2025 -- S 0791
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LC002367
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
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A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Senators Bissaillon, Tikoian, Lawson, Murray, DiMario, and Appollonio
Date Introduced: March 14, 2025
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-18-54 of the General Laws in Chapter 27-18 entitled "Accident 1
and Sickness Insurance Policies" is hereby amended to read as follows: 2
27-18-54. Health insurance rates. 3
No insurance company organized as a stock or mutual corporation which merges or 4
consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater 5
of the operating assets of, or otherwise acquires control of a non-profit hospital service corporation 6
organized under chapter 19 of this title, a non-profit medical service corporation organized under 7
chapter 20 of this title or a health maintenance organization organized under chapter 41 of this title 8
may: (1) file with any state agency for review or approval any proposed rate to be used by the 9
company in the state, or (2) charge to any party in the state any rate or premium, which takes into 10
account or reflects in any manner the value of any contribution, distribution or allocation the 11
company expends or incurs in establishing or funding a charitable foundation organized to maintain 12
or account for the assets of a non-profit hospital service corporation, non-profit medical service 13
corporation or health maintenance organization, or (3) pay a rate that is less than the approved 14
Medicaid rate set by the executive office of health and human services. For any rate that is to be 15
charged to policy holders, regardless of whether the rate is subject to approval by a state agency 16
under this or another chapter, the company shall at least thirty (30) days before implementing the 17
rate submit under oath to the commissioner of insurance an accounting that documents the cost 18
structure on which the rate is based and demonstrates the company’s compliance with this section. 19
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SECTION 2. Section 27-19-30.1 of the General Laws in Chapter 27-19 entitled "Nonprofit 1
Hospital Service Corporations" is hereby amended to read as follows: 2
27-19-30.1. Health insurance rates. 3
No insurance company organized as a stock or mutual corporation that merges or 4
consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater 5
of the operating assets of, or otherwise acquires control of a nonprofit hospital service corporation 6
organized under this chapter, a nonprofit medical service corporation organized under chapter 20 7
of this title, or a health maintenance organization organized under chapter 41 of this title, may: (1) 8
File with any state agency for review or approval any proposed rate to be used by the company in 9
the state, or (2) Charge to any party in the state any rate or premium that takes into account or 10
reflects in any manner the value of any contribution, distribution, or allocation the company 11
expends or incurs in establishing or funding a charitable foundation organized to maintain or 12
otherwise account for the assets of a nonprofit hospital service corporation, nonprofit medical 13
service corporation, or health maintenance organization, or (3) pay a rate that is less than the 14
approved Medicaid rate set by the executive office of health and human services. For any rate that 15
is to be charged to policyholders, regardless of whether the rate is subject to approval by a state 16
agency under this or another chapter, the company shall at least thirty (30) days before 17
implementing the rate submit under oath to the commissioner of insurance an accounting that 18
documents the cost structure on which the rate is based and demonstrates the company’s 19
compliance with this section. 20
SECTION 3. Section 27-20-25.2 of the General Laws in Chapter 27-20 entitled "Nonprofit 21
Medical Service Corporations" is hereby amended to read as follows: 22
27-20-25.2. Health insurance rates. 23
No insurance company organized as a stock or mutual corporation that merges or 24
consolidates with; acquires ownership or control or possession of twenty percent (20%) or greater 25
of the operating assets of; or acquires control of a nonprofit hospital service corporation organized 26
under chapter 19 of this title, a nonprofit medical service corporation organized under this chapter, 27
or a health maintenance organization organized under chapter 41 of this title may: (1) File with any 28
state agency for review or approval any proposed rate to be used by the company in the state, or 29
(2) Charge to any party in the state any rate or premium, that takes into account or reflects in any 30
manner the value of any contribution, distribution, or allocation the company expends or incurs in 31
establishing or funding a charitable foundation organized to maintain or account for the assets of a 32
nonprofit hospital service corporation, nonprofit medical service corporation, or health 33
maintenance organization, or (3) pay a rate that is less than the approved Medicaid rate set by the 34
LC002367 - Page 3 of 4
executive office of health and human services. For any rate that is to be charged to policyholders, 1
regardless of whether this rate is subject to approval by a state agency under this or another chapter, 2
the company shall at least thirty (30) days before implementing the rate submit under oath to the 3
commissioner of insurance an accounting that documents the cost structure on which the rate is 4
based and demonstrates the company’s compliance with this section. 5
SECTION 4. Section 27-41-27.2 of the General Laws in Chapter 27-41 entitled "Health 6
Maintenance Organizations" is hereby amended to read as follows: 7
27-41-27.2. Health insurance rates. 8
No insurance company organized as a stock or mutual corporation that merges or 9
consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater 10
of the operating assets of, or acquires control of a nonprofit hospital service corporation organized 11
under chapter 19 of this title, a nonprofit medical service corporation organized under chapter 20 12
of this title, or a health maintenance organization organized under chapter 41 of this title: (1) May 13
file with any state agency for review or approval any proposed rate to be used by the company in 14
the state, or (2) May charge to any party in the state any rate or premium, that takes into account or 15
reflects in any manner the value of any contribution, distribution, or allocation the company 16
expends or incurs in establishing or funding a charitable foundation organized to maintain or 17
account for the assets of a nonprofit hospital service corporation, nonprofit medical service 18
corporation, or health maintenance organization, or (3) pay a rate that is less than the approved 19
Medicaid rate set by the executive office of health and human services. For any rate that is to be 20
charged to policyholders, regardless of whether this rate is subject to approval by a state agency 21
under this or another chapter, the company shall at least thirty (30) days before implementing the 22
rate submit under oath to the commissioner of insurance an accounting that documents the cost 23
structure on which the rate is based and demonstrates the company’s compliance with this section. 24
SECTION 5. This act shall take effect on January 1, 2026. 25
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would prohibit insurance companies from paying a rate that is less than the 1
approved Medicaid rate set by the executive office of health and human services. 2
This act would take effect on January 1, 2026. 3
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