75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
 
NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .
 
LC 788
 
                         House Bill 2193
 
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
  Presession filed (at the request of Governor Theodore R.
  Kulongoski for Department of Consumer and Business Services)
 
 
                             SUMMARY
 
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
 
  Reduces Oregon Medical Insurance Pool assessment for insurers
providing insurance against risk of economic loss.
 
                        A BILL FOR AN ACT
Relating to Oregon Medical Insurance Pool assessment; creating
  new provisions; and amending ORS 735.614.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + Section 2 of this 2009 Act is added to and made
a part of the Insurance Code. + }
  SECTION 2.  { +  ' Covered life' means a subscriber,
policyholder, certificate holder, spouse, dependent child or any
other individual insured under an insurance policy or whose
benefits are administered by a third party administrator. + }
  SECTION 3. ORS 735.614 is amended to read:
  735.614. (1) If the Oregon Medical Insurance Pool Board
determines at any time that funds in the Oregon Medical Insurance
Pool Account are or will become insufficient for payment of
expenses of the pool in a timely manner, the board shall
determine the amount of funds needed and shall impose and collect
assessments against insurers, as provided in this section, in the
amount of the funds determined to be needed.
  (2) Each insurer's assessment shall be determined by
multiplying the total amount to be assessed by a fraction
 { - , - }  { + . + } The numerator of   { - which - }   { + the
fraction + } equals   { - the - }  { +  that insurer's total + }
number of Oregon   { - insureds and certificate holders insured
or reinsured by each insurer, and - }  { +  insured covered lives
and 40 percent of reinsured covered lives. + } The denominator of
 { - which - }  { +  the fraction + } equals the total
 { + number of Oregon insured lives covered by all insurers in
this state and 40 percent of reinsured lives covered by all
insurers in this state. The number of covered lives shall be
determined as of March 31 of each year. + }   { - of all Oregon
insureds and certificate holders insured or reinsured by all
insurers, all determined as of March 31 each year. - }
  (3) The board shall ensure that each insured and certificate
holder is counted only once with respect to any assessment. For
that purpose, the board shall require each insurer that obtains
reinsurance for its insureds and certificate holders to include
in its count of insureds and certificate holders all insureds and
certificate holders whose coverage is reinsured in whole or part.
The board shall allow an insurer who is a reinsurer to exclude
from its number of insureds those that have been counted by the
primary insurer or the primary reinsurer for the purpose of
determining its assessment under this subsection.
  (4) Each insurer shall pay its assessment as required by the
board.
  (5) If assessments exceed the amounts actually needed, the
excess shall be held and invested and, with the earnings and
interest, used by the board to offset future net losses or to
reduce pool premiums. For purposes of this subsection, 'future
net losses' includes reserves for claims incurred but not
reported.
  (6) Each insurer's proportion of participation in the pool
shall be determined by the board based on annual statements and
other reports deemed necessary by the board and filed by the
insurer with the board. The board may use any reasonable method
of estimating the number of insureds and certificate holders of
an insurer if the specific number is unknown. With respect to
insurers that are reinsurers, the board may use any reasonable
method of estimating the number of persons insured by each
reinsurer.
  (7) The board may abate or defer, in whole or in part, the
assessment of an insurer if, in the opinion of the board, payment
of the assessment would endanger the ability of the insurer to
fulfill the insurer's contractual obligations. In the event an
assessment against an insurer is abated or deferred in whole or
in part, the amount by which the assessment is abated or deferred
may be assessed against the other insurers in a manner consistent
with the basis for assessments set forth in this section. The
insurer receiving the abatement or deferment shall remain liable
to the board for the deficiency for four years.
  (8) The board shall abate or defer assessments authorized by
this section if a court orders that assessments cannot be made
applicable to reinsurers. However, if a court orders that
assessments cannot be made applicable to reinsurers, the board
may continue to assess insurers to the end of the biennium in
which the determination is made.
  (9) Subject to the approval of the Director of the Department
of Consumer and Business Services, the board may develop a
program for adjusting the assessment of an insurer in the
individual health benefits market based on that insurer's
contribution to reducing the enrollment in the Oregon Medical
Insurance Pool. When developing the program, the board may
consider, but is not limited to, the following factors:
  (a) The insurer's level of participation;
  (b) Level of health benefit plan coverage offered; and
  (c) Assumption of risk in the individual health benefits
market.
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