7

Statutes/Other Implemented: ORS 743B.012, 743B.104, 743B.126 & 2017 Or Laws, ch 260, sec 4-7