Current through Register Vol. 63, No. 9, September 1, 2024
(1) A carrier shall submit the information
required by ORS 743.748 electronically in the format and according to the
directions established by the director of the Department of Consumer and
Business Services and made available on the website of the Division of
Financial Regulation.
(2) The
following terms used in ORS 743.748 have the following meanings for the purpose
of the information required by 743.748. References in this section to specific
schedules and instructions are to schedules and instructions for the NAIC
health annual statement blank. The terms are defined as follows:
(a) "Average amount of premiums per member
per month" means total earned premiums as reported on the exhibit of premiums,
enrollment and utilization divided by the total member months for the required
reporting year.
(b) "Carrier's
annual report" is the carrier's annual statement submitted as required by ORS
731.574.
(c) "Medical loss ratio"
means the total medical claims cost divided by the total premiums earned, both
as reported on the exhibit of premiums, enrollment and utilization.
(d) "Percentage change in the average premium
per member per month" means the average amount of premiums per member per month
for the reporting year less the average premium per member per month for the
preceding reporting year divided by the average premium per member per month
for the preceding reporting year.
(e) "Total amount of costs for claims" means
incurred claims as reported by the carrier on the exhibit of premiums,
enrollment and utilization in its annual statement. If the annual statement
blank used by a carrier does not include an exhibit of premiums, enrollment and
utilization, "total amount of costs for claims" means total incurred claims
costs as calculated by the carrier using the instructions for the exhibit of
premiums, enrollment and utilization for reporting the information.
(f) "Total amount of premiums" means earned
premium as reported by the carrier on the exhibit of premiums, enrollment and
utilization in its annual statement. If the annual statement blank used by a
carrier does not include an exhibit of premiums, enrollment and utilization,
"total amount of premiums" means total premiums as calculated by the carrier
using the instructions for the exhibit of premiums, enrollment, and utilization
for reporting the information.
(g)
"Total number of members" means total number of members as of December 31 of
the reporting year, as reported by the carrier in its annual statement. If the
annual statement blank used by a carrier does not include an exhibit of
premiums, enrollment and utilization, "total number of members means the total
number of members as calculated by" the carrier using the instructions for the
exhibit of premiums, enrollment and utilization for reporting the
information.
(3) A
carrier shall submit the following information by total for all comprehensive
hospital and medical products nationwide, for all such products in each Oregon
market segment and for the carrier's association health plans:
(a) Number of members.
(b) Number of member months.
(c) Premiums earned.
(d) Medical claims costs.
(e) Medical loss ratio.
(f) Average premium per member per month for
the reporting year.
(g) Average
premium per member per month for the preceding reporting year.
(h) Percentage change in premium per member
per month from the preceding reporting year.
