OAR 945-030-0040: Assessment and Collection of Administrative Charge on Insurers

(1) By the last Wednesday of each month, an insurer shall report to the Marketplace the insurer’s effectuated enrollment as of 11:59 PM on the 15th of the month and the anticipated effectuated enrollment for the following month. (2) The Marketplace shall assess an insurer an administrative charge on or before the 10th day of each month based on the number of reasonably anticipated effectuated members enrolled in Marketplace coverage in that month. (3) The Marketplace shall adjust the administrative charge when it reasonably believes an insurer has had changes or has made accurate corrections to enrollment for prior months, as follows: (a) For report months beginning July of a given year and ending June of the following year, the Marketplace shall adjust the administrative charge for coverage months beginning January of the given year through the report month. (b) The Marketplace shall not adjust the administrative charge for changes or corrections in enrollment for coverage months preceding the period described in paragraph (a) of this section. (4) The administrative charge is due in full to the Marketplace on the 10th day of the month following the assessment. (5) For any month in which the insurer does not make full payment within 5 days following the due date for the administrative charge, the Marketplace may impose a late payment charge of 1 percent of the amount due, to be paid on the next due date for the administrative charge. (6) If an insurer fails to pay the administrative charge or any late payment charge or both, the Director may: (a) Impose an annual 9% interest charge on the amount due; (b) Close that insurer’s Marketplace plans to new enrollment until all outstanding charges are paid; and/or (c) De-certify the insurer’s qualified health plans and/or stand-alone dental plans. (7) The insurer must maintain data that are sufficient: (a) To support the assessment reported to the director and any adjustments or corrections; and (b) For the Director to verify the amount reported, adjusted, or corrected. (8) Upon request and in the form, manner, and time prescribed by the Director, an insurer must provide to the Director the data described in paragraph 7 of this rule. (9) An insurer may contest the amount of the administrative charge assessed under this section through a contested case hearing under ORS 183.411 to 183.471.