76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session
Enrolled
Senate Bill 514
Sponsored by Senator MONNES ANDERSON (Presession filed.)
CHAPTER ................
AN ACT
Relating to the Oregon Medical Insurance Pool; amending ORS
735.614; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 735.614 is amended to read:
735.614. (1) { + (a) + } 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 { + for that amount + }, as
provided in this section { - , in the amount of the funds
determined to be needed - } .
{ + (b) If the Department of Consumer and Business Services
adopts rules establishing a reinsurance program for children's
coverage, the board shall include the costs of such program, as
determined by the department, in the determination of the amount
of funds needed under paragraph (a) of this subsection. + }
(2) Each insurer's assessment shall be determined by
multiplying the total amount to be assessed by a fraction, the
numerator of which equals the number of Oregon insureds and
certificate holders insured or reinsured by each insurer, and the
denominator of which equals the total 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) All insurers authorized to transact medical insurance in
Oregon and that insure persons residing in Oregon are subject to
the assessment under this section. Insureds under the following
types of coverage, as defined by rule by the board, are excluded
in the calculation of the assessment:
(a) Medicaid;
(b) State Children's Health Insurance Program;
(c) Medicare;
Enrolled Senate Bill 514 (SB 514-A) Page 1
(d) Disability income insurance;
(e) Hospital only insurance;
(f) Dental insurance;
(g) Vision only insurance;
(h) Accident only insurance;
(i) Automobile insurance;
(j) Specific disease insurance;
(k) Medical supplemental plans;
(L) TRICARE;
(m) CHAMPUS;
(n) Prescription drug only plans;
(o) Long term care insurance; and
(p) Federal Employees Health Benefits Program.
(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 Oregon
Health Authority, 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.
SECTION 2. { + This 2011 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2011 Act takes effect on its
passage. + }
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Enrolled Senate Bill 514 (SB 514-A) Page 2
Passed by Senate March 9, 2011
.............................................................
Robert Taylor, Secretary of Senate
.............................................................
Peter Courtney, President of Senate
Passed by House May 16, 2011
.............................................................
Bruce Hanna, Speaker of House
.............................................................
Arnie Roblan, Speaker of House
Enrolled Senate Bill 514 (SB 514-A) Page 3
Received by Governor:
......M.,............., 2011
Approved:
......M.,............., 2011
.............................................................
John Kitzhaber, Governor
Filed in Office of Secretary of State:
......M.,............., 2011
.............................................................
Kate Brown, Secretary of State
Enrolled Senate Bill 514 (SB 514-A) Page 4