OAR 409-036-0055: Rural Medical Practitioners Insurance Subsidy Program-Medical Professional Liability Carrier Participation

(1) Carrier Participation. To participate in the medical professional liability insurance premium subsidy program outlined in OAR 409-036-0050, a Carrier must certify that it is authorized to issue professional liability insurance policies or certificates in Oregon. The Carrier must provide written certification to the Authority no more than 30 days prior to the beginning date of a calendar quarter in which the Carrier will participate in the subsidy program. (a) The certification must be delivered to the Authority: (A) By mail, to the following address: Oregon Health Authority, 500 Summer St NE, Salem, OR 97301, Attention: Health Care Provider Incentive Program–Medical Malpractice Insurance Subsidy; or (B) By email, to providerincentives@odhsoha.oregon.gov. (b) The certification must be signed by an individual authorized to represent the Carrier. (c) The certification must certify that the Carrier: (A) Is an insurance company holding a valid certificate of authority from the Director of the Department of Consumer and Business Services (DCBS) that authorizes the transaction of insurance as defined in ORS 731.066(1) and 731.072(1), and does not include DCBS-listed insurers pursuant to ORS 735.300 to 735.365 and ORS 735.400 to 735.495; (B) Understands the Authority may confirm the representations in paragraph OAR 409-036-0055(1)(c)(A) with DCBS, and that DCBS’ determination about whether the Carrier holds a valid certificate of authority to engage in professional liability insurance in the state of Oregon and the other criteria in paragraph (A) must be relied upon by the Authority in determining whether an insurer may participate in the subsidy program; and (C) Agrees to comply with the terms and conditions of the rules applicable to the subsidy program in effect at the time of initial certification and those rules in effect when any request for subsidy payment is submitted to the Authority for payment. (d) If a Carrier does not provide the certification to the Authority within the time established in subsection (1), the Carrier may not submit a request for premium subsidy payment for the applicable calendar quarter and eligible practitioners insured by the Carrier may not receive a premium subsidy for that quarter. (e) A Carrier must notify the Authority in writing of a material change in any status or condition that relates to their eligibility to participate in the subsidy program. (2) Carrier Discontinuation. A Carrier must notify the Authority at least 90 days prior to the beginning date of the next calendar quarter if the Carrier wants to discontinue participation in the program. The Carrier must notify its insured eligible practitioners of its intent to discontinue to participate at least 60 days prior to the date of the next calendar quarter. (3) Each Carrier participating in the program must electronically (using Microsoft Excel or similar spreadsheet application) submit: (a) A report to the Authority within 30 days after the end of each billing period (monthly or quarterly), showing the following information for each insured eligible practitioner who has been determined eligible for a premium subsidy as of the end of the billing quarter. This report must be delivered to the Authority by email to providerincentives@odhsoha.oregon.gov. The report must include the following: (A) Carrier’s name; (B) Practitioner’s name; and (C) For each practitioner: (i) Oregon Board of Medical Examiners license number or Oregon State Board of Nursing certification number; (ii) Practitioner’s specialty and specialty class; (iii) Insurance Services Office (ISO) code; (iv) Policy number and effective date; (v) Billing period coverage start and end dates; (vi) Billing frequency (annually, quarterly, monthly); (vii) Current in-force annual premium for coverage limits of $1 million per occurrence and up to $3 million annual aggregate; (viii) Premium subsidy percentage, calculated in accordance with OAR 409-036-0080 (3); (ix) Dollar amount of premium subsidy, calculated in accordance with OAR 409-036-0080 (3); (x) Explanation of any adjustments under this program from previous reports; (xi) Policy coverage limits; (xii) Claims-made step of practitioner, if applicable; and (xiii) Identify practitioners who were not on the eligible list at the beginning of the quarter. (b) Annually a copy of their base rates and increased limits factors table. Carrier must also notify the Authority if there is any change to the current base rates and increased limits factors table within 30 days of the change. (4) Failure to make timely submissions under subsection (3) may result in delay in processing or declining a payment request. (5) The Authority must calculate the payment of premium subsidies from the Rural Medical Liability Subsidy Fund based on the funds available for the applicable billing period. A Carrier must reduce the premium charged to an eligible practitioner by the amount of any premium subsidy paid or to be paid under the program. (6) If there are insufficient funds to provide the maximum premium subsidy to all eligible practitioners, the Authority may reduce or eliminate subsidies for eligible practitioners in an equitable manner and will notify affected Carriers and eligible practitioners. In the event of insufficient funds, the risk of Carrier delay in submission of a request for subsidy payment is on the Carrier, because payments will be based on the subsidy requests received timely for each applicable billing period. (7) Each Carrier participating in the program must provide its insured eligible practitioners with the following information quarterly with each eligible practitioner’s billing statement: (a) The quarterly premium due before the premium subsidy is applied; (b) The amount of the premium subsidy; and (c) The premium after the premium subsidy is applied.