Regulation and Monitoring - Enforcement
Charged with regulating Rhode Island's health insurance industry, OHIC investigates insurers' operations and takes action to halt violations of state law. OHIC regulates insurers' relationships with consumers and providers, while Rhode Island's Department of Business Regulation (DBR) makes sure insurers pay their taxes and comply with all other financial regulations.
Though jurisdiction varies from case to case, insurer discrimination, excessive fees, and fair treatment of small businesses generally fall under OHIC's regulatory umbrella. OHIC has previously taken action against insurers for unfairly declining coverage to a particular group of people, arbitrarily assigning different rates to similar customers, or failing to offer equal coverage to all small employers. If an insurer charges rates that are too high, or refuses to pay for benefits supposedly covered under a particular plan, OHIC is responsible for taking on the case.
When insurers violate Rhode Island law, the commissioner has broad powers to step in and set things right. Not only can the commissioner write a legally-binding order forcing the insurer to ceasing its harmful practices, but he or she can also fine the company or demand that it pay damages to consumers. In 2011, for example, the commissioner forced an insurer to pay 2.3 million dollars in restitution to Rhode Island's small businesses. These penalties force insurers to take the law seriously, creating a safer health insurance market for everyone in Rhode Island.
Please note: OHIC does not regulate "self-insured companies," or companies that fund their own employees' medical services. Regulation of these bodies falls to the federal government.
Regulation Enforcement Documents
To promote transparency, OHIC releases documents from every step of its regulatory process. The first step in this process is always a market conduct examination, which OHIC's regulators summarize in an examination report. The commissioner then looks over the report, determines what changes and/or penalties are appropriate, and issues a legally binding market conduct examination order. If the insurer decides to appeal this decision, the resulting court case may result in a court decision or a settlement. These documents are available below for each of OHIC's enforcement actions.
Delta Dental 2011-2012
Market Conduct Order-Delta-January 2012
Market Conduct Compliance Audit-Delta Dental-Nov 2011
Memo about Market Conduct Audit-Delta Dental-Nov 2011
Response to Market Conduct Report-Delta-July 2011
Market Conduct Report-Delta-June 2011
BCBS and Care New England 2009-2011
Targeted Market Conduct Exam Order-BCBS and Care New England-Oct 2011
Court Decision-Targeted Market Conduct Exam-BCBS and Care New England-July 2011
Targeted Market Conduct Exam Order BCBS and Care New England
Targeted Market Conduct Exam Recs-BCBS and Care New England-Oct 2010
Targeted Market Conduct Exam Report-BCBS and Care New England-Jan 2009
UHC Feb 2007
For more documents related to the financial regulation of Rhode Island’s health insurers, please visit the website of the Rhode Island Department of Business Regulation (DBR).