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April 27, 2023 – Yesterday, the Rhode Island Office of the Health Insurance Commissioner (OHIC) notified the Self-Insurance Institute of America, Inc. (SIIA) that they would no longer apply the gender rating prohibitions on health insurance products to stop-loss insurance. This is a positive result for SIIA members and is the culmination of several discussions with OHIC over the last 6 months.
In 2021, Rhode Island enacted a health insurance law (RI General Law section 27-18-88), which prohibits a gender rating on health insurance policies. In the Fall of 2022, by objection through the rate filing process with a number of SIIA members, OHIC took the position that the law was applicable to stop-loss insurance.
In a letter from November of last year, SIIA clearly defined the differences between stop-loss and health insurance. SIIA cited Rhode Island General Laws § 27-8.2-1 et al., the Stop-Loss Insurance Act, which differentiates stop-loss from group health insurance by setting forth the statutory requirements specifically for stop-loss insurance. Unlike health insurance, stop-loss insurance does not have a network of health care providers. SIIA also reiterated that there exists long-standing precedent in a number of states, including Rhode Island, through laws and regulations, as well as guidance by the National Association of Insurance Commissioners, that stop-loss insurance is not the same as
medical/health insurance.
SIIA continued a constructive dialogue with OHIC through staff discussions, and a follow-up letter in February, demonstrating that a variety of SIIA members, with 30,000 covered lines in Rhode Island, were concerned about the negative implications of this ruling for self-insured plans in the state, which covers nearly 65% of private sector employees in Rhode Island.
SIIA and a group of stakeholder members were granted a meeting with Acting Commissioner Cory King and OHIC staff on March 17, 2023. During the meeting, SIIA continued to demonstrate and outline the need to hold the definition of stop-loss under the R.I. statute.
As a result of this meeting, OHIC consulted with the Insurance Division of the RI Department of Business Regulation (DBR) and reached the decision that the gender rating prohibitions of R.I. Gen. Laws §27-18-88, as enacted in 2021, will not be applied to stop-loss insurance moving forward.
This is an important victory that acknowledges and preserves the distinction between health insurance and stop-loss. We appreciate the OHIC’s time and consideration in memorializing this distinction. If you have any questions on this or other state issues, please contact Anthony Murrello at amurrello@siia.org.
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