230 R.I. Code R. 230-RICR-20-30-5.5

Current through December 3, 2024

Section 230-RICR-20-30-5.5 - Minimum Policy Language Simplification Standards

A. In addition to any other requirements of law, no policy form may be approved under this regulation, unless:

1. The text of the policy form does not exceed the eighth-grade reading level as measured by the Flesch-Kincaid formula;

2. The policy form is printed in not less than twelve-point type, except for type used for specification pages, schedules, tables and minor instructions concerning the preparation of forms by the consumer (e.g., instructions indicating where a consumer should provide his or her name, address or other information);

3. The style, arrangement and overall appearance of the policy form gives no undue prominence to any portion of the text of the policy or to any endorsements or riders; and

4. The policy form contains a table of contents or an index of the principal sections of the policy form, if the policy has more than 3,000 words or than three pages regardless of the number of words.

B. An insurer may use an alternate method or formula for evaluating the readability of a policy form instead of the Flesch-Kincaid formula as long as the insurer can demonstrate that the alternate method or formula can be used to determine a reading level at or below the eighth-grade reading level.

C. If a policy form contains 10,000 or fewer words of text, the entire form shall be analyzed by the health insurer for compliance with subsection (1) of this section. If a policy form contains more than 10,000 words of text, two 200-word samples per page may be analyzed by the health insurer for compliance with subsection (1) of this section instead. The samples shall be separated by at least 10 printed lines.

D. The term "text" as used in this section shall include all printed matter except the following:

1. The name and address of the insurer; the name, number or title of the policy; the table of contents or index; captions and sub captions; specification pages, schedules or tables; and

2. Any policy language which is drafted to conform to the requirements of any federal law, regulation or agency interpretation; any policy language required by any collectively bargained agreement; any medical terminology; any words which are defined in the policy; and any policy language required by law or regulation; provided, however, the insurer identifies the language or terminology excepted by this paragraph and certifies, in writing, that the language or terminology is entitled to be excepted by this paragraph.

E. At the option of the insurer, riders, endorsements, applications and other forms may be scored as separate forms or as part of the policy with which they may be used.

F. Policy forms subject to this regulation shall be accompanied by a certificate signed by an officer of the insurer, or someone else who has specific authority to sign on behalf of and bind the insurer, that provides a Flesch-Kincaid grade score (to the closest tenth of a point) for the policy form and

1. A certification that the policy form meets the minimum reading level requirement and other standards set out by this section; or

2. A statement that the policy form does not meet the minimum reading level requirement and/or other standards set out by this section, but requests approval of the policy form pursuant to § 5.6 of this Part.

G. To confirm any certification, the health insurance commissioner may require the submission of further information to verify the certification in question.

H. A failure to comply with the requirements of either § 5.5(F) of this Part will result in rejection of the policy form.

230 R.I. Code R. 230-RICR-20-30-5.5