Title 27
Insurance

Chapter 20
Nonprofit Medical Service Corporations

§ 27-20-6. Rates charged subscribers — Hearing by commissioner.

(a) General. The rates proposed to be charged or a rating formula proposed to be used by any corporation organized under this chapter to its subscribers, employers, the state, or any political subdivision of the state, or individuals, shall be filed by the corporation at the office of the health insurance commissioner (the “commissioner”).

(b) Public hearings.  Within ten (10) days after receipt of a filing, the commissioner shall determine, subject to the provisions of subsection (f) 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. Any such public hearing shall commence within sixty (60) days after receipt of the application, upon not less than ten (10) days’ written notice prior to the hearing, published by the commissioner in a newspaper or newspapers having aggregate general circulation throughout the state, at least ten (10) days prior to the hearing. 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 department 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. All public hearings held pursuant to this section shall be held in accordance with the provisions of chapter 35 of title 42.

(c) Filings with the attorney general’s office.  The applicant shall provide a copy of the filing on all rates proposed for health insurance coverage offered in the individual market as defined in § 27-18.5-2 or for a Medicare supplement policy as defined in § 27-18.2-1 to the insurance advocacy unit of the attorney general’s office simultaneously with the filing at the office of the health insurance commissioner.

(d) Procedures.

(1) The applicant shall be required to establish that the rates proposed to be charged are consistent with the proper conduct of its business and with the interest of the public.

(2) Any documents presented in support of a filing of proposed rates under this section shall be made available for public examination at a time and place that the commissioner may deem reasonable.

(3) If a public hearing is held pursuant to subsection (b) of this section, the commissioner, or designee, upon the 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 books, papers, records, correspondence, or other documents they deem relevant. 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 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 rates proposed to be charged by the applicant.

(e) The term “designee,” as used in this section, 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 so as to enable that person to conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee, as appointed by the commissioner, shall be paid by the applicant requesting changes in the rates.

(f) 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.

(g) In the event that subsection (f) of this section, in combination with § 42-62-13(b), would result in more than one public hearing in any given calendar year, the commissioner may defer one or more public hearing(s) for an applicant resulting from subsection (f) of this section or § 42-62-13(b) 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 the applicants’ filing satisfies the requirements of subsection (f) of this section or § 42-62-13(b) in that subsequent calendar year.

(h) 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) deferred in accordance with subsection (g) of this section.

(i) Notwithstanding any other provision 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, shall be held in accordance with the provisions of chapter 35 of title 42.

(j) Public comment. Whether or not a public hearing is held pursuant to subsection (f) of this section, the commissioner shall solicit public comment regarding the rates proposed to be charged. 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, or the formula proposed to be used, and a copy of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of the attorney general. The attorney general shall be permitted to conduct discovery in relation to the actuarial analyses 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.

(k) 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.