AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Prohibits insurance companies from paying a rate that is less than the approved Medicaid rate set by the executive office of health and human services.)

H7346

2026 -- H 7346
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LC004620
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By:
Representatives Hull, J. Lombardi, DeSimone, Tanzi, Felix, Azzinaro,
Alzate, Bennett, Slater, and Diaz

Date Introduced:
January 28, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Section 27-18-54 of the General Laws in Chapter 27-18 entitled "Accident
2
and Sickness Insurance Policies" is hereby amended to read as follows:
3

27-18-54. Health insurance rates.
4
No insurance company organized as a stock or mutual corporation that merges or
5
consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater
6
of the operating assets of, or otherwise acquires control of a nonprofit hospital service corporation
7
organized under chapter 19 of this title, a nonprofit medical service corporation organized under
8
chapter 20 of this title, or a health maintenance organization organized under chapter 41 of this title
9
may: (1) File with any state agency for review or approval any proposed rate to be used by the
10
company in the state;
or
(2) Charge to any party in the state any rate or premium, that takes into
11
account or reflects in any manner the value of any contribution, distribution, or allocation the
12
company expends or incurs in establishing or funding a charitable foundation organized to maintain
13
or account for the assets of a nonprofit hospital service corporation, nonprofit medical service
14
corporation, or health maintenance organization
; or (3) Pay a rate that is less than the approved
15
Medicaid rate set by the executive office of health and human services
. For any rate that is to be
16
charged to policy holders, regardless of whether the rate is subject to approval by a state agency
17
under this or another chapter, the company shall at least thirty (30) days before implementing the
18
rate submit under oath to the commissioner of insurance an accounting that documents the cost
19
structure on which the rate is based and demonstrates the company’s compliance with this section.

1
SECTION 2. Section 27-19-30.1 of the General Laws in Chapter 27-19 entitled "Nonprofit
2
Hospital Service Corporations" is hereby amended to read as follows:
3

27-19-30.1. Health insurance rates.
4
No insurance company organized as a stock or mutual corporation that merges or
5
consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater
6
of the operating assets of, or otherwise acquires control of a nonprofit hospital service corporation
7
organized under this chapter, a nonprofit medical service corporation organized under chapter 20
8
of this title, or a health maintenance organization organized under chapter 41 of this title, may: (1)
9
File with any state agency for review or approval any proposed rate to be used by the company in
10
the state
, or
;
(2) Charge to any party in the state any rate or premium that takes into account or
11
reflects in any manner the value of any contribution, distribution, or allocation the company
12
expends or incurs in establishing or funding a charitable foundation organized to maintain or
13
otherwise account for the assets of a nonprofit hospital service corporation, nonprofit medical
14
service corporation, or health maintenance organization
; or (3) Pay a rate that is less than the
15
approved Medicaid rate set by the executive office of health and human services
. For any rate that
16
is to be charged to policyholders, regardless of whether the rate is subject to approval by a state
17
agency under this or another chapter, the company shall at least thirty (30) days before
18
implementing the rate submit under oath to the commissioner of insurance an accounting that
19
documents the cost structure on which the rate is based and demonstrates the company’s
20
compliance with this section.
21
SECTION 3. Section 27-20-25.2 of the General Laws in Chapter 27-20 entitled "Nonprofit
22
Medical Service Corporations" is hereby amended to read as follows:
23

27-20-25.2. Health insurance rates.
24
No insurance company organized as a stock or mutual corporation that merges or
25
consolidates with; acquires ownership or control or possession of twenty percent (20%) or greater
26
of the operating assets of; or acquires control of a nonprofit hospital service corporation organized
27
under chapter 19 of this title, a nonprofit medical service corporation organized under this chapter,
28
or a health maintenance organization organized under chapter 41 of this title may: (1) File with any
29
state agency for review or approval any proposed rate to be used by the company in the state
, or
;

30
(2) Charge to any party in the state any rate or premium, that takes into account or reflects in any
31
manner the value of any contribution, distribution, or allocation the company expends or incurs in
32
establishing or funding a charitable foundation organized to maintain or account for the assets of a
33
nonprofit hospital service corporation, nonprofit medical service corporation, or health
34
maintenance organization
; or (3) Pay a rate that is less than the approved Medicaid rate set by the

LC004620 - Page 2 of 4
1
executive office of health and human services
. For any rate that is to be charged to policyholders,
2
regardless of whether this rate is subject to approval by a state agency under this or another chapter,
3
the company shall at least thirty (30) days before implementing the rate submit under oath to the
4
commissioner of insurance an accounting that documents the cost structure on which the rate is
5
based and demonstrates the company’s compliance with this section.
6
SECTION 4. Section 27-41-27.2 of the General Laws in Chapter 27-41 entitled "Health
7
Maintenance Organizations" is hereby amended to read as follows:
8

27-41-27.2. Health insurance rates.
9
No insurance company organized as a stock or mutual corporation that merges or
10
consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater
11
of the operating assets of, or acquires control of a nonprofit hospital service corporation organized
12
under chapter 19 of this title, a nonprofit medical service corporation organized under chapter 20
13
of this title, or a health maintenance organization organized under chapter 41 of this title: (1) May
14
file with any state agency for review or approval any proposed rate to be used by the company in
15
the state
, or
;
(2) May charge to any party in the state any rate or premium, that takes into account
16
or reflects in any manner the value of any contribution, distribution, or allocation the company
17
expends or incurs in establishing or funding a charitable foundation organized to maintain or
18
account for the assets of a nonprofit hospital service corporation, nonprofit medical service
19
corporation, or health maintenance organization
; or (3) Pay a rate that is less than the approved
20
Medicaid rate set by the executive office of health and human services
. For any rate that is to be
21
charged to policyholders, regardless of whether this rate is subject to approval by a state agency
22
under this or another chapter, the company shall at least thirty (30) days before implementing the
23
rate submit under oath to the commissioner of insurance an accounting that documents the cost
24
structure on which the rate is based and demonstrates the company’s compliance with this section.
25
SECTION 5. This act shall take effect on January 1, 2027.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
1
This act would prohibit insurance companies from paying a rate that is less than the
2
approved Medicaid rate set by the executive office of health and human services.
3
This act would take effect on January 1, 2027.
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LC004620 - Page 4 of 4