Chapter 765 Oregon Laws 2005
AN ACT
SB 501
Relating to health insurance; and declaring an emergency.
Be It Enacted by the People of the State of
Oregon:
SECTION 1. Section 2 of this 2005 Act is added to and made a part of ORS 743.730 to 743.773.
SECTION
2. (1) Each carrier offering a
health benefit plan shall submit to the Director of the Department of Consumer
and Business Services on or before April 1 of each year a report that contains:
(a)
The following information for the preceding year that is derived from the
exhibit of premiums, enrollment and utilization included in the carrier’s
annual report:
(A)
The total number of members;
(B)
The total amount of premiums;
(C)
The total amount of costs for claims;
(D)
The medical loss ratio;
(E)
The average amount of premiums per member per month; and
(F)
The percentage change in the average premium per member per month, measured
from the previous year.
(b)
The following aggregate financial information for the preceding year that is
derived from the carrier’s annual report:
(A)
The total amount of general administrative expenses, including identification
of the five largest nonmedical administrative expenses and the assessment
against the carrier for the Oregon Medical Insurance Pool;
(B)
The total amount of the surplus maintained;
(C)
The total amount of the reserves maintained for unpaid claims;
(D)
The total net underwriting gain or loss; and
(E)
The carrier’s net income after taxes.
(2)
A carrier shall electronically submit the information described in subsection
(1) of this section in a format and according to instructions prescribed by the
Department of Consumer and Business Services by rule after obtaining a
recommendation from the Health Insurance Reform Advisory Committee.
(3)
The advisory committee shall evaluate the reporting requirements under
subsection (1)(a) of this section by the following market segments:
(a)
Individual health benefit plans;
(b)
Health benefit plans for small employers;
(c)
Health benefit plans for employers described in ORS 743.733; and
(d)
Health benefit plans for employers with more than 50 employees.
(4) The department shall make the information reported under this section available to the public through a searchable public website on the Internet.
SECTION 3. Notwithstanding section 2 (1) of this 2005 Act, a carrier described in section 2 (1) of this 2005 Act shall submit its first report to the Director of the Department of Consumer and Business Services on or before July 1, 2006.
SECTION 4. Notwithstanding section 2 (1) of this 2005 Act, a carrier shall include the information described in section 2 (1)(a)(F) of this 2005 Act beginning with the annual report for 2007.
SECTION 5. Section 6 of this 2005 Act is added to and made a part of the Insurance Code.
SECTION
6. (1) An insurer offering a
health insurance policy that covers hospital, medical or surgical expenses,
other than coverage limited to expenses from accidents or specific diseases,
shall provide coverage for the following colorectal cancer screening examinations
and laboratory tests:
(a)
For an insured 50 years of age or older:
(A)
One fecal occult blood test per year plus one flexible sigmoidoscopy every five
years;
(B)
One colonoscopy every 10 years; or
(C)
One double contrast barium enema every five years.
(b)
For an insured who is at high risk for colorectal cancer, colorectal cancer
screening examinations and laboratory tests as recommended by the treating
physician.
(2)
For the purposes of subsection (1)(b) of this section, an individual is at high
risk for colorectal cancer if the individual has:
(a)
A family medical history of colorectal cancer;
(b)
A prior occurrence of cancer or precursor neoplastic polyps;
(c)
A prior occurrence of a chronic digestive disease condition such as
inflammatory bowel disease, Crohn’s disease or ulcerative colitis; or
(d)
Other predisposing factors.
(3) Health care service contractors, as defined in ORS 750.005, and trusts carrying out a multiple employer welfare arrangement, as defined in ORS 750.301, are also subject to this section.
SECTION 7. Section 6 of this 2005 Act applies to health insurance policies issued or renewed on or after January 1, 2006.
SECTION 8. This 2005 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 2005 Act takes effect on its passage.
Approved by the Governor August 23, 2005
Filed in the office of Secretary of State August 23, 2005
Effective date August 23, 2005
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