Health and Life Insurance

ORS 743.018
Filing of rates for life and health insurance

  • rules


Except for group life and health insurance, and except as provided in ORS 743.015 (Filing and approval of credit life and credit health insurance forms), every insurer shall file with the Director of the Department of Consumer and Business Services all schedules and tables of premium rates for life and health insurance to be used on risks in this state, and shall file any amendments to or corrections of such schedules and tables. Premium rates are subject to approval, disapproval or withdrawal of approval by the director as provided in ORS 742.003 (Filing and approval of policy forms), 742.005 (Grounds for disapproval of policy forms), 742.007 (Director’s withdrawal of approval) and, for health benefit plans as defined in ORS 743B.005 (Definitions), ORS 743.019 (Procedure for review of proposed rates for health benefit plans).


Except as provided in ORS 743B.013 (Requirements for small employer health benefit plans) and subsection (3) of this section, a rate filing by a carrier for any of the following health benefit plans subject to ORS 743.004 (Submission of information by carriers offering health benefit plans), 743.022 (Premium rates for individual health benefit plans), 743.535 (Health benefit coverage for guaranteed association) and 743B.003 (Purposes) to 743B.127 (Rules for ORS 743.022, 743B.125 and 743B.126) shall be available for public inspection immediately upon submission of the filing to the director:


Health benefit plans for small employers.


Individual health benefit plans.


The director may by rule:


Specify all information a carrier must submit as part of a rate filing under this section; and


Identify the information submitted that will be exempt from disclosure under this section because the information constitutes a trade secret and would, if disclosed, harm competition.


The director, after conducting an actuarial review of the rate filing, may approve a proposed premium rate for a health benefit plan for small employers or for an individual health benefit plan if, in the director’s discretion, the proposed rates are:


Actuarially sound;


Reasonable and not excessive, inadequate or unfairly discriminatory; and


Based upon reasonable administrative expenses.


In order to determine whether the proposed premium rates for a health benefit plan for small employers or for an individual health benefit plan are reasonable and not excessive, inadequate or unfairly discriminatory, the director may consider:


The insurer’s financial position, including but not limited to profitability, surplus, reserves and investment savings.


Historical and projected administrative costs and medical and hospital expenses, including expenses for drugs reported under ORS 743.025 (Rate filing to include prescription drug cost information).


Historical and projected loss ratio between the amounts spent on medical services and earned premiums.


Any anticipated change in the number of enrollees if the proposed premium rate is approved.


Changes to covered benefits or health benefit plan design.


Changes in the insurer’s health care cost containment and quality improvement efforts since the insurer’s last rate filing for the same category of health benefit plan.


Whether the proposed change in the premium rate is necessary to maintain the insurer’s solvency or to maintain rate stability and prevent excessive rate increases in the future.


Any public comments received under ORS 743.019 (Procedure for review of proposed rates for health benefit plans) pertaining to the standards set forth in subsection (4) of this section and this subsection.


The requirements of this section do not supersede other provisions of law that require insurers, health care service contractors or multiple employer welfare arrangements providing health insurance to file schedules or tables of premium rates or proposed premium rates with the director or to seek the director’s approval of rates or changes to rates. [1967 c.359 §340; 2007 c.391 §1; 2009 c.595 §31; 2013 c.681 §11; 2015 c.88 §2; 2018 c.7 §8; 2019 c.441 §2]


Last accessed
Jun. 26, 2021