OAR 836-053-0480: Consumer Friendly Summary Document for Rate Filings

(1) This rule applies to plan years beginning on and after January 1, 2026. (2) Every insurer that offers a health benefit plan for small employers or an individual health benefit plan must file with each rate filing a consumer-friendly summary document that includes the following: (a) Filing company’s legal name; (b) Filing company’s website; (c) Filing company’s customer service phone number; (d) Rate Filing SERFF tracking number; (e) Requested average annual rate change expressed as a percentage; (f) Range of requested annual rate change, from minimum to maximum, expressed as a percentage; (g) Requested rate change effective date; (h) Plans impacted including number of plans discontinued, number of plans modified by the rate request, and number of new plans created by the rate request; (i) Covered lives impacted by the rate request; (j) Visual representation of changes in service areas in this state; (k) A breakdown of the rate request attributed to the following: (A) Dollar and percentage for medical trend; (B) Dollar and percentage for pharmacy trend; (C) Dollar and percentage from recent legislation; (D) Dollar and percentage for market-wide uncertainty; (E) Dollar and percentage for other significant drivers of the rate request; (l) A breakdown of retained premium and Medical Loss Ratio for the past three, full calendar years and; (m) A narrative description of any significant changes in networks and may include, but not be limited to: (A) Changes in network type, such as switching from a preferred provider organization (PPO) to an exclusive provider organization (EPO); (B) Changes in out of area coverages; (C) Changes to major health care provider network contracting including, but not limited to, adding or removing large regional hospital systems.