230 R.I. Code R. 230-RICR-20-30-10.4

Current through December 3, 2024

Section 230-RICR-20-30-10.4 - Transition or Assumption of Business from Another Carrier

A. Approval required for transfer or assumption insurance risk. A small employer carrier shall not transfer or assume the entire insurance obligation and/or risk of a health benefit plan covering a small employer in this state unless:

1. the transaction has been approved by the insurance commissioner of the state of domicile of the assuming carrier or the OHIC if the assuming carrier is domiciled in Rhode Island;

2. the transaction has been approved by the insurance commissioner of the state of domicile of the ceding carrier or the OHIC if the ceding carrier is domiciled in Rhode Island; and

3. the transaction otherwise meets the requirements of the Act and this regulation.

B. Approval of the transaction-carriers domiciled in Rhode Island. A carrier domiciled in this state that proposes to assume or cede the entire insurance obligation or risk of one or more small employer health benefit plans from another carrier shall make a filing for approval with the health insurance commissioner at least sixty days prior to the date of the proposed assumption. The commissioner may approve the transaction if the commissioner finds that the transaction is in the best interests of the individuals insured under the health benefit plans to be transferred and is consistent with the purposes of the Act and this regulation. The commissioner shall not approve the transaction until at least thirty days after the date of the filing, unless the ceding carrier is in hazardous financial condition. If the ceding carrier is in hazardous financial condition, the commissioner may approve the transaction as soon as the commissioner deems appropriate after the filing

C. Requirements for the filing. The filing required under § 10.4(B) of this Part shall:

1. describe whether the health benefit plans being assumed are currently available for purchase by small employers;

2. describe the potential effect of the assumption, if any, on the benefits provided by the health benefit plans to be assumed

3. describe the potential effect of the assumption, if any, on the premiums for the health benefit plans to be assumed;

4. describe any other potential material effects of the assumption on the coverage provided to the small employers covered by the health benefit plans to be assumed; and

5. include any other information required by the health insurance commissioner.

D. Informational filing required in other states. A small employer carrier required to make a filing under § 10.4(B) of this Part shall also make an informational filing with the insurance commissioner of each state in which there are small employer health benefit plans that would be included in the transaction. The informational filing to each state shall be made concurrently with the filing made under § 10.4(B) of this Part and shall include at least the information specified in § 10.4(C) of this Part for the small employer health benefit plans in that state.

E. Notice of the transaction-carriers not domiciled in Rhode Island. A small employer carrier not domiciled in Rhode Island shall not transfer or assume the entire insurance obligation and/or risk of a health benefit plan covering a small employer in this state unless it has provided a notice to the health insurance commissioner at least sixty days prior to the date of the proposed assumption that contains the information specified in § 10.4(C) of this Part for the health benefit plans covering small employers in this state.

F. Transfer. A small employer carrier making a transfer pursuant to § 10.4 of this Part may alter the benefits of the assumed health benefit plans to conform to the benefits currently offered by the carrier into which the health benefit plans have been transferred.

G. New rate for transfers. The premium rate for an assumed small employer health benefit plan shall not be modified by the assuming small employer carrier until the health benefit plan is transferred pursuant to § 10.4 of this Part. Upon transfer, the assuming small employer carrier shall calculate a new premium rate for the health benefit plan from the rate manual required under § 10.5 of this Part.

H. Eligibility requirements may not be more stringent. An assuming carrier may not apply eligibility requirements, including minimum participation and contribution requirements, with respect to an assumed health benefit plan or with respect to any health benefit plan subsequently offered to a small employer covered by such an assumed health benefit plan that are more stringent than the requirements applicable to such health benefit plan prior to the assumption.

I. Legal obligations, authorizations and protections. Nothing in § 10.4 of this Part or in the Act is intended to:

1. reduce or diminish any legal or contractual obligation or requirement, including any obligation provided in R.I. Gen. Laws §§ 27-53.1-1 et seq. of the ceding or assuming carrier related to the transaction;

2. authorize a carrier that is not admitted to transact the business of insurance in this state to offer or insure health benefit plans in this state; or

3. reduce or diminish the protections related to an assumption reinsurance transaction provided in R.I. Gen. Laws §§ 27-53.1-1 et seq. or otherwise provided by law.

230 R.I. Code R. 230-RICR-20-30-10.4