Health Plan Review

In order to ensure that insurance rates are fair to consumers and that insurance carriers stay financially healthy, OHIC reviews the prices that insurance carriers set and the plans that they create through the form and rate review process. Insurers in the state must submit information on plan benefits and plan rates annually. OHIC then reviews all proposed rates to determine if health insurance companies are proposing unreasonable rates.

OHIC also uses the rate review process to monitor insurer solvency. Insurers must be able to stay in business and pay all their customers' health expenses. An insurance company going out of business hurts the entire health care system. OHIC uses criteria to approve plans that ensure that prices are fair for both insurers and consumers.

For the individual and small group market, OHIC examines the details of each health plan, which the insurers share with OHIC in documents known as "forms." These documents include all of the information about what the plan covers, the plan’s network, and member cost sharing structure (what the co-pays and deductibles are). OHIC must make sure the plans follow all state and federal laws. And when an insurer claims that consumers will only be responsible for a set percentage of their health costs, OHIC can use these documents to make sure the insurer's claims are true.

Health Plan Review Documents

Here you will find a listing of all documents related to OHIC's form and rate review process. For the individual (direct pay), small group, and large group markets, insurers submit proposed rates for each of their plans in their annual rate filings. Once all rates have been submitted, OHIC hears public comment on the rates. Consumers and small employers are invited to submit their input on the rates. The commissioner considers the input, along with actuarial and other data. Then the Commissioner issues a legally-binding decision and sets the rates for the coming year.

OHIC generally requires insurers to submit their proposed rates for individual (direct pay), small group, and large group plans in May. The process for Medicare Supplement Plans, also referred to as Medigap plans, generally begins later in the summer. Definitions for key abbreviations can be found here.

For previous year Form and Rate Review documents please click here.

2017 Process and Documents

On August 17, 2017, Health Insurance Commissioner Marie Ganim, PhD announced her final decision on commercial health insurance premiums for 2018. She approved lower rates than those requested by most health insurers. The rising cost of medical care - the prices insurers pay to providers for particular services and the number of services members use - continues to be the main driver of health insurance premium growth. Also, the reinstatement of the federal health insurance tax adds up to 2% to premiums in some markets.

Press Release: 2018 Rate Announcement

2018 Rate Review All Market Requested and Approved Summary

Blue Cross Blue Shield of Rhode Island (BCBSRI), Neighborhood Health Plan of Rhode Island (NHPRI), Tufts Health Plan (Tufts), and United Healthcare (United) filed with the State of Rhode Island Office of the Health Insurance Commissioner (OHIC) to request approval for rates to be charged to individuals, small employers, and large employers effective in 2018.

BCBSRI and NHPRI have filed in the individual market. All four commercial health insurers have filed in the small employer market. BCBSRI, Tufts, and United have filed in the large employer market. OHIC has the responsibility of reviewing the rates with the goal of holding the insurers publicly accountable for making health insurance more affordable while ensuring their solvency.
As a part of its review of the rates filed, OHIC is soliciting public comment on what has been submitted by the insurers. OHIC believes that public input is essential and will take all input received into account in developing its final decision. All public comments must be received by OHIC by July 27, 2017. There will also be a public input meeting on June 18, 2017 at 5:30pm at the State of Rhode Island Public Utilities Commission (89 Jefferson Boulevard, Warwick).


The documents below explain how to submit public comment to OHIC:

2017 Rate Review Process Public Input Session Agenda

2017 Small Employer Rate Review Detailed Summary

2017 Individual Rate Review Detailed Summary

2017 Public Comment Solicitation Rate Review Process

2017 Rate Review Process Large Group Detailed Summary

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For public access to the form and rate filings submitted on May 12, 2017 and June 16, 2017, please use the link below and enter in the SERFF Tracking numbers to access the filing. These submissions are currently under review by OHIC and are subject to change as the review process continues. Insurers filing in the individual and small group market are required to file a consumer disclosure form explaining their proposed rate increases. For access to the federal website on rate review, please visit: https://ratereview.healthcare.gov/.

RI SERFF Filings 2017
Access Rhode Island Rate Review SERFF Filings 

2018 Individual Market Contingency Filings
SERFF Tracking Numbers:

2017 BCBSRI Individual Submission (Form): BCBS-131178081
2017 BCBSRI Individual Submission (Rate): BCBS-131191183
2017 NHPRI Individual Submission (Form): NHRI-131187574
2017 NHPRI Individual Submission (Rate): NHRI-131188692


SERFF Tracking Numbers:
2017 BCBSRI Individual Submission (Form): BCBS-130979141
2017 BCBSRI Individual Submission (Rate): BCBS-131023122
2017 BCBSRI Small Group Submission (Form): BCBS-130979146
2017 BCBSRI Small Group Submission (Rate): BCBS-131023065
2017 BCBSRI Large Group Submission (Rate): BCBS-131023061
2017 NHPRI Individual Submission (Form): NHRI-130972744
2017 NHPRI Individual Submission (Rate): NHRI-130988977
2017 NHPRI Small Group Submission (Form): NHRI-130972843
2017 NHPRI Small Group Submission (Rate): NHRI-130989122
2017 United HMO Small Group Submission (Form): UHLC-130978061
2017 United PPO Small Group Submission (Form): UHLC-130980366
2017 United Small Group Submission (Rate): UHLC-131081175
2017 United Large Group Submission (Rate): UHLC-131031867
2017 Tufts HMO Small Group Submission (Form): THPC-130980553
2017 Tufts HMO Small Group Submission (Rate): THPC-131081744
2017 Tufts PPO Small Group Submission (Form): THPC-130980562
2017 Tufts PPO Small Group Submission (Rate): THPC-131081765
2017 Tufts Large Group Submission (Rate): THPC-131036470

Consumer Disclosures for Coverage Year 2018
(Updated as of 7/7/2017)

Blue Cross Individual 2018 Consumer Disclosure
Blue Cross Small Group 2018 Consumer Disclosure
NHP Individual 2018 Consumer Disclosure
NHP Small Group 2018 Consumer Disclosure
United Small Group HMO 2018 Consumer Disclosure
United Small Group PPO 2018 Consumer Disclosure
Tufts Small Group 2018 Consumer Disclosure


2017 BCBSRI Direct Pay Hearing Process

For public access to BCBSRI's individual market form and rate filing submitted on June 16, 2017, please use the link below and enter in the SERFF Tracking number to access the filing. Insurers filing in the individual and small group market were required to file a consumer disclosure form explaining their proposed rate increases (please see above).

Direct Pay Notice of Public Hearing Times

Access Rhode Island Rate Review SERFF Filings 

SERFF Tracking Number for Direct Pay:
2017 BCBSRI Individual Submission (Rate): BCBS-131023122

Blue Cross Direct Pay Hearing:
2017 BCBSRI Direct Pay hearings will be held July 20th and 21st, 2017 at 9:00 a.m. On July 20th, 2017 at 6:00 p.m. and July 21st, 2017 at 9:00 a.m. will be heard public comment at the Rhode Island Public Utilities Commission Hearing Room 89 Jefferson Blvd. Warwick, Rhode Island. 

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2016 Process and Documents

On August 11, 2016, Health Insurance Commissioner Kathleen C Hittner, MD announced her final decision on commercial health insurance premiums for 2017. She approved lower rates than those requested by most health insurers. The rising cost of medical care - the prices insurers pay to providers for particular services and the number of services members use - continues to be the main driver of health insurance premium growth.

Press Release: OHIC Approves Commerical Health Insurance Rates for 2017

Requested and Approved Summary for 2016 Rates for Individual, Small Group, & Large Group Markets 8/11/2016

On May 13, 2016, Blue Cross Blue Shield of Rhode Island (BCBSRI), Neighborhood Health Plan of Rhode Island (NHPRI), Tufts Health Plan (Tufts), and United Healthcare (United) filed with the State of Rhode Island Office of the Health Insurance Commissioner (OHIC) to request approval for rates to be charged to individuals, small employers, and large employers effective in 2017.

BCBSRI and NHPRI have filed in the individual market. All four commercial health insurers have filed in the small employer market. BCBSRI, Tufts, and United have filed in the large employer market. OHIC has the responsibility of reviewing the rates with the goal of holding the insurers publicly accountable for making health insurance more affordable while ensuring their solvency.

As a part of its review of the rates filed, OHIC is soliciting public comment on what has been submitted by the insurers. OHIC believes that public input is essential and will take all input received into account in developing its final decision. All public comments must be received by OHIC by June 27, 2015. There will also be a public input meeting on June 22, 2016 at 5:30pm at the State of Rhode Island Public Utilities Commission (89 Jefferson Boulevard, Warwick).

The documents below explain how to submit public comment to OHIC:

2016 Rate Review Public Comments (Non-BCBSRI Direct Pay)

2016 Public Comment Solicitation Rate Review Process 06222016

2016 Rate Review Process Public Input Session Updated Agenda 2016

Individual Rate Review Detailed Summary 06142016

2016 Small Employer Rate Review Detailed Summary 06142016

2016 Rate Review Process Large Group Detailed Summary 06142016

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For public access to the form and rate filings submitted on May 13, 2016, please use the link below and enter in the SERFF Tracking numbers to access the filing. These submissions are currently under review by OHIC and are subject to change as the review process continues. Insurers filing in the individual and small group market are required to file a consumer disclosure form explaining their proposed rate increases. For access to the federal website on rate review, please visit: https://ratereview.healthcare.gov/.


RI SERFF Filings 2016
Access Rhode Island Rate Review SERFF Filings 
SERFF Tracking Numbers:
2016 BCBSRI Individual Submission (Form): BCBS-130505786
2016 BCBSRI Individual Submission (Rate): BCBS-130553707
2016 BCBSRI Small Group Submission (Form): BCBS-130516039
2016 BCBSRI Small Group Submission (Rate): BCBS-130553711
2016 BCBSRI Large Group Submission (Rate): BCBS-130553712
2016 NHPRI Individual Submission (Form): NHRI-130508098
2016 NHPRI Individual Submission (Rate): NHRI-130562545
2016 NHPRI Small Group Submission (Form): NHRI-130508104
2016 NHPRI Small Group Submission (Rate): NHRI-130562590
2016 United HMO Small Group Submission (Form): UHLC-130515390
2016 United PPO Small Group Submission (Form): UHLC-130515392
2016 United Small Group Submission (Rate): UHLC-130567098
2016 United Large Group Submission (Rate): UHLC-130569721
2016 Tufts HMO Small Group Submission (Form): THPC-130517176
2016 Tufts HMO Small Group Submission (Rate): THPC-130563630
2016 Tufts PPO Small Group Submission (Form): THPC-130517273
2016 Tufts PPO Small Group Submission (Rate): THPC-130563601
2016 Tufts Large Group Submission (Rate): THPC-130563634

Consumer Disclosures for Coverage Year 2017
(Updated as of 5/20/2016)

Blue Cross Individual 2017 Consumer Disclosure
Blue Cross Small Group 2017 Consumer Disclosure
NHP Individual 2017 Consumer Disclosure
NHP Small Group 2017 Consumer Disclosure
United Small Group HMO 2017 Consumer Disclosure
United Small Group PPO 2017 Consumer Disclosure
Tufts Small Group 2017 Consumer Disclosure

2016 BCBSRI Direct Pay Hearing Process

For public access to BCBSRI's individual market form and rate filing submitted on May 13, 2016, please use the link below and enter in the SERFF Tracking number to access the filing. Insurers filing in the individual and small group market were required to file a consumer disclosure form explaining their proposed rate increases (please see above).

Access Rhode Island Rate Review SERFF Filings 
SERFF Tracking Number for Direct Pay:
2016 BCBSRI Individual Submission (Rate): BCBS-130553707

Blue Cross Direct Pay Hearing:
2016 BCBSRI Direct Pay hearings were held June 28th and 29th, 2016 at 9:00 a.m. June 28th, 2016 at 6:00 p.m. and June 29, 2016 at 9:00 a.m. for public comment at the Rhode Island Public Utilities Commission Hearing Room 89 Jefferson Blvd. Warwick, Rhode Island. 

Essential Health Benefits Benchmark Plan 2017

The Office of the Health Insurance Commissioner (OHIC) is seeking public comment on the selection of the state’s essential health benefits (EHB) for 2017. Beginning in 2014, the federal Affordable Care Act required health plans sold in the individual and small group markets to offer a comprehensive package of items and services, known as “essential health benefits.” Rhode Island chose a benchmark plan in 2012 for use in the 2014-2016 plan years. The federal government now requires that all states choose a new benchmark plan, for use in plan year 2017, by July 1, 2015.

2015 Public Comment Solicitation EHB 06232015

RI EHB Benchmark Plan Options Chart 06232015

The documents listed below exhibit the 2012 Benchmark Plan selection of the State of Rhode Island for Essential Health Benefits purposes.

VantageBlueSPD

EHBTemplateBCBSRI

PrescriptionDrugFormularyVantageBlue

VantageBlueSBC

MetLife pediatric dental plan

FEP Blue Vision pediatric vision plan

Additional Information on the 2012 Selection:

2012 RI EHB Benchmark Plan BCBSRI VantageBlue

2012 CMS Guide to EHB Benchmark Review

2012 RI State Mandates

For previous year Form and Rate Review documents please click here.