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The Oregon Administrative Rules contain OARs filed through September 15, 2014
 
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OREGON HEALTH INSURANCE EXCHANGE

 

DIVISION 30

ADMINISTRATIVE CHARGE FOR OPERATING EXPENSES

945-030-0010

Statutory Authority; Purpose

(1) OAR chapter 945, division 30 is adopted pursuant to the general rulemaking authority of the Exchange in ORS 741.002.

(2) The purpose of division 30 is to establish a process for the adoption of an administrative charge to be paid by health insurers offering qualified health plans through the Exchange to pay the administrative and operational expenses of the corporation, including costs of grants to certified navigators.

Stat. Auth.: ORS 741.002
Stats. Implemented: ORS 741.105
Hist.: OHIE 1-2013, f. & cert. ef. 3-18-13; Suspended by OHIE 3-2013(Temp), f. & cert. ef. 5-28-13 thru 11-22-13

945-030-0020

Establishment of Administrative Charge Paid by Insurers

(1) Exchange staff will annually provide a Report on Administrative Charges to the Finance and Audit Committee of the Oregon Health Insurance Exchange Board of Directors (Board).

(2) The report will be posted on the Exchange’s website for public review and comment.

(3) At a minimum, the report will include

(a) A projection of Exchange operating expenses for the next calendar year,

(b) A projection of Exchange enrollment for the next calendar year, and

(c) A proposed administrative charge for the next calendar year.

(4) The Finance and Audit Committee will hold a public hearing on a proposed administrative charge.

(5) No later than the end of the first quarter of a calendar year the Finance and Audit Committee will recommend to the Board, and the Board shall amend or approve, an administrative charge for the next calendar year.

(6) Any administrative charge adopted by the Board shall be established in rule.

(7) The administrative charge shall be expressed as a per member per month figure.

(8) As a percent of the total premiums of all Exchange enrollees, the annual aggregate administrative charge assessed by the Exchange shall not exceed the limits set forth in ORS 741.105.

Stat. Auth.: ORS 741.002
Stats. Implemented: ORS 741.105
Hist.: OHIE 1-2013, f. & cert. ef. 3-18-13

945-030-0025

Annual Administrative Charge on Insurers

(1) Effective January 1, 2014, each health insurer offering qualified health plans through the Exchange shall pay a monthly administrative charge equal to $9.38 times the number of members enrolled through the Exchange in that month.

(2) Effective January 1, 2014, each health insurer offering standalone dental plans through the Exchange shall pay a monthly administrative charge equal to $0.93 times the number of members enrolled through the Exchange in that month.

(3) If the total charges collected exceed the maximum amount permissible under ORS 741.105, Cover Oregon will return excess funds to carriers on a pro-rata basis no later than the end of the 2nd quarter of the next calendar year.

Stat. Auth.: ORS 741.002
Stats. Implemented: ORS 741.105
Hist.: OHIE 4-2014(Temp), f. & cert. ef. 7-9-14 thru 12-31-14

945-030-0030

Annual Administrative Charge on Insurers

(1) Effective January 1, 2015, each health insurer offering qualified health plans through the Exchange shall pay a monthly administrative charge equal to $9.66 times the number of members enrolled through the Exchange in that month.

(2) Effective January 1, 2015, each health insurer offering standalone dental plans through the Exchange shall pay a monthly administrative charge equal to $0.97 times the number of members enrolled through the Exchange in that month.

(3) If the total charges collected exceed the maximum amount permissible under ORS 741.105, Cover Oregon will return excess funds to carriers on a pro-rata basis no later than the end of the 2nd quarter of the next calendar year.

Stat. Auth.: ORS 741.002
Stats. Implemented: ORS 741.105
Hist.: OHIE 1-2013, f. & cert. ef. 3-18-13; OHIE 3-2013(Temp), f. & cert. ef. 5-28-13 thru 11-22-13; OHIE 5-2013, f. & cert. ef. 8-19-13; OHIE 2-2014, f. & cert. ef. 4-15-14

945-030-0040

Assessment and Collection of Administrative Charge on Insurers

(1) The Exchange shall assess the administrative charge on or before the 10th business day of each month.

(2) Each insurer’s monthly administrative charge will be based on the number of members enrolled through the Exchange in that month. The administrative charge will be adjusted for any changes to prior months enrollment.

(3) The administrative charge is due in full to the Exchange on the last business day of the month assessed.

(4) For any month in which the insurer does not make full payment within 10 days following the last business day of that month, the Exchange shall impose a late payment charge of 1 percent of the amount due.

(5) If an insurer fails to pay the administrative charge, the Board may:

(a) Close that insurer’s Exchange plans to new enrollment until all outstanding charges are paid; and/or

(b) De-certify that insurer’s qualified health plans and/or standalone dental plans.

Stat. Auth.: ORS 741.002
Stats. Implemented: ORS 741.105
Hist.: OHIE 1-2013, f. & cert. ef. 3-18-13; OHIE 3-2013(Temp), f. & cert. ef. 5-28-13 thru 11-22-13; OHIE 5-2013, f. & cert. ef. 8-19-13

945-030-0045

Administrative Assessment on State Programs

(1) The administrative assessment on state programs shall be established in an Intergovernmental Agreement between the Exchange and the Oregon Health Authority.

(2) The administrative assessment, expressed as a per member per month figure, shall be based on the number of individuals enrolled in state programs offered through the Exchange.

(3) The Intergovernmental Agreement shall specify the intervals and manner in which the administrative assessment is to be paid.

(4) Exchange staff will annually report to the Finance and Audit Committee of the Oregon Health Insurance Exchange Board of Directors on the assessment on state programs.

Stat. Auth.: ORS 741.002
Stats. Implemented: ORS 741.105
Hist.: OHIE 1-2014, f. & cert. ef. 1-16-14

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