Or. Admin. Code § 836-031-0270

Current through Register Vol. 63, No. 11, November 1, 2024

Section 836-031-0270 - Specific Standards for Morbidity

The following standards apply to morbidity:

(1) Minimum morbidity standards for valuation of specified benefits provided in individual health insurance policies are as follows:

(a) For disability income benefits due to accident or sickness:

(A) Contract reserves:

(i) Contracts issued on or after January 1, 1965 and prior to January 1, 1987: The 1964 Commissioners Disability Table (64 CDT) or, at the option of the insurer, a more recent table approved by the Director;

(ii) Contracts issued on or after January 1, 1995 and prior to January 1, 2017: the 1985 Commissioners Individual Disability Tables A (85CIDA) or the 1985 Commissioners Individual Disability Tables B (85CIDB). Each insurer shall elect, with respect to all individual contracts issued in any one statement year, whether it will use Tables A or Tables B as the minimum standard. An insurer may, however, elect to use the other tables with respect to any subsequent statement year;

(iii) Contracts issued during 1987 through 1994: Optional use of either the 1964 Table or the 1985 Tables as provided in paragraph (ii) of this subsection;

(iv) Contracts issued on or after January 1, 2017 and prior to January 1, 2020: the 1985 Tables as provided in paragraph (ii) of this subsection or, at the election of the insurer, the 2013 Individual Disability Income (IDI) Valuation Table (with modifiers as described in Actuarial Guideline L); and,

(v) Contracts issued on or after January 1, 2020: the 2013 IDI Valuation Table (with modifiers as described in Actuarial Guideline L).

(B) Claim reserves: The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the claim is incurred: provided, however, an insurer may make a one-time election to apply the minimum standard then in effect to all open claims.

(b) For hospital benefits, surgical benefits and maternity benefits (scheduled benefits or fixed time period benefits only):

(A) Contract reserves:

(i) Contracts issued on or after January 1, 1955, and before January 1, 1982: The 1956 Intercompany Hospital-Surgical Tables; and

(ii) Contracts issued on or after January 1, 1982: the 1974 Medical Expense Tables, Table A, Transactions of the Society of Actuaries, Volume XXX, pg. 63. Refer to the paper (in the same volume, pg. 9) to which this table is appended, including its discussions, for methods of adjustment for benefits not directly valued in Table A: Development of the 1974 Medical Expense Benefits, Houghton and Wolf.

(B) Claim reserves: No specific standard. See subsection (e) of this section.

(c) Cancer expense benefits (Scheduled benefits or fixed time period benefits only):

(A) Contract reserves:

(i) Contracts issued on or after January 1, 1986 and prior to January 1, 2018: the 1985 NAIC Cancer Claim Cost Tables (1985 CCCT);

(ii) Contracts issued on or after January 1, 2018 and prior to January 1, 2019: the 1985 CCCT or, at the election of the insurer, the 2016 Cancer Claim Cost Valuation Tables (2016 CCCVT); and,

(iii) Contracts issued on or after January 1, 2019: the 2016 CCCVT.

(B) Claim reserves: No specific standard. See subsection (e) of this section.

(d) Accidental death benefits:

(A) Contract reserves: Contracts issued on or after January 1, 1965: the 1959 Accidental Death Benefits Table.

(B) Claim reserves: Actual amount incurred.

(e) Other individual contract benefits:

(A) Contract reserves: For all other individual contract benefits, morbidity assumptions are to be determined by using tables established for reserve purposes by a qualified actuary and acceptable to the Director;

(B) Claim reserves: For all benefits other than disability, claim reserves are to be determined by using tables established for reserve purposes by a qualified actuary and acceptable to the Director.

(2) Minimum morbidity standards for valuation of specified benefits for group health insurance policies are as follows:

(a) For disability income benefits due to accident or sickness:

(A) Contract reserves:

(i) Contracts issued prior to January 1, 1995: Use of the 87CGDT is optional;

(ii) Contracts issued on or after January 1, 1995 and prior to October 1, 2014: the 1987 Commissioners Group Disability Income Table (87CGDT);

(iii) Contracts issued on or after October 1, 2014 and prior to January 1, 2017: the 87CGDT or, at the election of the insurer, the 2012 Group Long-Term Disability (GLTD) Valuation Table (with consideration of Actuarial Guideline XLVII); and

(iv) Contracts issued on or after January 1, 2017: the 2012 GLTD Valuation Table (with consideration of Actuarial Guideline XLVII).

(B) Claim reserves: The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the claim is incurred; provided, however, an insurer may make a one-time election to apply the minimum standard then in effect to all open claims.

(b) Other group contract benefits:

(A) Contract reserves: For all other group contract benefits, morbidity assumptions are to be determined by using tables established for reserve purposes by a qualified actuary and acceptable to the Director;

(B) Claim reserves: For all benefits other than disability, claim reserves are to be determined by using tables established for reserve purposes by a qualified actuary and acceptable to the Director.

Or. Admin. Code § 836-031-0270

ID 7-1995, f. & cert. ef. 11-15-95; ID 35-2018, amend filed 12/19/2018, effective 12/19/2018

Tables referenced are available from the agency.

Statutory/Other Authority: ORS 731.244 & ORS 733.080

Statutes/Other Implemented: ORS 733.080