RELATING TO INSURANCE - SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT
Introduced By: Senators Badeau, Cote, Graziano, Hunter, and P Fogarty
Date Introduced: March 20, 2002
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-50-5 of the General Laws in Chapter 27-50 entitled "Small Employer Health Insurance Availability Act" is hereby amended to read as follows:
27-50-5. Restrictions relating to premium rates. -- (a) Premium rates for health benefit plans subject to this chapter are subject to the following provisions:
(1) Subject to subdivision (2), a small employer carrier shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:
(ii) Gender; and
(iii) Family composition.
(2) Until October 1, 2002, a small employer carrier who as of June 1, 2000, varied rates by health status may vary the adjusted community rates for health status by ten percent (10%), provided that the resulting rates comply with the other requirements of this section, including subdivision (5). After October 1, 2002, no small employer carrier may vary the adjusted community rate based on health status.
(3) The adjustment for age in subparagraph (1)(i) may not use age brackets smaller than five year increments and these shall begin with age thirty (30) and end with age sixty-five (65).
(4) The small employer carriers are permitted to develop separate rates for individuals age sixty-five (65) or older for coverage for which Medicare is the primary payer and coverage for which Medicare is not the primary payer. Both rates are subject to the requirements of this subsection.
(5) For each health
benefit plan offered by a carrier, the highest premium rate for each family
composition type shall not exceed two (2) times the premium rate that could be
charged to a small employer with the lowest premium rate for that family
. ,effective two (2) years after enactment of this
chapter [July 13, 2000] During the first two (2) years after enactment of this
chapter the highest premium rate for each family composition type shall not
exceed four (4) times the premium rate that could be charged to a small
employer with the lowest premium rate for that family composition.
(6) [Effective until September 30, 2002.]Upon renewal of a health benefit plan, the premium rate for each group shall not exceed the premium rate charged by that carrier to that group during the prior rating period by more than: (i) cost and utilization trends for that carrier; plus (ii) the sum of any premium changes due to changes in the size, age, gender or family composition of the group; plus, (iii) ten percent (10%); plus (iv) the change in the actuarial value of the benefits due to changes in the health benefit plan for that group. This subdivision expires on September 30, 2002.
(7) Premium rates for bona fide associations except for the Rhode Island Builders' Association whose membership is limited to those who are actively involved in supporting the construction industry in Rhode Island shall comply with the requirements of section 27-50-5.
(b) The premium charged for a health benefit plan may not be adjusted more frequently than annually except that the rates may be changed to reflect:
(1) Changes to the enrollment of the small employer;
(2) Changes to the family composition of the employee; or
(3) Changes to the health benefit plan requested by the small employer.
(c) Premium rates for health benefit plans shall comply with the requirements of this section.
(d) Small employer carriers shall apply rating factors consistently with respect to all small employers. Rating factors shall produce premiums for identical groups which differ only by the amounts attributable to plan design and do not reflect differences due to the nature of the groups assumed to select particular health benefit plans. However, nothing in this section shall be construed to prevent a group health plan and a health insurance carrier offering health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention, provided that the resulting rates comply with the other requirements of this section, including subdivision (a)(5).
(e) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restriction of benefits to network providers results in substantial differences in claim costs.
(f) The director may establish regulations to implement the provisions of this section and to assure that rating practices used by small employer carriers are consistent with the purposes of this chapter, including regulations that assure that differences in rates charged for health benefit plans by small employer carriers are reasonable and reflect objective differences in plan design or coverage (not including differences due to the nature of the groups assumed to select particular health benefit plans or separate claim experience for individual health benefit plans).
(g) In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:
(1) The provisions of the health benefit plan concerning the small employer carrier's right to change premium rates and the factors, other than claim experience, that affect changes in premium rates;
(2) The provisions relating to renewability of policies and contracts;
(3) The provisions relating to any preexisting condition provision; and
(4) A listing of and descriptive information, including benefits and premiums, about all benefit plans for which the small employer is qualified.
(h) (1) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
(2) Each small employer carrier shall file with the director annually on or before March 15 an actuarial certification certifying that the carrier is in compliance with this chapter and that the rating methods of the small employer carrier are actuarially sound. The certification shall be in a form and manner, and shall contain the information, specified by the director. A copy of the certification shall be retained by the small employer carrier at its principal place of business.
(3) A small employer carrier shall make the information and documentation described in subdivision (h)(1) available to the director upon request. Except in cases of violations of this chapter, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the director to persons outside of the department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.
(i) The requirements of this section apply to all health benefit plans issued or renewed on or after October 1, 2000.
SECTION 2. This act shall take effect on October 1, 2003.