Regulation and Monitoring - Developing Regulations

Beyond simply enforcing Rhode Island law in individual cases, OHIC adds substance to the law by creating its own market regulations. Based on legislation passed by Rhode Island's legislature, these regulations provide more detail on each law's interpretation and implementation. When the legislature simply gives the commissioner authority to oversee a particular aspect of the health insurance market, regulations create clear, consistent standards for both OHIC and insurers to follow. And when a loophole or vague provision in a state law allows insurers to avoid particular requirements, OHIC can sometimes create or amend a regulation to fill in the gaps. These regulations then become a legally binding part of Rhode Island's regulatory system.

From requiring insurers to cover nicotine patches, to setting standards for the readability of health insurance forms, OHIC's regulations have a far-reaching impact on Rhode Island's consumers. Working on a larger scale, OHIC has also created regulations to enforce the Small Employer Health Insurance Availability Act and to set minimum standards for Medicare supplement insurance.

To keep the commissioner's office from becoming too powerful, however, the state sets limits on OHIC's authority. All regulations must arise from specific clauses of Rhode Island law, and the public has an opportunity to provide input before a regulation is adopted. To see how new regulations are created, please view the documents below.

Regulations and Regulation Development Documents

To ensure transparency, OHIC releases all regulations and publicizes every stage of the regulation development process. The process begins when the health insurance commissioner writes a proposal for a regulation or an amendment to a regulation that's already on the books. OHIC then releases a letter announcing the proposed changes and inviting the public to comment. This letter may be referred to as a solicitation of public comment, a hearing notice, or simply a notice. When proposing an amendment, OHIC may also release a “redlined” version of the regulation with all potential changes marked.

Once the public has provided its input, OHIC continues the process by releasing a list of public comments. In its concise explanatory statement of the regulation, OHIC reiterates the intent of the new regulation or amendment and may also respond directly the concerns raised by the public. Finally, after making any changes to the proposal that he or she feels to be necessary, the commissioner signs the final regulation and it essentially becomes law.

Regulation 1 Adopting DBR Regulations

Adopted effective May 17, 2006, this regulation is designed to ensure the smooth transition of regulatory and oversight responsibilities from the DBR to the OHIC. Under this regulation, OHIC adopts certain regulations of the DBR.

Regulation 1 Adopting DBR Regulations

Regulation 7 Prompt Processing of Claims

The Office adopted Regulation 7 as proposed October 6, 2006, with an effective date of January 1, 2007. This regulation was adopted to effectuate administration and enforcement of Rhode Island's prompt processing statutes. This regulation replaces the state's existing prompt processing regulation issued by the Department of Business Regulation in 2003.

Regulation 7 Prompt Processing of Claims

Concise Explanatory Statement of Regulation 7

Bulletin 2008-6 Exemption From Annual Prompt Processing Report

Bulletin 2006-4 prompt processing and pharmacy claim

Bulletin 2006-3 Prompt Processing Regulation

Regulation 8 Medicare Supplement Insurance Minimum Standards

Regulation 8 Medicare Supplement Minimum Standards

Concise Explanatory Statement Regulation 8

Regulation 9 Advertisements of Medicare Supplement Insurance with Interpertative Guidelines

Regulation 9 Advertisements of Medicare Supplement Insurance

Concise Explanatory Statement Regulation 9

Regulation 10 Adoption of Cafeteria Plans

This regulation is an adoption which will implement the provisions of Title 27, Chapter 70, entitled "The Health Insurance Tax Incentive" (the HITI). The HITI requires each Rhode Island employer which meets a designated size requirement to adopt and maintain for its employees a cafeteria plan, also known as a Section 125 plan. The purpose of a cafeteria plan is so that employees and their dependents may purchase health insurance with pre-tax wages.

Regulation 10 Cafeteria Plans

Concise Explanatory Statement Regulation 10

Bulletin 2009-1 Cafeteria Plan Mandate

Regulation 11 Small Employer Health Insurance Availability Regulation

This regulation is adopted to implement the provisions of Title 27, Chapter 50, the "Small Employer Health Insurance Availability Act" (the "Act") and replaces Regulation 82 of the Department of Business Regulation ("DBR Regulation 82"), which had been adopted by OHIC.

Regulation 11 Small Employer Health Insurance Availability

Concise Explanatory Statement Amendment Regulation 11 #1

Concise Explanatory Statement Amendment Regulation 11 #2

Concise Explanatory Statement Regulation 11

Red-Lined Amendment to Regulation 11-2011

Public Comments on Regulation 11-2011

Solicitation of Public Comment on Regulation 11-2011

Bulletin 2008-3 Small Group Annual filing

Regulation 13 Mulitiple Employer Welfare Arrangements

The Health Insurance Commissioner has determined that certain multiple employer welfare arrangements may be transacting the business of insurance in the State of Rhode Island; that certain multiple employer welfare arrangements and their actions are hazardous to the public; that in order to protect the interests of the public concerning multiple employer welfare arrangements that provide employee benefits, it is necessary to regulate such activities. This regulation helps protect the interests of the public.

Regulation 13 Multiple Employer Welfare Agreements

Concise Explanatory Statement Regulation 13

Regulation 16 Insurance Issued to Trusts or Associations

Regulaton 16 Insurance Issued to Trusts and Associations