1. (1) As a condition of receiving reinsurance payments from the Oregon Reinsurance Program, a reinsurance eligible issuer must provide, for each benefit year, the following information to the department in the form and manner prescribed by the department:

   1. (a) The name and company code assigned to the reinsurance eligible issuer by the National Association of Insurance Commissioners;
   2. (b) The identification number assigned to the reinsurance eligible issuer by the Health Insurance Oversight System (HIOS);
   3. (c) The total amount of the reinsurance eligible issuer’s reinsurance eligible claims for the benefit year;
   4. (d) The portion of the reinsurance eligible issuer’s total reinsurance eligible claims for the benefit year that fall between the attachment point and reinsurance cap;

   5. (e) A summary data file containing the following information for each reinsurance eligible individual with claims for which reinsurance payments are being requested:

      1. (A) The member identification number assigned by the reinsurance eligible issuer to the reinsurance eligible individual;
      2. (B) The start and end dates of coverage for the reinsurance eligible individual;
      3. (C) The HIOS plan identification number for the reinsurance eligible health benefit plan in which the reinsurance eligible individual was enrolled;
      4. (D) The total amount of reinsurance eligible claims for the reinsurance eligible individual for the benefit year; and
      5. (E) The total amount of reinsurance eligible claims for the reinsurance eligible individual for the benefit year that fall between the attachment point and reinsurance cap;
   6. (f) A detailed claims file extracted from the reinsurance eligible issuer’s claims processing system that includes the issuer’s complete record of all reinsurance eligible claims for the benefit year;
   7. (g) An attestation signed by an executive officer of the reinsurance eligible issuer stating that the information is accurate as of the date of submission; and
   8. (h) Any other information requested by the department.

2. (2) As a condition of receiving reinsurance payments from the Oregon Reinsurance Program, a reinsurance eligible issuer must submit the information required under this rule to the department:

   1. (a) Using a secure method of transmission approved by the department; and
   2. (b) On or before July 15 of the year following the benefit year for which the reinsurance payment is requested.

Statutory/Other Authority

ORS 731.244 & 2017 Or Laws ch 538 sec 19

Statutes/Other Implemented

2017 Or Laws ch 538 sec 18-21

History

ID 38-2018, adopt filed 12/19/2018, effective 01/01/2019