Section 230-RICR-20-30-15.5 - Filing of Health Insurance Plan Rates, Rating Formulas, and Rate Manuals - GeneralA. No health insurance plan shall be offered, issued, delivered or renewed to any person or entity in this state unless the rates, the rating formula, and the rate manual used in connection with the plan have been filed in a complete manner with the Office, and the filing has been approved by the Commissioner, or approved as modified by the Commissioner; provided that with respect to small group health insurance plans, issuers shall comply with the filing and maintenance of records requirements of R.I. Gen. Laws § 27-50-5(h). 1. Rates, rate factors, premiums, rating formulas and rate manuals for individual and small group market plans (including qualified health plans sold on the Exchange) proposed to be effective between January 1 and December 31 of each calendar year shall be filed with the Commissioner on the date set annually by the Commissioner unless a waiver of such filing deadline is approved by the Commissioner. Rate factors for large group market plans proposed to be effective between January 1and December 31 of each calendar year shall be filed with the Commissioner on the date set annually by the Commissioner.2. A nonprofit health insurance issuer filing rates, rate factors, premiums, rating formulas or rate manuals with respect to health insurance plans in the individual market, and in the Medicare supplemental insurance market shall provide a copy of such filings to the Insurance Advocacy Unit of the Attorney General's Office, in accordance with R.I. Gen. Laws §§ 27-19-6(b) and 27-20-6(b).3. The Commissioner shall notify the Issuer when the filing is deemed complete. Nothing in § 15.5(A)(3) of this Part is intended to limit the obligation of Issuers to provide information relating to the filing requested by the Commissioner after the filing is deemed complete.B. The Commissioner may delegate to an employee or official of the Office his or her authority to receive, approve, disapprove, or approve as modified rates, rating formulas, and rate manuals filed under § 15.5 of this Part.C. A health insurance rate, rating formula, or rate manual filing is not made in a complete manner unless it is filed by means of SERFF, and unless it is filed in accordance with filing instructions authorized by the Commissioner.D. The Commissioner may authorize the use of filing instructions prescribing the content of a health insurance rate filing, rating formula filing, or rate manual filing and requiring the filing of evidence of the issuer's compliance with its obligations relating to the matters identified in § 15.5(E)(1) through (9) of this Part.E. Such filing instructions may include content requirements and evidence of compliance with issuer obligations relating to: 1. Actuarial statements and analysis;2. The rate schedule, rating formula, or rate manual;3. The benefits, coverages, limitations and exclusions to which the rates, rating formula, or rate manual shall apply;4. Proposed premiums for health insurance plans in the individual and small group markets, including individual and SHOP qualified health plans offered on the Exchange;5. Issuer participation in any risk adjustment program or a reinsurance program administered in connection with health insurance plans;6. Compliance with federal and state rating and underwriting requirements, and with the prohibition on variability of rates by geographical area;7. The issuer's allocation of medical loss ratio rebate amounts, if applicable, together with any medical loss ratio and rebate calculations, and any other medical loss ratio and rebate information reported to the U.S. Secretary of Health and Human Services during the previous 12 months;8. In connection with qualified health plans only:a. Issuer compliance with the segregated accounting of premium allocations for abortion services;b. Issuer compliance with federal rate year requirements;c. Uniform plan pricing requirements for plans offered inside and outside the Exchange;d. issuer compliance with qualified health plan certification requirements to be issued and revised from time to time by the Exchange in accordance with federal and state laws and regulations, including 45 C.F.R. §§ 155.1000 et seq. and 45 C.F.R. §§ 156.200 et seq., unless the Commissioner determines that the certification requirement has not been included in the Commissioner's authorized filing instructions because the requirement is contrary to federal or state laws and regulations, or is contrary to the public interest; and9. Any other necessary or desirable content requirement or evidence of compliance.F. The Commissioner's filing instructions applicable to the content of qualified health plan rates, rating formulas, and rate manuals shall include all relevant qualified health plan certification standards to be issued and revised from time to time by the Exchange in accordance with federal and state laws and regulations, including 45 C.F.R. § 155.1000 et seq. and 45 C.F.R. § 156.200 et seq., unless the Commissioner determines that the certification requirement is contrary to federal or state laws and regulations, or is contrary to the public interest. The Commissioner shall solicit and consider the recommendations of the Exchange in connection with the authorization of filing instructions applicable to qualified health plan rates, rating formulas, and rate manuals. The Office shall notify the Exchange upon the filing of a qualified health plan rate with the Office and upon request of the Exchange shall promptly transmit any such filed qualified health plan rate filing to the Exchange. At the request of the Exchange, the Office shall consider the comments of the Exchange with respect to the approval or disapproval of the qualified health plan rate filing. The Office shall promptly transmit to the Exchange the approved rate of a qualified health plan, together with data concerning the rate filed by the issuer. The Commissioner's approval of a qualified health plan rate or premium shall constitute approval of the rate and premium for a qualified health plan, but shall not constitute certification on behalf of the Exchange with respect to any other aspect of the plan.230 R.I. Code R. 230-RICR-20-30-15.5