OR State Updates - 2015 Jan 06 No.02

On Sept. 23, 2015, the Oregon Department of Consumer and Business Services adopted a new temporary rule, OAR 836-010-0014, to provide carriers with guidance for filing expanded transitional health benefit plans. Expanded transitional health benefit plans are plans that are issued to or renewed by an employer with 51 to 100 employees before Jan. 1, 2016. This temporary rule incorporates Exhibit 1 which contains guidance provided to carriers on the process and procedures related to these plans and for rate filings for these plans.

As background, on Jan. 1, 2016, under PPACA, the definition of ‘small group’ changes from 1-50 employees to 1-100 employees, meaning small group plans in the 51-100 group will become subject to many of PPACA’s requirements. However, on March 5, 2014, the CCIIO published a bulletin announcing transition relief for non-PPACA compliant plans with plan years beginning on or before Oct. 1, 2016. The CCIIO transitional policy allows small employers with between 51-100 employees to renew their existing policies and remain in the large group market without violating PPACA.

Effective Jan. 1, 2016, the definition of ‘small group’ set forth in ORS 743.730(29)(a) is modified to mean an employer that employed at least one but not more than 100 employees. The Oregon Legislature enacted Senate Bill 2466 (2015 Regular Session) that allows carriers the option to provide transitional relief to employer groups with 51 to 100 employees. HB 2466 also provides that the division shall adopt rules for determining group size.

The Division has made available on their website separate guidance that covers how small or large group size will be calculated. The calculation method mirrors federal requirements and is being provided immediately to assist carriers in determining the correct placement of employer groups. The division will adopt an administrative rule incorporating this guidance and correcting inconsistencies in existing rules.

Although the rule is directed toward carriers, Oregon employers in the 51-100 group should take notice of the rule and work with their carriers to determine if transitional renewal is an appropriate course of action.

Note that this edition of Compliance Corner includes an article on recent federal legislative developments that could alter PPACA’s definition of ‘small group’. As such, Oregon may alter this temporary rule. We will continue to monitor this issue and will notify you of any developments pertaining to this temporary rule.

As of now, this temporary rule is effective Sept. 23, 2015 through March 18, 2016.

Notice and Procedural Requirements for Expanded Transitional Health Benefit Plans »
Exhibit 1 to OAR 836-010-0014(T) »