Oregon Insurance Division Bulletin INS 2013-01
DATE: February 22, 2013
TO: Carriers Renewing or Issuing Non-Grandfathered Individual Health Benefit Plans
RE: Coverage Effective Periods for Non-Grandfathered Individual Health Benefit Plans
The Oregon Insurance Division issues this bulletin to carriers to facilitate a transparent and timely implementation of changes to non-grandfathered individual health benefit plans required by the Affordable Care Act (ACA). Federal regulations promulgated by the U.S. Department of Health and Human Services (HHS) to address market reforms take effect for plans issued on or after January 1, 2014. The division will require all non-grandfathered individual health benefit plans to reflect 2014 ACA market reforms no later than April 1, 2014. The following guidance describes a transition plan for non-grandfathered individual coverage issued on or after April 1, 2013. The director will exercise his authority under ORS 731.236, 731.244, 743.769, and 743.773 to issue emergency rules consistent with the guidance provided herein.
Non-Grandfathered Individual Health Benefit Plans Issued in 2013
Coverage Effective Periods
Coverage issued or renewed with an effective date on or after April 1, 2013 must terminate no later than March 31, 2014. A carrier may comply with the requirement by:
Modification/Discontinuance of Non-Grandfathered Individual Coverage
All short-term policies issued pursuant to number 1 above, all existing policies extended pursuant to number 2 above, and all policies issued or renewed pursuant to number 3 above, must be discontinued according to the requirements of ORS 743.766(5)(e) and (g) effective by the date coverage under the policy is scheduled to terminate.
Adjustments to Deductibles, Out-of-Pocket Limitations, and Other Accumulators
A carrier issuing a short term policy must pro-rate plan-year deductibles, dollar or visit limits, and out-of-pocket limitations based on the number of months in the term of the policy. An endorsement must be included in the policy to reflect the pro-rated accumulators. This requirement does not apply to short-term policies with calendar year accumulators.
A carrier extending existing in-force policies may not alter existing policy terms, including plan-year deductibles, dollar or visit limits, and out-of-pocket limitations to reflect a plan year longer than 12 months. Calendar year accumulators must also remain unchanged for extended policy periods.
When issuing or renewing non-grandfathered individual coverage on or after April 1, 2013 and prior to December 31, 2013, carriers must disclose the following in a form and manner approved by the division:
The division strongly encourages carriers to provide an accompanying notification letter at policy issuance or renewal that contains the same information required in the endorsement.
Form Filing Requirements
To facilitate the timely implementation of the policy changes and disclosures described above, the division developed endorsement templates for use by carriers. The templates are attached at the end of this document. Effective immediately, carriers may use these templates without modification to the endorsement language and without prior approval from the division. Carriers using the templates must submit an informational filing to the division, through the System for Electronic Rate and Form Filing (SERFF), no later than March 15, 2013 that includes a company logo or other identifying information. Carriers must also include a copy of the notification letter that will accompany the endorsement with the informational filing.
Carriers that choose to use independent endorsements must file these forms with the division for prior approval, using the established filing standards and process. The division encourages prompt filing of independent endorsements to ensure compliance with the required policy changes, but the timing of approval cannot be guaranteed.
Rate Filing Requirements
Carriers extending existing policies must use existing approved rates through December 31, 2013. For short-term policies, carriers must apply their approved rates in effect for the relevant effective date (i.e., a short-term policy issued on October 1, 2013 must reflect the approved rates for policies effective October 1, 2013).
Non-Grandfathered Individual Health Benefit Plans Issued in 2014
Coverage Effective Periods
Coverage issued on or after January 1, 2014 must terminate no later than December 31, 2014. Carriers may modify these policies according to Oregon law for January 1, 2015 renewal.