Title 42
State Affairs and Government

Chapter 62
Catastrophic Health Insurance Plan Act

Article 2
Minimum Standards Protection

§ 42-62-13. Rates charged.

(a) The rates proposed to be charged, or a rating formula proposed to be used, by any health insurer, dental insurer, or health maintenance organization subject to title 27, to employers, the state or any political subdivision of the state, or individuals, shall be filed at the office of the health insurance commissioner (the “commissioner”). The rates proposed to be used by any health insurer, dental insurer, or health maintenance organization in the individual market as defined in § 27-18.5-2 shall be filed at the office of the health insurance commissioner and simultaneously with the attorney general’s insurance advocacy unit. The applicant shall be required to establish that the rates proposed to be charged, or the rating formula proposed to be used, are consistent with the proper conduct of its business and with the interest of the public. Within ten (10) days after receipt of the filing, the commissioner shall determine, subject to subsection (b) of this section, whether they intend to hold a public meeting or a public hearing at which time notice of such determination shall be sent to the insurance advocacy unit of the attorney general. In the event there is a public hearing, the attorney general may engage the services of any expert or consultant necessary to assist in reviewing the filing, including having the ability to seek additional relevant information from the filer. Any such public hearing shall commence within sixty (60) days after receipt of the filing. The commissioner, or designee, may hold a hearing upon not less than ten (10) days’ prior written notice to the public in a newspaper or newspapers having aggregate general circulation throughout the state. The notice shall contain a description of the rates proposed to be charged, and a copy of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of attorney general. Any documents presented in support of the filing under this section shall be made available for public examination at any time and place that the commissioner may deem reasonable.

(b) Notwithstanding any provision of this section to the contrary, the commissioner shall hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more enrolled individuals in the individual market, and the rates proposed in the filing for the annual rate increase for products offered in the individual market produce an overall average-rate increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate increase for products offered in the individual market shall include the calculation of the overall average-rate increase in order to determine whether a public hearing is required.

(1) For the purposes of this section, the calculation of the overall average-rate increase shall be based on the overall average-increase percent weighted by member premiums, excluding the effects of age scale increases. To calculate the overall average-rate increase, the applicant shall multiply the proposed rate increase by product times the total monthly renewing premium for each product, and then divide the product by the sum of monthly renewing premiums for all products. The commissioner shall require this calculation to be provided as part of the applicant’s individual market rate filing.

(c) In the event that subsection (b) of this section, in combination with §§ 27-19-6(f) and 27-20-6(f), would result in more than one public hearing in any given calendar year, the commissioner may defer one or more public hearing(s) for applicant(s) resulting from subsection (b) of this section or §§ 27-19-6(f) and 27-20-6(f) until the subsequent calendar year, with the provision that one of the deferred applicants shall be required to have a public hearing in the subsequent year whether or not it satisfies the requirements of subsection (b) of this section or §§ 27-19-6(f) and 27-20-6(f) for that subsequent calendar year.

(d) The commissioner shall notify the attorney general of the filing(s) to be deferred and the attorney general shall be given the opportunity to provide written comments and recommendations to the commissioner regarding any such filing(s) that is deferred in accordance with subsection (c) of this section.

(e) Public Hearings. If a public hearing is held pursuant to subsection (b) of this section, the commissioner, or designee, upon that hearing may administer oaths, examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of all books, papers, records, correspondence, or other documents which they deem relevant. The public hearing shall be held in accordance with the provisions of chapter 35 of title 42. Any designee who shall conduct a hearing pursuant to this section shall report their findings in writing to the commissioner, within a reasonable time following the conclusion of the hearing, with a recommendation for approval, disapproval, or modification of the rates proposed to be charged by the applicant. The recommended decision shall become part of the record. The commissioner shall make and issue a decision not later than ten (10) days following the issuance of the recommended decision or, if the commissioner hears the application without the appointment of a designee, as soon as is reasonably possible following the completion of the hearing on the proposed rate change. The decision may approve, disapprove, or modify the filing.

(f) Notwithstanding any other provisions of law to the contrary, the filing of proposed rates, or a rating formula, and the holding and conducting of any public hearing in connection with these proposed rates, or rating formula, of any health insurer, dental insurer, or health maintenance organization subject to title 27 shall be held in accordance with the provisions of chapter 35 of title 42.

(g) Whenever the term “designee” is used in this section, it shall mean a person who is impartial, a member in good standing of the Rhode Island bar and a person who is sufficiently acquainted with the rules of evidence as used in the superior court of the state in order to enable that person to conduct a hearing as designee of the director. The reasonable per diem cost of the designee as appointed by the director shall be paid by the insurers requesting changes in the rates.

(h) Public comment. Whether or not a public hearing is held pursuant to subsection (b) of this section, the commissioner shall solicit public comment regarding the rates proposed to be used. Public comment shall be solicited upon not less than ten (10) days’ written notice prior to the date that either:

(1) A public meeting at which verbal comments may be provided; or

(2) That written comment must be received by the commissioner.

The notice shall contain a description of the rates proposed to be charged, and a copy of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of attorney general. The attorney general shall be permitted to conduct discovery in relation to the actuarial analysis and actuarial assumptions of the filer regarding any filing in the individual market as defined in § 27-18.5-2. Any documents presented in support of the filing under this section shall be made available for public examination at a time and place that the commissioner may deem reasonable.

(i) The applicant shall bear reasonable expenses of the commissioner in connection with a filing made pursuant to this section, including any costs related to advertisements, stenographic reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear reasonable expenses of the attorney general in relation to any public hearing conducted pursuant to this section. The applicant shall bear reasonable expenses of the attorney general in relation to any filing in the individual market that is not subject to a public hearing.