Chapter 089
2021 -- S 0003 SUBSTITUTE A
Enacted 06/25/2021

A N   A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By: Senators Sosnowski, McCaffrey, Goodwin, Gallo, Felag, Coyne, Lawson, Cano, Acosta, and DiPalma

Date Introduced: January 11, 2021

It is enacted by the General Assembly as follows:
     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance
Policies" is hereby amended by adding thereto the following section:
     27-18-85 27-18-88. Gender rating.
     (a) No individual or group health insurance contract, plan, or policy delivered, issued for
delivery, or renewed in this state, which that provides medical coverage that includes coverage for
physician services in a physician's office, and no policy which that provides major medical or
similar comprehensive-type coverage, excluding disability income, long-term care, and insurance
supplemental policies which that only provide coverage for specified diseases or other
supplemental policies, shall vary the premium rate for a health coverage plan based on the gender
of the individual policy holders, enrollees, subscribers, or members.
     (b) This section shall not apply to insurance coverage providing benefits for any of the
following:
     (1) Hospital confinement indemnity;
     (2) Disability income;
     (3) Accident only;
     (4) Long-term care;
     (5) Medicare supplement;
     (6) Limited benefit health;
     (7) Specified disease indemnity;
     (8) Sickness of bodily injury or death by accident or both; and
     (9) Other limited benefit policies.
     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
Corporations" is hereby amended by adding thereto the following section:
     27-19-77 27-19-80. Gender rating.
     (a) No individual or group health insurance contract, plan, or policy delivered, issued for
delivery, or renewed in this state, which that provides medical coverage that includes coverage for
physician services in a physician's office, and no policy which that provides major medical or
similar comprehensive-type coverage, excluding disability income, long-term care, and insurance
supplemental policies which that only provide coverage for specified diseases or other
supplemental policies, shall vary the premium rate for a health coverage plan based on the gender
of the individual policy holders, enrollees, subscribers, or members.
     (b) This section shall not apply to insurance coverage providing benefits for any of the
following:
     (1) Hospital confinement indemnity;
     (2) Disability income;
     (3) Accident only;
     (4) Long-term care;
     (5) Medicare supplement;
     (6) Limited benefit health;
     (7) Specified disease indemnity;
     (8) Sickness of bodily injury or death by accident or both; and
     (9) Other limited benefit policies.
     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
Corporations" is hereby amended by adding thereto the following section:
     27-20-73 27-20-76. Gender rating.
     (a) No individual or group health insurance contract, plan, or policy delivered, issued for
delivery, or renewed in this state, which that provides medical coverage that includes coverage for
physician services in a physician's office, and no policy which that provides major medical or
similar comprehensive-type coverage, excluding disability income, long-term care, and insurance
supplemental policies which that only provide coverage for specified diseases or other
supplemental policies, shall vary the premium rate for a health coverage plan based on the gender
of the individual policy holders, enrollees, subscribers, or members.
     (b) This section shall not apply to insurance coverage providing benefits for any of the
following:
     (1) Hospital confinement indemnity;
     (2) Disability income;
     (3) Accident only;
     (4) Long-term care;
     (5) Medicare supplement;
     (6) Limited benefit health;
     (7) Specified disease indemnity;
     (8) Sickness of bodily injury or death by accident or both; and
     (9) Other limited benefit policies.
     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
Organizations" is hereby amended by adding thereto the following section:
     27-41-90 27-41-93. Gender rating.
     (a) No individual or group health insurance contract, plan, or policy delivered, issued for
delivery, or renewed in this state, which that provides medical coverage that includes coverage for
physician services in a physician's office, and no policy which that provides major medical or
similar comprehensive-type coverage, excluding disability income, long-term care, and insurance
supplemental policies which that only provide coverage for specified diseases or other
supplemental policies, shall vary the premium rate for a health coverage plan based on the gender
of the individual policy holders, enrollees, subscribers, or members.
     (b) This section shall not apply to insurance coverage providing benefits for any of the
following:
     (1) Hospital confinement indemnity;
     (2) Disability income;
     (3) Accident only;
     (4) Long-term care;
     (5) Medicare supplement;
     (6) Limited benefit health;
     (7) Specified disease indemnity;
     (8) Sickness of bodily injury or death by accident or both; and
     (9) Other limited benefit policies.
     SECTION 5. 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) of this subsection subsection (a)(2) of this section, a small
employer carrier shall develop its rates based on an adjusted community rate and may only vary
the adjusted community rate for:
     (i) Age; and
     (ii) Gender; and
     (iii)(ii)(iii) Family composition;.
     (2) The adjustment for age in paragraph (1)(i) of this subsection subsection (a)(1)(i) of
this section may not use age brackets smaller than five-(5) year (5) increments and these shall
begin with age thirty (30) and end with age sixty-five (65).
     (3) 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.
     (4) For each health benefit plan offered by a carrier, 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.
     (5) 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 this section.
     (6) For a small employer group renewing its health insurance with the same small employer
carrier which that provided it small employer health insurance in the prior year, the combined
adjustment factor for age and gender for that small employer group will not exceed one hundred
twenty percent (120%) of the combined adjustment factor for age and gender for that small
employer group in the prior rate year.
     (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 that 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. Two groups that are otherwise identical, but which
have different prior year rate factors may, however, have rating factors that produce premiums that
differ because of the requirements of subdivision (a)(6) of this section. 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, including those included in affordable health benefit plans, provided that the resulting
rates comply with the other requirements of this section, including subdivision subsection (a)(5)(4)
of this section.
     The calculation of premium discounts, rebates, or modifications to otherwise applicable
copayments or deductibles for affordable health benefit plans shall be made in a manner consistent
with accepted actuarial standards and based on actual or reasonably anticipated small employer
claims experience. As used in the preceding sentence, "accepted actuarial standards" includes
actuarially appropriate use of relevant data from outside the claims experience of small employers
covered by affordable health plans, including, but not limited to, experience derived from the large
group market, as this term is defined in § 27-18.6-2(19).
     (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 health insurance commissioner may establish regulations to implement the
provisions of this section and to assure ensure that rating practices used by small employer carriers
are consistent with the purposes of this chapter, including regulations that assure ensure 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) and to ensure that small employer groups with one eligible
subscriber are notified of rates for health benefit plans in the individual market.
     (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 commissioner 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 commissioner. 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 (1) of this subsection subsection (h)(1) of this section available to the commissioner
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.
     (4) For the wellness health benefit plan described in § 27-50-10, the rates proposed to be
charged and the plan design to be offered by any carrier shall be filed by the carrier at the office of
the commissioner no less than thirty (30) days prior to their proposed date of use. The carrier shall
be required to establish that the rates proposed to be charged and the plan design to be offered are
consistent with the proper conduct of its business and with the interest of the public. The
commissioner may approve, disapprove, or modify the rates and/or approve or disapprove the plan
design proposed to be offered by the carrier. Any disapproval by the commissioner of a plan design
proposed to be offered shall be based upon a determination that the plan design is not consistent
with the criteria established pursuant to § 27-50-10(b).
     (i) The requirements of this section apply to all health benefit plans issued or renewed on
or after October 1, 2000.
     SECTION 6. This act shall take effect on January 1, 2023.
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LC000417/SUB A
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