Or. Admin. Code § 836-053-0030
Current through Register Vol. 63, No. 11, November 1, 2024
Section 836-053-0030 - Marketing of a Health Benefit Plan to Small Employers(1) A carrier may offer different small employer health benefit plans in different geographic areas. The bronze and silver plan required to be offered under ORS 743B.130 and a point-of-service plan required under ORS 743B.220 must be offered in every geographic area in which the carrier offers or renews its small employer health benefit plans. A carrier may not cease offering or renewing, or offering and renewing, the bronze or silver small group health benefit plan required to be offered under ORS 743B.130 or a point-of -service plan required under ORS 743B.130 in a geographic area unless the carrier discontinues all plans in the geographic area as provided in ORS 743B.013. (2) A carrier must offer all of its approved nongrandfathered small employer health benefit plans and plan options, to all small employers on a guaranteed issue basis without regard to health status, claims experience or industry except that a carrier may limit enrollment to the period from November 15 to December 15 of each calendar year for small employers that fail to meet the carrier's reasonable participation or contribution requirements. A carrier may not serve only a portion of the small employer market, such as employers with more than 25 employees, and a carrier may not establish or maintain a closed plan or plan option or a closed book of business in the small employer market. For purposes of this section, a "closed" arrangement is one in which coverage is maintained and renewed for currently enrolled small employers, but the coverage is not offered or issued to other small employers. (3) A carrier may not require a small employer to purchase or maintain other lines of coverage, such as group life insurance, in order to purchase or maintain a small employer health benefit plan. However, a small group carrier may require reasonable assurance of pediatric dental coverage consistent with Essential Health Benefits, Final Rule, 78 Fed. Reg. 12853 (February 25, 2013). (4) A carrier must market fairly all of its small employer health benefit plans and plan options and shall not engage in any practice that: (a) Restricts a small employer's choice of such plans and plan options; or (b) Has the effect or is intended to influence a small employer's choice of such plans and plan options for reasons of risk selection. (5) A carrier shall not provide to any insurance producer any financial or other incentive that conflicts with the requirements of section (4) of this rule. (6) A carrier must use the same sales compensation methodology for all small employer health benefit plans offered by the carrier. (7) A small employer carrier may not terminate, fail to renew, or limit its contract or agreement of representation with an insurance producer for any reason related to the following: the health status, claims experience, occupation, geographic location of small employer groups, or the type of small employer plans placed by the insurance producer with the carrier.Or. Admin. Code § 836-053-0030
ID 17-1992, f. 12-3-92, cert. ef. 12-7-92; ID 12-1996, f. & cert. e.f 9-23-96; ID 5-1998, f. & cert. ef. 3-9-98; ID 5-2000, f. & cert. ef. 5-11-00; ID 8-2005, f. 5-18-05, cert. ef. 8-1-05; ID 5-2007(Temp), f. 8-17-07, cert. ef. 8-20-07 thru 2-15-08; ID 2-2008, f. & cert. ef. 2-11-08; ID 12-2013, f. 12-31-13, cert. ef. 1-1-14; ID 4-2016, f. & cert. ef. 4/8/2016Stat. Auth.: ORS 731.244 & 743B.003
Stats. Implemented: ORS 743B.003, 743B.012, 743B.013, 743B.130, 746.650