- (1) This rule applies to plan years beginning on and after January 1, 2026.
(2) Every insurer that offers a health benefit plan for small employers or an individual health benefit plan must file with each rate filing a consumer-friendly summary document that includes the following:
- (a) Filing company’s legal name;
- (b) Filing company’s website;
- (c) Filing company’s customer service phone number;
- (d) Rate Filing SERFF tracking number;
- (e) Requested average annual rate change expressed as a percentage;
- (f) Range of requested annual rate change, from minimum to maximum, expressed as a percentage;
- (g) Requested rate change effective date;
- (h) Plans impacted including number of plans discontinued, number of plans modified by the rate request, and number of new plans created by the rate request;
- (i) Covered lives impacted by the rate request;
- (j) Visual representation of changes in service areas in this state;
(k) A breakdown of the rate request attributed to the following:
- (A) Dollar and percentage for medical trend;
- (B) Dollar and percentage for pharmacy trend;
- (C) Dollar and percentage from recent legislation;
- (D) Dollar and percentage for market-wide uncertainty;
- (E) Dollar and percentage for other significant drivers of the rate request;
- (l) A breakdown of retained premium and Medical Loss Ratio for the past three, full calendar years and;
(m) A narrative description of any significant changes in networks and may include, but not be limited to:
- (A) Changes in network type, such as switching from a preferred provider organization (PPO) to an exclusive provider organization (EPO);
- (B) Changes in out of area coverages;
- (C) Changes to major health care provider network contracting including, but not limited to, adding or removing large regional hospital systems.
Statutory/Other Authority
ORS 731.244 & Or Laws 2025, ch 541
Statutes/Other Implemented
Or Laws 2025, ch 541
History
ID 13-2025, adopt filed 12/15/2025, effective 01/01/2026