2016 -- S 2209 SUBSTITUTE A AS AMENDED | |
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LC003610/SUB A/2 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2016 | |
____________ | |
A N A C T | |
RELATING TO INSURANCE - RATE REVIEW ACT | |
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Introduced By: Senator Maryellen Goodwin | |
Date Introduced: January 27, 2016 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 27-19-6 of the General Laws in Chapter 27-19 entitled "Nonprofit |
2 | Hospital Service Corporations" is hereby amended to read as follows: |
3 | 27-19-6. Rates charged subscribers -- Reserves. -- (a) Public hearings General: - The |
4 | rates proposed to be charged or a rating formula proposed to be used by any corporation |
5 | organized under this chapter to employers, the state or any political subdivision of the state, or |
6 | individuals, shall be filed by the corporation at the office of the health insurance commissioner |
7 | (hereinafter referred to as the "commissioner"). Within sixty (60) days after receipt of the |
8 | application, the commissioner, or his or her designee shall hold a hearing on all rates proposed for |
9 | health insurance coverage offered in the individual market as defined in § 27-18.5-2 upon not less |
10 | than ten (10) days written notice prior to the hearing. With regard to any other rates subject to the |
11 | commissioner's jurisdiction the commissioner, or his or her designee, may hold a hearing upon |
12 | not less than ten (10) days written notice prior to the hearing. The notice shall be published by the |
13 | commissioner in a newspaper or newspapers having aggregate general circulation throughout the |
14 | state at least ten (10) days prior to the hearing. The notice shall contain a description of the rates |
15 | proposed to be charged and a copy of the notice shall be sent to the applicant and to the |
16 | department of the attorney general. In addition, the applicant shall provide by mail, at least ten |
17 | (10) days prior to the hearing, notice of the proposed rate increase for health insurance coverage |
18 | offered in the individual market as defined in § 27-18.5-2 to all subscribers subject to the |
19 | proposed rate increase. |
| |
1 | (b) Public hearings: Within ten (10) days after receipt of a filing, the commissioner shall |
2 | determine, subject to the provisions of section (f) of this section, whether they intend to hold a |
3 | public meeting or a public hearing at which time notice of such determination shall be sent to the |
4 | insurance advocacy unit of the attorney general. Any such public hearing shall commence within |
5 | sixty (60) days after receipt of the application, upon not less than ten (10) days written notice |
6 | prior to the hearing, published by the commissioner in a newspaper or newspapers having |
7 | aggregate general circulation throughout the state at least ten (10) days prior to the hearing. The |
8 | notice shall contain a description of the rates proposed to be charged and a copy of the notice |
9 | shall be sent to the applicant and to the department of the attorney general. In the event there is a |
10 | public hearing, the attorney general may engage the services of any expert or consultant |
11 | necessary to assist in reviewing the filing, including having the ability to seek additional relevant |
12 | information from the filer. All public hearings held pursuant to this section shall be held in |
13 | accordance with the provisions of chapter 35 of title 42 (administrative procedures act). |
14 | (b)(c) Filings with the Attorney General's Office: - The applicant shall provide a copy of |
15 | the filing on all rates proposed for health insurance coverage offered in the individual market as |
16 | defined in § 27-18.5-2 to the Insurance Advocacy Unit of the Attorney General's Office |
17 | simultaneously with the filing at the office of the health insurance commissioner. |
18 | (c)(d) Procedures: - At any hearing held under this section, the applicant shall be required |
19 | to establish that the rates proposed to be charged or the rating formula to be used are consistent |
20 | with the proper conduct of its business and with the interest of the public. |
21 | Rates proposed to be charged by any corporation organized under this chapter shall be |
22 | sufficient to maintain total reserves in a dollar amount sufficient to pay claims and operating |
23 | expenses for not less than one month. Those reserves shall be computed as of each December |
24 | 31st, and a report setting forth the computation shall be submitted to the commissioner together |
25 | with the corporation's Rhode Island annual statement to the commissioner. Any documents |
26 | presented in support of a filing of proposed rates under this section shall be made available for |
27 | inspection by any party entitled to participate in a hearing or admitted as an intervenor in a |
28 | hearing or such conditions as the commissioner may prescribe provided under this section at a |
29 | time and at a place as the commissioner may deem reasonable. The commissioner, or his or her |
30 | designee, upon the hearing, may administer oaths, examine and cross-examine witnesses, receive |
31 | oral and documentary evidence, and shall have the power to subpoena witnesses, compel their |
32 | attendance, and require the production of books, papers, records, correspondence, or other |
33 | documents which he or she deems relevant. The commissioner shall issue a decision as soon as is |
34 | reasonably possible following the completion of the hearing. The decision may approve, |
| LC003610/SUB A/2 - Page 2 of 13 |
1 | disapprove, or modify the rates proposed to be charged by the applicant. Applicants requesting |
2 | changes in rates shall underwrite the reasonable expenses of the commissioner in connection with |
3 | the hearing, including any costs related to advertisements, stenographic reporting, and expert |
4 | witnesses fees. |
5 | (1) The applicant shall be required to establish that the rates proposed to be charged are |
6 | consistent with the proper conduct of its business and with the interest of the public. |
7 | (2) Any documents presented in support of a filing of proposed rates under this section |
8 | shall be made available for public examination at a time and place that the commissioner may |
9 | deem reasonable. |
10 | (3) If a public hearing is held pursuant to subsection (b) of this section, the commissioner, |
11 | or their designee, upon the hearing, may administer oaths, examine and cross-examine witnesses, |
12 | receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel |
13 | their attendance, and require the production of books, papers, records, correspondence, or other |
14 | documents which they deem relevant. Any designee who shall conduct a hearing pursuant to this |
15 | section shall report their findings in writing to the commissioner within a reasonable time |
16 | following the conclusion of the hearing with a recommendation for approval, disapproval, or |
17 | modification of the rates proposed to be charged by the applicant. The commissioner shall make |
18 | and issue a decision not later than ten (10) days following the issuance of the recommended |
19 | decision or, if the commissioner hears the application without the appointment of a designee, as |
20 | soon as is reasonably possible following the completion of the hearing on the proposed rate |
21 | change. The decision may approve, disapprove, or modify the rates proposed to be charged by the |
22 | applicant. |
23 | (d)(e) The term "designee" as used in this section shall mean a person who is impartial, a |
24 | member in good standing of the Rhode Island bar and a person who is sufficiently acquainted |
25 | with the rules of evidence as used in the superior court of the state so as to enable that person to |
26 | conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee |
27 | as appointed by the commissioner shall be paid by the applicant requesting changes in the rates. |
28 | (f) Notwithstanding any provision of this section to the contrary, the commissioner shall |
29 | hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more |
30 | enrolled individuals in the individual market, and the rates proposed in the filing for the annual |
31 | rate increase for products offered in the individual market produce an overall average rate |
32 | increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate |
33 | increase for products offered in the individual market shall include the calculation of the "overall |
34 | average rate increase" in order to determine whether a public hearing is required. |
| LC003610/SUB A/2 - Page 3 of 13 |
1 | (1) For the purposes of this section, the calculation of the "overall average rate increase" |
2 | shall be based on the overall average increase percent weighted by member premiums, excluding |
3 | the effects of age scale increases. To calculate the overall average rate increase, the applicant |
4 | shall multiply the proposed rate increase by product times the total monthly renewing premium |
5 | for each product, and then divide the product by the sum of monthly renewing premiums for all |
6 | products. The commissioner shall require this calculation to be provided as part of the applicant's |
7 | individual market rate filing. |
8 | (g) In the event that subsection (f) of this section in combination with §42-62-13(b) |
9 | would result in more than one public hearing in any given calendar year, the commissioner may |
10 | defer one or more public hearing(s) for an applicant resulting from subsection (f) of this section |
11 | or §42-62-13(b) until the subsequent calendar year, with the provision that one of the deferred |
12 | applicants shall be required to have a public hearing in the subsequent year, whether or not the |
13 | applicants' filing satisfies the requirements of subsection (f) of this section or §42-62-13(b) in that |
14 | subsequent calendar year. |
15 | (h) The commissioner shall notify the attorney general of the filing(s) to be deferred and |
16 | the attorney general shall be given the opportunity to provide written comments and |
17 | recommendations to the commissioner regarding any such filing(s) deferred in accordance with |
18 | subsection (g) of this section. |
19 | (i) Notwithstanding any other provision of law, the filing of proposed rates or a rating |
20 | formula and the holding and conducting of any public hearing in connection with these proposed |
21 | rates or rating formula shall be held in accordance with the provisions of chapter 35 of title 42 |
22 | (administrative procedures act). |
23 | (j) Public comment. Whether or not a public hearing is held pursuant to subsection (f) of |
24 | this section, the commissioner shall solicit public comment regarding the rates proposed to be |
25 | charged. Public comment shall be solicited upon not less than ten (10) days written notice prior to |
26 | the date that either: |
27 | (1) A public meeting at which verbal comments may be provided; or |
28 | (2) That written comment must be received by the commissioner. The notice shall contain |
29 | a description of the rates proposed to be charged or the formula proposed to be used, and a copy |
30 | of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of |
31 | attorney general. The attorney general shall be permitted to conduct discovery in relation to the |
32 | actuarial analysis and actuarial assumptions of the filer regarding any filing in the individual |
33 | market as defined in §27-18.5-2. Any documents presented in support of the filing under this |
34 | section shall be made available for public examination at a time and place that the commissioner |
| LC003610/SUB A/2 - Page 4 of 13 |
1 | may deem reasonable. |
2 | (k) The applicant shall bear reasonable expenses of the commissioner in connection with |
3 | a filing made pursuant to this section, including any costs related to advertisements, stenographic |
4 | reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear |
5 | reasonable expenses of the attorney general in relation to any public hearing conducted pursuant |
6 | to this section. The applicant shall bear reasonable expenses of the attorney general in relation to |
7 | any filing in the individual market that is not subject to a public hearing. |
8 | SECTION 2. Section 27-20-6 of the General Laws in Chapter 27-20 entitled "Nonprofit |
9 | Medical Service Corporations" is hereby amended to read as follows: |
10 | 27-20-6. Rates charged subscribers -- Reserves -- Hearing by director. -- (a) Public |
11 | hearings General: - The rates proposed to be charged or a rating formula proposed to be used by |
12 | any corporation organized under this chapter to its subscribers, employers, the state or any |
13 | political subdivision of the state, or individuals, shall be filed by the corporation at the office of |
14 | the health insurance commissioner (hereinafter referred to as the "commissioner"). Within sixty |
15 | (60) days after receipt of the application, the commissioner, or his or her designee, shall hold a |
16 | hearing on all rates proposed for health insurance coverage offered in the individual market as |
17 | defined in § 27-18.5-2 upon not less than ten (10) days written notice prior to the hearing. With |
18 | regard to any other rates or rating formula subject to the commissioner's jurisdiction the |
19 | commissioner, or his or her designee, may hold a hearing upon not less than ten (10) days written |
20 | notice prior to the hearing. The notice shall be published by the commissioner in a newspaper or |
21 | newspapers having aggregate general circulation throughout the state at least ten (10) days prior |
22 | to the hearing. The notice shall contain a description of the rates proposed to be charged and a |
23 | copy of the notice shall be sent to the applicant and to the department of the attorney general. In |
24 | addition, the applicant shall provide by mail, at least ten (10) days prior to the hearing, notice of |
25 | the proposed rate increase for health insurance coverage offered in the individual market as |
26 | defined in § 27-18.5-2 to all subscribers subject to the proposed rate increase. |
27 | (b) Public hearings: Within ten (10) days after receipt of a filing, the commissioner shall |
28 | determine, subject to the provisions of section (f) of this section, whether they intend to hold a |
29 | public meeting or a public hearing at which time notice of such determination shall be sent to the |
30 | insurance advocacy unity of the attorney general. Any such public hearing shall commence within |
31 | sixty (60) days after receipt of the application, upon not less than ten (10) days written notice |
32 | prior to the hearing, published by the commissioner in a newspaper or newspapers having |
33 | aggregate general circulation throughout the state at least ten (10) days prior to the hearing. The |
34 | notice shall contain a description of the rates proposed to be charged and a copy of the notice |
| LC003610/SUB A/2 - Page 5 of 13 |
1 | shall be sent to the applicant and to the department of the attorney general. In the event there is a |
2 | public hearing, the attorney general may engage the services of any expert or consultant |
3 | necessary to assist in reviewing the filing, including having the ability to seek additional relevant |
4 | information from the filer. All public hearings held pursuant to this section shall be held in |
5 | accordance with the provisions of chapter 35 of title 42 (administrative procedures act). |
6 | (b)(c) Filings with the Attorney General's Office: - The applicant shall provide a copy of |
7 | the filing on all rates proposed for health insurance coverage offered in the individual market as |
8 | defined in § 27-18.5-2 or for a Medicare supplement policy as defined in § 27-18.2-1 to the |
9 | Insurance Advocacy Unit of the Attorney General's Office simultaneously with the filing at the |
10 | office of the health insurance commissioner. |
11 | (c)(d) Procedures: - At any hearing held under this section, the applicant shall be required |
12 | to establish that the rates proposed to be charged or the rating formula proposed to be used are |
13 | consistent with the proper conduct of its business and with the interest of the public. |
14 | Rates proposed to be charged by any corporation organized under this chapter shall |
15 | maintain total reserves in a dollar amount sufficient to pay claims and operating expenses for not |
16 | less than one month. Those reserves shall be computed as of each December 31st, and a report |
17 | setting forth the computation shall be submitted to the commissioner together with the |
18 | corporation's Rhode Island annual statement to the insurance commissioner of the state of Rhode |
19 | Island. Any documents presented in support of a filing of proposed rates under this section shall |
20 | be made available for inspection by any party entitled to participate in a hearing or admitted as an |
21 | intervenor in a hearing on such conditions as the commissioner may prescribe provided pursuant |
22 | to this section at a time and at a place as the commissioner may deem reasonable. The |
23 | commissioner, or his or her designee, upon the hearing, may administer oaths, examine and cross |
24 | examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena |
25 | witnesses, compel their attendance, and require the production of books, papers, records, |
26 | correspondence, or other documents which the director deems relevant. The commissioner shall |
27 | issue a decision as soon as is reasonably possible following completion of the hearing. The |
28 | decision may approve, disapprove, or modify the rates proposed to be charged by the applicant. |
29 | Applicants requesting changes in rates shall underwrite the reasonable expenses of the |
30 | commissioner in connection with the hearing, including any costs related to advertisements, |
31 | stenographic reporting, and expert witnesses fees. |
32 | (1) The applicant shall be required to establish that the rates proposed to be charged are |
33 | consistent with the proper conduct of its business and with the interest of the public. |
34 | (2) Any documents presented in support of a filing of proposed rates under this section |
| LC003610/SUB A/2 - Page 6 of 13 |
1 | shall be made available for public examination at a time and place that the commissioner may |
2 | deem reasonable. |
3 | (3) If a public hearing is held pursuant to subsection (b) of this section, the commissioner, |
4 | or their designee, upon the hearing, may administer oaths, examine and cross-examine witnesses, |
5 | receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel |
6 | their attendance, and require the production of books, papers, records, correspondence, or other |
7 | documents which they deem relevant. Any designee who shall conduct a hearing pursuant to this |
8 | section shall report their findings in writing to the commissioner within a reasonable time |
9 | following the conclusion of the hearing with a recommendation for approval, disapproval, or |
10 | modification of the rates proposed to be charged by the applicant. The commissioner shall make |
11 | and issue a decision not later than ten (10) days following the issuance of the recommended |
12 | decision or, if the commissioner hears the application without the appointment of a designee, as |
13 | soon as is reasonably possible following the completion of the hearing on the proposed rate |
14 | change. The decision may approve, disapprove, or modify the rates proposed to be charged by the |
15 | applicant. |
16 | (d)(e) The term "designee" as used in this section shall mean a person who is impartial, a |
17 | member in good standing of the Rhode Island bar and a person who is sufficiently acquainted |
18 | with the rules of evidence as used in the superior court of the state so as to enable that person to |
19 | conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee |
20 | as appointed by the commissioner shall be paid by the applicant requesting changes in the rates. |
21 | (f) Notwithstanding any provision of this section to the contrary, the commissioner shall |
22 | hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more |
23 | enrolled individuals in the individual market, and the rates proposed in the filing for the annual |
24 | rate increase for products offered in the individual market produce an overall average rate |
25 | increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate |
26 | increase for products offered in the individual market shall include the calculation of the "overall |
27 | average rate increase" in order to determine whether a public hearing is required. |
28 | (1) For the purposes of this section, the calculation of the "overall average rate increase" |
29 | shall be based on the overall average increase percent weighted by member premiums, excluding |
30 | the effects of age scale increases. To calculate the overall average rate increase, the applicant |
31 | shall multiply the proposed rate increase by product times the total monthly renewing premium |
32 | for each product, and then divide the product by the sum of monthly renewing premiums for all |
33 | products. The commissioner shall require this calculation to be provided as part of the applicant's |
34 | individual market rate filing. |
| LC003610/SUB A/2 - Page 7 of 13 |
1 | (g) In the event that subsection (f) of this section in combination with §42-62-13(b) |
2 | would result in more than one public hearing in any given calendar year, the commissioner may |
3 | defer one or more public hearing(s) for an applicant resulting from subsection (f) of this section |
4 | or §42-62-13(b) until the subsequent calendar year, with the provision that one of the deferred |
5 | applicants shall be required to have a public hearing in the subsequent year, whether or not the |
6 | applicants' filing satisfies the requirements of subsection (f) of this section or §42-62-13(b) in that |
7 | subsequent calendar year. |
8 | (h) The commissioner shall notify the attorney general of the filing(s) to be deferred and |
9 | the attorney general shall be given the opportunity to provide written comments and |
10 | recommendations to the commissioner regarding any such filing(s) deferred in accordance with |
11 | subsection (g) of this section. |
12 | (i) Notwithstanding any other provision of law, the filing of proposed rates or a rating |
13 | formula and the holding and conducting of any public hearing in connection with these proposed |
14 | rates or rating formula shall be held in accordance with the provisions of chapter 35 of title 42 |
15 | (administrative procedures act). |
16 | (j) Public comment. Whether or not a public hearing is held pursuant to subsection (f) of |
17 | this section, the commissioner shall solicit public comment regarding the rates proposed to be |
18 | charged. Public comment shall be solicited upon not less than ten (10) days written notice prior to |
19 | the date that either: |
20 | (1) A public meeting at which verbal comments may be provided; or |
21 | (2) That written comment must be received by the commissioner. The notice shall contain |
22 | a description of the rates proposed to be charged or the formula proposed to be used, and a copy |
23 | of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of |
24 | attorney general. The attorney general shall be permitted to conduct discovery in relation to the |
25 | actuarial analyses and actuarial assumptions of the filer regarding any filing in the individual |
26 | market as defined in §27-18.5-2. Any documents presented in support of the filing under this |
27 | section shall be made available for public examination at a time and place that the commissioner |
28 | may deem reasonable. |
29 | (k) The applicant shall bear reasonable expenses of the commissioner in connection with |
30 | a filing made pursuant to this section, including any costs related to advertisements, stenographic |
31 | reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear |
32 | reasonable expenses of the attorney general in relation to any public hearing conducted pursuant |
33 | to this section. The applicant shall bear reasonable expenses of the attorney general relation to |
34 | any filing in the individual market that is not subject to a public hearing. |
| LC003610/SUB A/2 - Page 8 of 13 |
1 | SECTION 3. Section 42-62-13 of the General Laws in Chapter 42-62 entitled |
2 | "Catastrophic Health Insurance Plan Act" is hereby amended to read as follows: |
3 | 42-62-13. Rates charged. -- (a) The rates proposed to be charged or a rating formula |
4 | proposed to be used by any insurer or health maintenance organization under this section to |
5 | employers, the state or any political subdivision of the state, or individuals, shall be filed by the |
6 | insurer or health maintenance organization at the office of the director of business regulation. |
7 | This section does not apply to any entity subject to § 27-19-1 et seq., and/or § 27-20-1 et seq. The |
8 | rates proposed to be charged by those entities shall be governed by the provisions of § 27-19-1 et |
9 | seq., and/or § 27-20-1 et seq. Within sixty (60) days after receipt of the application, the director, |
10 | or the director's designee, may hold a hearing upon not less than ten (10) days' written notice |
11 | prior to the hearings. The notice shall contain a description of the rates proposed to be charged, |
12 | and a copy of the notice shall be sent to the applicant and to the consumer protection unit of the |
13 | department of attorney general. At any hearing held under this section, the applicant shall be |
14 | required to establish that the rates proposed to be charged or the rating formula proposed to be |
15 | used are consistent with the proper conduct of its business and with the interest of the public. Any |
16 | documents presented in support of a filing of proposed rates under this section shall be made |
17 | available for public examination at any time and place that the director may deem reasonable. The |
18 | director, or the director's designee, upon that hearing may administer oaths, examine and cross- |
19 | examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena |
20 | witnesses, compel their attendance and require the production of all books, papers, records, |
21 | correspondence, or other documents which he or she deems relevant. Any designee who shall |
22 | conduct a hearing pursuant to this section shall report his or her findings in writing to the director |
23 | within eighty (80) days of the filing with a recommendation for approval, disapproval, or |
24 | modification of the rates proposed to be charged by the applicant. The recommended decision |
25 | shall become part of the record. The director shall make and issue a decision not later than ten |
26 | (10) days following the issuance of the recommended decision or, if the director hears the |
27 | application without the appointment of a designee, as soon as is reasonably possible following the |
28 | completion of the hearing on the proposed rate change. The decision may approve, disapprove, or |
29 | modify the rates proposed to be charged by the applicant. Insurers requesting changes in rates |
30 | shall underwrite the reasonable expenses of the department of business regulation in connection |
31 | with the hearing, including any costs related to advertisements, stenographic reporting, and expert |
32 | witnesses fees. Notwithstanding any other provisions of law, the filing of proposed rates or a |
33 | rating formula and the holding and conduct of any hearings in connection with these proposed |
34 | rates or rating formula shall be pursuant to this section. |
| LC003610/SUB A/2 - Page 9 of 13 |
1 | (b) Whenever the term "designee" is used in this section, it shall mean a person who is |
2 | impartial, a member in good standing of the Rhode Island bar and a person who is sufficiently |
3 | acquainted with the rules of evidence as used in the superior court of the state so as to enable that |
4 | person to conduct a hearing as designee of the director. The reasonable per diem cost of the |
5 | designee as appointed by the director shall be paid by the insurers requesting changes in the rates. |
6 | The rates proposed to be charged or a rating formula proposed to be used by any health |
7 | insurer, dental insurer, or health maintenance organization subject to title 27 to employers, the |
8 | state or any political subdivision of the state, or individuals, shall be filed at the office of the |
9 | health insurance commissioner (hereinafter referred to as the "commissioner"). The rates |
10 | proposed to be used by any health insurer, dental insurer, or health maintenance organization in |
11 | the individual market as defined in §27-18.5-2 shall be filed at the office the of the health |
12 | insurance commissioner and simultaneously with the attorney general's insurance advocacy unit. |
13 | The applicant shall be required to establish that the rates proposed to be charged or the rating |
14 | formula proposed to be used are consistent with the proper conduct of its business and with the |
15 | interest of the public. Within ten (10) days after receipt of the filing the commissioner shall |
16 | determine, subject to subsection (b) of this section, whether they intend to hold a public meeting |
17 | or a public hearing at which time notice of such determination shall be sent to the insurance |
18 | advocacy unit of the attorney general. In the event there is a public hearing, the attorney general |
19 | may engage the services of any expert or consultant necessary to assist in reviewing the filing, |
20 | including having the ability to seek additional relevant information from the filer. Any such |
21 | public hearing shall commence within sixty (60) days after receipt of the filing. The |
22 | commissioner, or the commissioner's designee, may hold a hearing upon not less than ten (10) |
23 | days' prior written notice to the public in a newspaper or newspapers having aggregate general |
24 | circulation throughout the state. The notice shall contain a description of the rates proposed to be |
25 | charged, and a copy of the notice shall be sent to the applicant and to the insurance advocacy unit |
26 | of the department of attorney general. Any documents presented in support of the filing under this |
27 | section shall be made available for public examination at any time and place that the |
28 | commissioner may deem reasonable. |
29 | (b) Notwithstanding any provision of this section to the contrary, the commissioner shall |
30 | hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more |
31 | enrolled individuals in the individual market, and the rates proposed in the filing for the annual |
32 | rate increase for products offered in the individual market produce an overall average rate |
33 | increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate |
34 | increase for products offered in the individual market shall include the calculation of the "overall |
| LC003610/SUB A/2 - Page 10 of 13 |
1 | average rate increase" in order to determine whether a public hearing is required. |
2 | (1) For the purposes of this section, the calculation of the "overall average rate increase" |
3 | shall be based on the overall average increase percent weighted by member premiums, excluding |
4 | the effects of age scale increases. To calculate the overall average rate increase, the applicant |
5 | shall multiply the proposed rate increase by product times the total monthly renewing premium |
6 | for each product, and then divide the product by the sum of monthly renewing premiums for all |
7 | products. The commissioner shall require this calculation to be provided as part of the applicant's |
8 | individual market rate filing. |
9 | (c) In the event that subsection (b) of this section in combination with §§27-19-6(f) and |
10 | 27-20-6(f) would result in more than one public hearing in any given calendar year, the |
11 | commissioner may defer one or more public hearing(s) for applicant(s) resulting from subsection |
12 | (b) or §§27-19-6(f) and 27-20-6(f) until the subsequent calendar year, with the provision that one |
13 | of the deferred applicants shall be required to have a public hearing in the subsequent year |
14 | whether or not it satisfies the requirements of subsection (b) or §§27-19-6(f) and 27-20-6(f) for |
15 | that subsequent calendar year. |
16 | (d) The commissioner shall notify the attorney general of the filing(s) to be deferred and |
17 | the attorney general shall be given the opportunity to provide written comments and |
18 | recommendations to the commissioner regarding any such filing(s) that is deferred in accordance |
19 | with subsection (c) of this section. |
20 | (e) Public Hearings. If a public hearing is held pursuant to subsection (b) of this section, |
21 | the commissioner, or the commissioner's designee, upon that hearing may administer oaths, |
22 | examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the |
23 | power to subpoena witnesses, compel their attendance and require the production of all books, |
24 | papers, records, correspondence, or other documents which they deem relevant. The public |
25 | hearing shall be held in accordance with the provisions of chapter 35 of title 42 (administrative |
26 | procedures act). Any designee who shall conduct a hearing pursuant to this section shall report |
27 | their findings in writing to the commissioner within a reasonable time following the conclusion of |
28 | the hearing with a recommendation for approval, disapproval, or modification of the rates |
29 | proposed to be charged by the applicant. The recommended decision shall become part of the |
30 | record. The commissioner shall make and issue a decision not later than ten (10) days following |
31 | the issuance of the recommended decision or, if the commissioner hears the application without |
32 | the appointment of a designee, as soon as is reasonably possible following the completion of the |
33 | hearing on the proposed rate change. The decision may approve, disapprove, or modify the filing. |
34 | (f) Notwithstanding any other provisions of law, the filing of proposed rates or a rating |
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1 | formula and the holding and conducting of any public hearing in connection with these proposed |
2 | rates or rating formula of any health insurer, dental insurer, or health maintenance organization |
3 | subject to title 27 shall be held in accordance with the provisions of chapter 35 of title 42. |
4 | (g) Whenever the term "designee" is used in this section, it shall mean a person who is |
5 | impartial, a member in good standing of the Rhode Island bar and a person who is sufficiently |
6 | acquainted with the rules of evidence as used in the superior court of the state so as to enable that |
7 | person to conduct a hearing as designee of the director. The reasonable per diem cost of the |
8 | designee as appointed by the director shall be paid by the insurers requesting changes in the rates. |
9 | (h) Public comment. Whether or not a public hearing is held pursuant to subsection (b) of |
10 | this section, the commissioner shall solicit public comment regarding the rates proposed to be |
11 | used. Public comment shall be solicited upon not less than ten (10) days written notice prior to the |
12 | date that either: |
13 | (1) A public meeting at which verbal comments may be provided; or |
14 | (2) That written comment must be received by the commissioner. The notice shall contain |
15 | a description of the rates proposed to be charged, and a copy of the notice shall be sent to the |
16 | applicant and to the insurance advocacy unit of the department of attorney general. The attorney |
17 | general shall be permitted to conduct discovery in relation to the actuarial analysis and actuarial |
18 | assumptions of the filer regarding any filing in the individual market as defined in §27-18.5-2. |
19 | Any documents presented in support of the filing under this section shall be made available for |
20 | public examination at a time and place that the commissioner may deem reasonable. |
21 | (i) The applicant shall bear reasonable expenses of the commissioner in connection with a |
22 | filing made pursuant to this section, including any costs related to advertisements, stenographic |
23 | reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear |
24 | reasonable expenses of the attorney general in relation to any public hearing conducted pursuant |
25 | to this section. The applicant shall bear reasonable expenses of the attorney general in relation to |
26 | any filing in the individual market that is not subject to a public hearing. |
27 | SECTION 4. This act shall take effect on January 1, 2017, and shall sunset on January 1, |
28 | 2021. |
29 | . |
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LC003610/SUB A/2 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE - RATE REVIEW ACT | |
*** | |
1 | This act would create a uniform rate review procedure for rates proposed to be changed |
2 | or rating formulas proposed to be used by nonprofit hospital service corporations, nonprofit |
3 | medical services corporations and the catastrophic health insurance plan requiring public hearings |
4 | or public meetings with the applicant bearing the reasonable expenses of the filing. This act |
5 | would not limit the appeal rights of any person or entity that had the right to appeal a final |
6 | decision of the commissioner under the applicable provisions of titles 27 and 42 relating to health |
7 | insurance. |
8 | This act would take effect on January 1, 2017, and shall sunset on January 1, 2021. |
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LC003610/SUB A/2 | |
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