Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-0002 - Modification of a Health Benefit Plan Subject to Levels of Coverage Requirements
Universal Citation: OR Admin Rules 836-053-0002
Current through Register Vol. 63, No. 9, September 1, 2024
(1) A modification of a health benefit plan subject to the levels of coverage defined in 42 U.S.C. 18022(d) is defined in this rule for the purposes of:
(a) ORS
743B.013, regarding small
employer health benefit plans; and
(b) ORS
743B.125, regarding individual
health benefit plans.
(2) At the time of coverage renewal insurers may modify the coverage for a product offered to a group or an individual.
(a) The modification must be consistent with
state law and effective uniformly with that product.
(b) Modifications made uniformly and solely
under applicable federal or state requirements are considered a uniform
modification of coverage if:
(A) The
modification is made within a reasonable time period after the imposition or
modification of the federal or state requirement; and
(B) The modification is directly related to
the imposition or modification of the federal or state requirement.
(c) Other types of modification
made uniformly are considered a uniform modification of coverage if the
coverage for the product in the individual or small group market meets all of
the following criteria:
(A) The product is
offered by the same health insurer;
(B) The product offered has the same product
network type;
(C) The product
continues to cover at least a majority of the same service area;
(D) Within the product, each plan has the
same cost sharing structure as before the modification, except for any
variation in cost sharing solely related to changes in cost and utilization of
medical care, or to maintain the same metal tier level described in
42 U.S.C.
18022(d); and
(E) The product provides the same covered
benefits, except for any changes in benefits that cumulatively impact the
plan-adjusted index rate for any plan within the product within an allowable
variation of the plus or minus two percentage points (not including changes
required under applicable federal or state law).
(3) Insurers must:
(a) Give the individual notice of a
modification to which this rule applies not later than 30 days before the date
of renewal of the plan to which the modification applies.
(b) Use either the standard notice created by
Centers for Medicare and Medicaid Services or the standardized notice of
modification or discontinuance as set forth on website for the Department of
Consumer and Business Services at dfr.oregon.gov.
Statutory/Other Authority: ORS 731.244, 743B.127 & 743B.324
Statutes/Other Implemented: ORS 743B.013, 743B.105 & 743B.125
Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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