health care

Koller issues rate-review guidelines

Posted 5/7/12

PROVIDENCE – R.I. Health Insurance Commissioner Christopher F. Koller issued guidelines for commercial health insurers to follow in the upcoming 2012 rate review process for small and large employer groups.

In a letter dated April 19, Koller said that particular importance would be given to the expectation that insurers should submit aggregate predicted medical trends for increased expenses that “do not exceed 4 percent for either small group or large group” businesses. The inclusion of this new “expectation” as a factor in the rate review process, Koller continued, was based on the need to have rates consistent with the public interest and the affordability of health insurance.

Koller said that the culmination of the review process “will be a decision to approve an expected overall average premium trend” for each commercial health insurer in the small group and large group markets. Koller called the expected overall average premium trend “a rate cap.”

The rate review process will govern rates that begin on Jan. 1, 2013, and run through Dec. 31, 2013. All submissions must be filed electronically with OHIC by May 8. A decision on each insurer’s filing is expected by July 2.

As part of the information required in the insurers’ filings, Koller is requesting, for the first time, a listing from insurers for all of their small group products for which the rates are projected to increase 10 percent or more during 2013, based upon rate factors submitted.

While this information will be collected in accordance with requirements under the health care reform law, Koller said that OHIC will not review or make any product-specific decisions during the current rate process.

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