Modification and Discontinuance of Health Benefit Plans
Any change to a health benefit plan is either a modification or a discontinuation. (Small Employer ORS 743.736(12), Large Group ORS 743.752(2), Individual ORS 743.769(6), Portability ORS 743.760(9) (c), and OAR 836-053-0001.)
Because, the statutes and rule listed above require prior notification to the Director and policy holders prior to a discontinuation or modification of a health benefit plan, the TRANSMITTAL AND REQUIREMENTS FOR MODIFICATION AND DISCONTINUANCE OF HEALTH BENEFIT PLANS form (440-2896) was created in March of 2004. The tool continues to provide Industry a standardized format for reporting the information necessary for the Oregon Insurance Division (OID) to protect consumers who will be losing coverage or receiving benefit changes that may interrupt their medical treatments.
Recently, it was brought to our attention that the TRANSMITTAL AND REQUIREMENTS FOR MODIFICATION AND DISCONTINUANCE OF HEALTH BENEFIT PLANS form (440-2896) did not provide a place for insurers to report closed blocks of business. Further review of the form revealed the form needed to include questions related to portability and the new Patient Protection Affordability Care Act (PPACA). We made these revisions, sought Industry input, and have finalized the changes to the new form.
Specifically, we have added a section for Insurers to report whether the plan modifications are on grandfathered or non-grandfathered plans and whether the changes constitute the loss of grandfathered status. We included a place for insurers to report information related to portability, a clarification as to a closed block verses a withdrawal of a plan or form, and we made some formatting changes.
Each modification or discontinuation filing should include a completed TRANSMITTAL AND REQUIREMENTS FOR MODIFICATION AND DISCONTINUANCE OF HEALTH BENEFIT PLANS form (440-2896 (rev. 7/10/ins)) with all required information. It is especially important that we receive a clear explanation of the changes that are being made, the reason(s) for the change, the impact the changes may have on policy holders, and whether the plan is grandfathered or non-grandfathered under PPACA.
As with other types of health benefit plan filings, in accordance with OAR 836-010-0011(5), such filings may be rejected at intake or the review will be delayed if the filing does not include form 440-2896 (rev. 7/10/ins), along with all additional information required as stated in the form.
PLEASE NOTE: This requirement is waived for the Patient Protection and Affordable Care Act of 2009 (PPACA) endorsement filings.
Additional product standards that were revised recently with minor changes: