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State regulator orders premiums up

The other side of health insurance regulation: making sure premiums cover costs.

Oregon’s Insurance Division is working with insurers selling individual and small group health plans to increase premiums, out of concern that plans are being priced a bit too low following the first year of insuring the ACA exchange population.  

In 2014, individual health plans in Oregon brought in $703 million in premiums but spent $830 million on claims, with costs exceeding premiums by more than $600 per person, the Insurance Division found.

"As regulators, our mission is to protect Oregon's insurance consumers,” said Insurance Commissioner Laura Cali. “That means consumers are not overcharged for health insurance, but it also means that rates must cover the cost of patients' medical bills when they go to the doctor, hospital, or pharmacy. We have proposed increased rates in order for consumers to continue counting on the coverage they have purchased."

In Oregon’s individual market, the Insurance Division has made preliminary rate decisions on 13 health plans from 12 insurers (Regence Blue Cross Blue Shield is selling under two brands). The pending proposals would see premiums increase on average anywhere from 8.3 percent to 38 percent. In metropolitan Portland, the standard silver plan premium would range from $271 to $389.

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(Source: Oregon Insurance Division)

The lowest-cost silver standard option, for $233, is being sold by what is perhaps the most unique of all the payers, Zoom Health Plan. The new insurance plan from is Zoom+, a 9-year-old company founded by two entrepreneurial-physicians promising “twice the health at half the cost with ten times the delight.” That encompasses direct primary care, access to speciality and hospital care, and nontraditional health services like"food and movement as medicine" classes, parenting coaching and free preventive dental care.

The company’s health plan offers comprehensive primary and urgent care through its 27 neighborhood clinics in Portland, Vancouver, Washington and Seattle, and relies on hospital networks with Oregon Health and Science University, Providence Health & Services and Legacy Health.