Section 230-RICR-20-30-15.4 - Filing of Health Insurance Plan FormsA. No health insurance plan shall be offered, issued, delivered or renewed to any person or entity in this state, nor shall a certificate or other evidence of coverage of a health insurance plan defined in § 15.3(A)(6)(b) of this Part be offered, issued, delivered or renewed unless all forms used in connection with the health insurance plan, including but not limited to any application, rider, endorsement, certificate of coverage, policy, subscriber contract, or group master contract, have been filed in a complete manner with the Office, and the filing has been approved by the Commissioner. 1. Individual and small group market plans (including Qualified Health Plans sold on the Exchange) proposed to be effective between January 1 and December 31 of each calendar year shall be filed with the Commissioner on the date set annually by the Commissioner unless a waiver of such filing deadline is approved by the Commissioner. 2. The Commissioner shall notify the Issuer when the filing is deemed complete. Nothing in § 15.4(A)(2) of this Part is intended to limit the obligation of Issuers to provide information relating to the filing requested by the Commissioner after the filing is deemed complete.B. The prior approval required by § 15.4(A) of this Part shall not apply to the following forms: summaries of benefits and coverage, advertisements other than those used in connection with a Medicare supplemental health insurance plan, and marketing and marketing training materials. 1. A health insurance issuer shall maintain for five (5) years all records of the forms and materials not required to be filed under this § 15.4(B) of this Part. Upon notice of the Commissioner, the health insurance plan issuer shall file with the Commissioner, within the time prescribed in the notice, any form, summary of benefits and coverage, advertisement, marketing training and other marketing materials, and any other related materials used by the health insurance issuer in connection with any health insurance plan. An issuer's obligations under § 15.4(B) of this Part are in addition to the issuer's obligations under Subchapter 60 Part 4 of this Chapter, and any other applicable records retention laws and regulations.C. The Commissioner may delegate to an employee or official of the Office his or her authority to receive, approve or disapprove forms and related materials filed under § 15.4 of this Part.D. The Commissioner may authorize the use of filing instructions prescribing or verifying the content of health insurance plan forms, and verifying the issuer's compliance with the laws and regulations applicable to the use of such health insurance plan forms. A health insurance plan filing is not made in a complete manner unless it is filed by means of SERFF, and unless it is filed in accordance with the Commissioner's filing instructions.E. The Commissioner's filing instructions with respect to health insurance plans may include: 1. The completion of a Checklist of requirements for the content of health insurance plans; and 2. Sworn verification of a Compliance Attestation demonstrating the Issuer's compliance with the laws and regulations applicable to the use of such health insurance plan forms. 3. The Checklist and the Compliance Attestation for individual and small group health insurance plans may relate to the following matters: a. Coverage of essential health benefits in connection with an individual or small group health insurance plan, including a qualified health plan.b. Cost sharing requirements in connection with an individual or small group health insurance plan, including a qualified health plan.c. Coverage required by federal or state laws and regulations.d. Designation of actuarial values, expressed in terms of "metallic color", in connection with individual and small group health insurance plans, including qualified health plans.e. Consumer disclosure of benefits, coverage and cost-sharing, claims payment policies and procedures, and standards and procedures relating to utilization review, grievances, internal appeals, and external appeals, termination of enrollment, notice of termination, nonpayment of premium, notice of nonpayment of premium, and grace periods for nonpayment of premium, in accordance with federal and state laws and regulations.f. Accreditation of one or more of an issuer's product lines. The term "product line" means the benefit design category of a set of health benefit plans, including but not limited to a Point of Service product line, a Preferred Provider Organization product line, and a Health Maintenance Organization plan product line.g. Compliance of the health insurance issuer, including issuers of qualified health plans, with federal laws and regulations relating to network adequacy and provider directories.h. Compliance with state laws and standards relating to network adequacy.i. Compliance with federal and state laws and regulations relating to benefit determination, utilization review, grievances, internal appeals, and external appeals.j. Compliance with federal laws and regulations relating to the summary of benefits and coverage applicable to the health insurance plan, including a qualified health plan.k. Compliance with federal requirements concerning non-discrimination of plan offerings in all locations of the state.l. Compliance with federal and state laws and regulations relating to an issuer's obligations to subscribers and insureds with respect to termination of enrollment, notice of termination, nonpayment of premium, notice of nonpayment of premium, and grace periods for nonpayment of premium.m. Compliance with federal requirements relating to non-discrimination, as provided for in 45 C.F.R. § 156.200(e).n. In connection with qualified health plans only: (1) Compliance with federal requirements with respect to the offerings of a minimum number of actuarial values tiered qualified health plans, and the offering of child-only qualified health plans.(2) Compliance with federal requirements relating to individual and SHOP enrollment, enrollment notification, and enrollment periods.(3) Compliance with qualified health plan certification requirements to be issued and revised from time to time by the Exchange in accordance with federal and state laws and regulations, including 45 C.F.R. §§ 155.1000 et seq. and 45 C.F.R. §§ 156.200 et seq., unless the Commissioner determines that the certification requirement has not been included in the Commissioner's authorized filing instructions because the requirement is contrary to federal or state laws and regulations, or is contrary to the public interest.o. Any other matter necessary or desirable for the Commissioners to determine whether the filing satisfies the standard of approval established by law of regulation. F. The Commissioner's filing instructions applicable to the content of qualified health plans shall include all relevant qualified health plan certification standards to be issued and revised from time to time by the Exchange in accordance with federal and state laws and regulations, including 45 C.F.R. §§ 155.1000 et seq. and 45 C.F.R. §§ 156.200 et seq., unless the Commissioner determines that the certification requirement is contrary to federal or state laws and regulations, or is contrary to the public interest. The Commissioner shall also solicit and consider the recommendations of the Exchange in connection with the authorization of filing instructions applicable to the content of qualified health plan forms. The Office shall notify the Exchange upon the filing of a qualified health plan form with the Office and upon request of the Exchange shall promptly transmit any such filed qualified health plan form to the Exchange. At the request of the Exchange, the Office shall consider the comments of the Exchange with respect to the approval or disapproval of the qualified health plan form. The Office shall promptly transmit to the Exchange each qualified health plan form approved by the Office, together with data filed by the issuer in connection with the qualified health plan form. The Commissioner's approval of a qualified health plan form shall constitute approval of the content of the qualified health plan form, but shall not constitute certification on behalf of the Exchange with respect to any other aspect of the plan.G. The issuers' Checklist and Compliance Attestation shall be incorporated by reference into the insurance plan form, for purposes of R.I. Gen. Laws §§ 27-18-8, 27-19-7.2, 27-20-6.2, and 27-41-29.2. H. A health insurance plan form shall not be approved if the Commissioner determines that it is contrary to the public interest, or contrary to the requirements of the laws and regulations applicable to the health insurance plan form, including the requirements of this Regulation. At a minimum, a form shall be considered contrary to the public interest if it fails to comply with the Commissioner's authorized filing instructions, or if the issuer fails to properly complete an applicable Checklist, or fails to file an applicable Compliance Attestation.I. In connection with the Commissioner's approval of a health insurance plan form, the Commissioner may attach such conditions as the Commissioner determines are necessary for the plan to be consistent with the public interest, and consistent with the requirements of the laws and regulations applicable to the health insurance plan form. Such conditions may establish issuer obligations relating to: 1. Issuer compliance with laws and regulations relating to marketing standards of conduct, and with requirements relating to marketing training and materials;2. Issuer compliance with state laws and regulations relating to the certification of health plans;3. Issuer compliance with federal and state laws and regulations relating to benefit determination, utilization review, grievances, internal appeals, and external appeals;4. Issuer compliance with federal requirements with respect to discrimination against individuals with significant health needs; and5. Any other necessary and proper issuer obligation.J. A health insurance issuer may appeal the final decision of the Commissioner in accordance with R.I. Gen. Laws § 42-35-15.230 R.I. Code R. 230-RICR-20-30-15.4