ORS 743.022 Premium rates for individual health benefit plans

Premium rates for individual health benefit plans shall be subject to the following provisions:

Each carrier must file the carrier’s initial geographic average rate and any changes to the geographic average rate for its individual health benefit plans with the Director of the Department of Consumer and Business Services.

The premium rates charged during a rating period for individual health benefit plans issued to individuals shall not vary from the individual geographic average rate, except that the premium rate may be adjusted to reflect differences in benefit design, age, tobacco use and family composition. For age adjustments to the individual plans, a carrier shall apply uniformly its schedule of age adjustments for individual health benefit plans as approved by the director.

A carrier may not increase the rates of an individual health benefit plan more than once in a 12-month period except as approved by the director. Annual rate increases shall be effective on the anniversary date of the individual health benefit plan’s issuance. The percentage increase in the premium rate charged for an individual health benefit plan for a new rating period may not exceed the sum of the following:

The percentage change in the carrier’s geographic average rate for its individual health benefit plan measured from the first day of the prior rating period to the first day of the new period; and

Any adjustment attributable to differences in benefit design, age, tobacco use and family composition.

A carrier offering an individual health benefit plan in this state shall include:

In one risk pool, all of the insureds residing in this state who are covered in the carrier’s individual health benefit plans that are not grandfathered health plans or student health plans; and

In a separate risk pool, all of the insureds residing in this state who are covered in the carrier’s individual grandfathered health plans.