ORS 743B.800: Risk adjustment procedures; rules.

(1) As used in this section, “health benefit plan” means a health benefit plan, as defined in ORS 743B.005, that is offered in the individual or small group market.

      (2) The Department of Consumer and Business Services may establish by rule a procedure for adjusting risk between insurers. If a procedure is established:

      (a) The procedure may include:

      (A) An assessment imposed on an insurer if the actuarial risk of the enrollees in the insurer’s health benefit plans is less than the average actuarial risk of all enrollees in all health benefit plans in this state; and

      (B) Payments to insurers if the actuarial risk of the enrollees in the insurer’s health benefit plans is greater than the average actuarial risk of all enrollees in all health benefit plans in this state.

      (b) The methodology for adjusting risk between insurers must be consistent with 42 U.S.C. 18063 and regulations adopted by the Secretary of the United States Department of Health and Human Services to carry out 42 U.S.C. 18063 that are in effect on January 1, 2019.