230 R.I. Code R. 230-RICR-20-30-1.11

Current through December 3, 2024

Section 230-RICR-20-30-1.11 - Filing of Forms and Rates

1.11.1Approval of Director

A. No health benefit contract shall be issued or delivered to any person in this state nor shall any application, rider, endorsement, individual certificate, subscriber contract or group master contract to be used in connection therewith be issued or delivered until a copy of the form thereof and of the classification of risks and the premium rates or the rating formula have been approved by the Director of Business Regulation. This requirement shall take effect two hundred seventy (270) days after promulgation of this Part, subject to the following conditions and exceptions:

1. No forms submitted to the Director for approval after the promulgation of this Part shall be approved unless such forms are in compliance with this Part.

2. Forms filed and approved under R.I. Gen. Laws Chapters 27-18 and 27-2 or otherwise approved in writing by the Director of Business Regulation may be issued or delivered without re-filing, provided that such forms are in compliance with this Part.

3. Forms filed and approved under R.I. Gen. Laws Chapter 27-18 or otherwise approved in writing by the Director of Business Regulation but which are not in compliance with this Part may be issued or delivered provided that such forms are amended by appropriate riders or endorsements designed to bring them into compliance. Such amendment forms must be approved by the Director of Business Regulation prior to use.

4. Forms filed and approved under R.I. Gen. Laws Chapter 27-18 or otherwise approved in writing by the Director of Business Regulation may be issued or delivered for up to three hundred sixty (360) days after promulgation of this Part provided that appropriate riders endorsements or revisions designed to bring such forms into compliance have been submitted to the Director for approval within two hundred seventy (270) days after promulgation of this Part.

5. Rates not previously submitted for approval and rates "received for filing" and not affirmatively approved by the Director may not be used in connection with contracts issued or delivered and placed in force in the state more than two hundred seventy (270) days after promulgation of this Part.

6. Rates affirmatively approved by the Director under R.I. Gen. Laws §§ 27-2-10, 27-19-6, 27-20-6, 27-20.1-3 or 42-16-13 remain approved without re-filing, subject to the terms and conditions of such approval.

1.11.2Filing and Approval

No such contract shall be issued, nor shall any application, rider, endorsement, individual certificate, subscriber contract, or group master contract be used in connection therewith, until the expiration of sixty (60) days after it has been so filed unless the Director of Business Regulation shall sooner give his written approval thereto, except that with respect to forms submitted within two hundred seventy (270) days after promulgation of this Part, no such forms shall be issued until the expiration of ninety (90) days unless the Director shall sooner give his written approval.

1.11.3Hearing

A. The Director of Business Regulation may, with or without a public hearing as provided for in R.I. Gen. Laws § 42-62-13, within sixty (60) days, except that ninety (90) days shall apply to forms submitted for approval within two hundred seventy (270) days after promulgation of this Part, after filing of any such form disapprove such form:

1. if the benefits provided therein are unreasonable in relation to the premium charged, or

2. if it contains a provision or provisions which are unjust, unfair, inequitable, misleading, deceptive or encourage misrepresentation of such contract. If the Director of Business Regulation shall notify the insurer which has filed any such form that it does not comply with all applicable laws and regulations, it shall be unlawful thereafter for such insurer to issue such form or use it in connection with any contract. In such notice the Director of Business Regulation shall specify the reasons for his disapproval.

1.11.4Withdrawal of Approval

The director of Business Regulation may at any time, after a hearing of which not less than twenty (20) days written notice shall have been given to the insurer, withdraw his approval of any such form on any of the grounds stated § 1.11 of this Part. The insurer may not issue such form or use it in connection with any contract after the effective date of such withdrawal of approval.

1.11.5Form of Contracts

A. The style, arrangement and over-all appearance of the contract shall give no undue prominence to any portion of the text, and every printed portion of the text of the contract and of any endorsements or attached papers shall be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lower-case unspaced alphabet length not less than one hundred and twenty (120) point (the "text" shall include all printed matter except the name and address of the insurer, name or title of the contract, the brief description if any, and captions and subcaptions); and

B. The exceptions and reductions of indemnity shall be set forth in the contract and, except those which are set forth in R.I. Gen. Laws §§ 27-18-3 to 27-18-10 inclusive, if such sections are applicable to such contract, are printed at the insurer's option, either included with the benefit provisions to which they apply, or under an appropriate caption such as "EXCEPTIONS," or "EXCEPTIONS AND REDUCTIONS," provided that if an exception or reduction specifically applies only to a particular benefit of the contract, a statement of such exception or reduction shall be included with the benefit provision to which it applies; and

C. Each form shall bear a unique form number printed in the lower left-hand corner of such form. All numbers, letters and other symbols appearing in the lower left-hand corner shall together constitute the entire form number, and any change in that number shall require filing as a separate form.

D. Each form shall contain no provision purporting to make any portion of the charter, rules, constitution, or by-laws of the insurer a part of the contract unless such portion is set forth in full in the contract, except in the case of the incorporation of, or reference to a statement of rates or classification of risks, or short-rate table filed with the insurance commissioner.

1.11.6Submission Instructions

A. Forms submitted for approval in accordance with § 1.11 of this Part must be submitted as follows:

1. A letter in triplicate must be included with each submission which:

a. specifies the form number and title of each form being submitted;

b. generally describes the purpose of each form;

c. states whether the form is new or a replacement of any existing form and describes by title and form number any forms being replaced;

d. with respect to applications and other forms which have been previously approved and are submitted in support of such filing, states the date(s) of approval of such form(s).

2. One specimen copy of each form in final printed form including a specimen of the application, if any, to be used with such form, whether or not such application has been previously approved (two copies if the insurer wishes to have a stamped copy returned for its records) with all blanks in the printed form filled in with hypothetical information, except that no hypothetical information is required on application forms. With respect to rider, endorsement or other amendment forms for use with individual health benefit contracts, one specimen copy of each contract form to which it will be attached, whether or not such contract form has been previously approved.

3. One specimen copy of each rate schedule or rating formula together with all required actuarial data as outlined in §1.11.7(A)(1) and (2) of this Part.

4. A stamped, self-addressed envelope.

1.11.7Rates

A. To the extent appropriate, rates submitted in accordance with § 1.11 of this Part should be submitted in duplicate, including complete rate schedules accompanied by the following supporting data:

1. For rates applied to new individual contract forms - A signed statement from an actuary giving the methods and assumptions used to determine the proposed premium rates including the formulas used to calculate gross premiums. The statement as to the assumptions used should give the exact source of the claim costs or other experience data on which the premium calculations are based and the source of any multipliers or other factors used to adjust such claim costs or other experience data to reflect the benefits provided.

a. If published experience is used, state the page and table number of the source. Unless published, the basic experience data (for example, claim costs) and adjustment factors should be included with such description. When the basic claim costs or other data are shown for age groupings, for example, quinquennial or decennial ages, state the method used to obtain the required values at intermediate ages.

b. Indicate where judgment is used to determine any adjustment factors applied to basic experience data.

c. Indicate any modifications used to reflect the effect of selection or to allow for future increases in claim costs.

d. A statement as to the contract termination rates used.

e. A statement of the methods used to incorporate margins for profit and contingencies in the premium rates.

f. If the contract is participating, give a statement as to the methods used to determine anticipated dividends.

g. A detailed statement of all expense assumptions including commissions, taxes, claims handling, and administrative expenses made in the premium calculations, and indicating allowances for future increase in expenses.

h. A statement of the expected benefit loss ratios at representative issue ages and an estimated composite benefit loss ratio indicating the distribution of issue ages for both males and females used to determine such composite loss ratio.

i. A statement summarizing the type of benefit provided, the range of benefits offered, and the average size of the benefits assumed.

j. A statement as to how gross premiums were calculated including the formula used.

2. For changes in rates that apply to presently-approved individual contract forms;

a. A statement of all premiums (both received and earned), and claims (both paid and incurred) and expenses incurred for each of the previous five (5) years;

b. A statement of the actual benefit loss ratio on both a cash basis and on an incurred claim to earned premium basis;

c. A statement of the approval date of the rate currently in use and the anticipated benefit loss ratio at the time the rate was approved;

d. A statement of the total number of contracts in force, to which the above rates will apply;

e. A statement of the total number of contracts in force, to which the above rates will apply, in Rhode Island.

f. A copy of the contract, rider, and/or endorsements for which the rates apply.

g. A copy of the rate schedule now in use and the rate schedule which reflects the proposed rate increase.

3. For rates that apply to new group and blanket contract forms and changes in rates that apply to presently-approved group and blanket contract forms;

a. One copy of each rate schedule, rating formula or formulas, or manual must be submitted. Upon receipt of manuals, formulas, or rate schedules, the Director of Business Regulation may request actuarial data and other pertinent information.

b. An outline of the essential benefits, coverages, limitations and exclusions to which such rates shall apply.

4. The Director may approve, disapprove or modify rates, with or without a public hearing, as provided in R.I. Gen. Laws § 42-62-13.

5. With respect to insurers, as defined in R.I. Gen. Laws § 42-62-4(c) that are not insurance companies subject to R.I. Gen. Laws Chapter 27-1 and R.I. Gen. Laws Chapter 27-2 the Director may waive any or all of the requirements of §1.11.7 of this Part and establish, through written correspondence or in the course of the review of filings and the conduct of public hearings, other statements or exhibits which he deems more appropriate to the review of rates proposed by such insurers.

230 R.I. Code R. 230-RICR-20-30-1.11