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.

2018 Process and Documents

On May 15th, 2018 Blue Cross Blue Shield of Rhode Island (BCBSRI), Neighborhood Health Plan of Rhode Island (NHPRI), Tufts Health Plan (Tufts HP), 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 2019.

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, 2018. Following this deadline, OHIC will make all comments received publicly available. All comments regarding the BCBSRI individual market rate filing must be submitted by July 10, 2018.

Comments may be submitted in two ways:

  • Written comments may be sent for consideration to OHIC.HealthInsInquiry@ohic.ri.gov.
  • The public is invited to attend a public input meeting on June 25, 2018 at 5:00 P.M. at the State of Rhode Island Department of Labor and Training, 1511 Pontiac Avenue, Building 73-1, Cranston, RI. Public comments will be taken in order of sign-up at the meeting. While oral comments are welcome, OHIC encourages members of the public to also submit any oral comment offered at the public input meeting in written form to OHIC.HealthInsInquiry@ohic.ri.gov by July 27, 2018. Please contact Jonelie Cardoza at (401) 462-6428 or Jonelie.Cardoza@ohic.ri.gov to arrange for special accommodations or for more information about the public input meeting.

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

2018 Public Comment Solicitation Rate Review Process

2018 Rate Review Process Large Group Detailed Summary

2018 Small Employer Rate Review Detailed Summary

2018 Individual Rate Review Detailed Summary

Press Release: 2019 Requested Commercial Health Insurance Rates Have Been Submitted to OHIC for Review

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For public access to the form and rate filings submitted on May 15, 2018 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 2018
Access Rhode Island Rate Review SERFF Filings 

SERFF Tracking Numbers:
2018 BCBSRI Individual Submission (Form): BCBS-131439180
2018 BCBSRI Individual Submission (Rate): BCBS-131477590
2018 BCBSRI Small Group Submission (Form): BCBS-131439249
2018 BCBSRI Small Group Submission (Rate): BCBS-131477589
2018 BCBSRI Large Group Submission (Rate): BCBS-131477538
2018 NHPRI Individual Submission (Form): NHRI-131449302
2018 NHPRI Individual Submission (Rate): NHRI-131446448
2018 NHPRI Small Group Submission (Form): NHRI-131449332
2018 NHPRI Small Group Submission (Rate): NHRI-131446492
2018 United HMO Small Group Submission (Form): UHLC-131445329
2018 United PPO Small Group Submission (Form): UHLC-131428638
2018 United Small Group Submission (Rate): UHLC-131500143
2018 United Large Group Submission (Rate): UHLC-131500989
2018 Tufts HMO Small Group Submission (Form): THPC-131441532
2018 Tufts HMO Small Group Submission (Rate): THPC-131502515
2018 Tufts PPO Small Group Submission (Form): THPC-131441609
2018 Tufts PPO Small Group Submission (Rate): THPC-131502540
2018 Tufts Large Group Submission (Rate): THPC-131502525

Consumer Disclosures for Coverage Year 2019
(Updated as of 5/29/2018)

Blue Cross Individual 2019 Consumer Disclosure

Blue Cross Small Group 2019 Consumer Disclosure

NHP Individual 2019 Consumer Disclosure

NHP Small Group 2019 Consumer Disclosure

United Small Group HMO 2019 Consumer Disclosure

United Small Group PPO 2019 Consumer Disclosure

Tufts Small Group HMO 2019 Consumer Disclosure

Tufts Small Group PPO 2019 Consumer Disclosure

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2018 BCBSRI Direct Pay Hearing Process
For public access to BCBSRI's individual market form and rate filing submitted on May 15, 2018, 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:
2018 BCBSRI Individual Submission (Rate): BCBS-131477590

Blue Cross Direct Pay Hearing:
2018 BCBSRI Direct Pay hearings will be held July 5th and 6th, 2018 at 9:00 a.m. On July 5th, 2018 at 6:00 p.m. and July 6th, 2018 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. 

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.