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Oregon-Rate Review Law

If you buy health insurance on the individual market, without help from an employer, you may want to know what Oregon is doing to protect you from unfair and unnecessary premium rate increases.  Here’s a summary of the Oregon laws that govern rate increases.  Caution: the laws and regulations on the books don’t always reflect what actually happens in practice.  Contact your state’s insurance agency for further information.

  • Oregon does have prior approval of individual market rates.
  • The director, after conducting an actuarial review of the rate filing, may approve a proposed premium rate if, in the director’s discretion, the proposed rates are (a) actuarially sound; (b) reasonable and not excessive, inadequate, or unfairly discriminatory; and (c) based upon reasonable administrative expenses. ORS § 743.018.
  •  Oregon law allows regulators to consider insurers’ profits, income investment, surplus, and other factors, including public comments, and cost containment and quality improvement efforts, when deciding whether to approve a rate request.  ORS § 743.018.
  • Oregon provides a 45-day public comment period on requested rate increases. ORS § 743.019.
  • Oregon has specific filing requirements at Oregon Administrative Rule 836-053-0471.
  • Oregon posts rate increase data, rate filings, rate filing summaries, and other information about rate increases online at http://insurance.oregon.gov/insurer/rates_forms/health_rate_filings/health-rate-filing-search.html.

Information is based on review of state statutes and regulations and, in some cases, interviews or emails with state insurance departments.