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Rules

Oregon Health Insurance Marketplace laws and rules

Proposed rules

2026 Health Insurance Marketplace Qualified Health Plan and Stand Alone Dental Plan Annual Assessment Rates

Permanent rule hearing notice filing date: TBD
Rule Hearing Date: 6/18/2025
Amends: OAR 945-030-0030
Need for the rule and description: ORS 741.105 and Senate Bill 65 (2021) require the Oregon Health Authority (OHA) to establish assessment rates for qualified health plans and stand alone dental plans sold through the Health Insurance Marketplace. The assessment is the funding source for the Oregon Health Insurance Marketplace’s operations and support for qualified health plan enrollment. These rates are reviewed annually, adjusted based on budget and enrollment projections, and updated by amending 945-030-0030.

Adopted rules

​Permanent rule hearing notice filing date: 3/29/2024
Rule Hearing Date: 4/18/2024
Permanent rule filing date: 6/3/2024
Amends: OAR 945-030-0030
Need for the rule and description: The proposed amendment to OAR 945-030-0030 establishes the assessment fees for qualified health plans and stand-alone dental plans for calendar year 2025.
ORS 741.105 and Senate Bill 65 (2021) require the Oregon Health Authority (OHA) to establish assessment rates for
qualified health plans and stand alone dental plans sold through the Health Insurance Marketplace. The assessment is
the funding source for the Oregon Health Insurance Marketplace’s operations and support for qualified health plan
enrollment. These rates are reviewed annually, adjusted based on budget and enrollment projections, and updated by
amending 945-030-0030.
The amendment maintains the assessment rates of $5.50 per member per month (PMPM) for qualified health plans and
$0.36 PMPM for stand-alone dental plans in calendar year 2025.

Meeting recording for 2/23 HIMAC Consultation hearing

​Permanent rule hearing notice filing date: 3/22/23
Rule Hearing Date: 4/21/2023
Permanent rule filing date: 12/11/23
Amends: OAR 945-030-0030
Need for the rule and description: The proposed amendment to OAR 945-030-0030 establishes the assessment fees for qualified health plans and stand-alone dental plans for calendar year 2024.
ORS 741.105 and Senate Bill 65 (2021) require the Oregon Health Authority (OHA) to establish assessment rates for
qualified health plans and stand alone dental plans sold through the Health Insurance Marketplace. The assessment is
the funding source for the Oregon Health Insurance Marketplace’s operations and support for qualified health plan
enrollment. These rates are reviewed annually, adjusted based on budget and enrollment projections, and updated by
amending 945-030-0030.
The amendment maintains the assessment rates of $5.50 per member per month (PMPM) for qualified health plans and
$0.36 PMPM for stand-alone dental plans in calendar year 2024.

Meeting recording for 3/15/23 HIMAC Consultation hearing


​Permanent rule hearing notice filing date: 2/12/2021
Rule Hearing Date: 3/24/2022
Permanent rule filing date: 8/17/2021
Amends: OAR 945-030-0030
Need for the rule and description: The proposed amendment to OAR 945-030-0030 establishes the assessment fees for qualified health plans and stand-alone dental plans for calendar year 2023. ORS 741.105 requires the Oregon Health Authority (OHA) to establish assessment fees for qualified health plans and stand-alone dental plans sold through the health insurance marketplace.

The Oregon Health Insurance Marketplace (Marketplace) office of the Health Policy and Analytics (HPA) division of OHA administers Oregon's health insurance exchange and partners with the federal platform (HealthCare.gov) for enrollment and eligibility determination. The assessment funds Marketplace administrative and operational expenses, as well as grants to navigators, in-person assisters, and application counselors certified under ORS 741.002. The assessment is calculated for each insurer per member-per-month (PMPM) based on the number of individuals who have effectuated enrollment in health insurance policies through the federal platform. These rates are reviewed annually, adjusted based on budget and enrollment projections, and submitted to the OHA director for approval. Proposed changes are subject to rulemaking as amendments to OAR 945-030-0030.

The proposed amendment maintains the current assessment rate of $5.50 PMPM for qualified health plans and $0.36 PMPM for stand-alone dental plans for calendar year 2023.