Network Plan Review

The Office of the Health Insurance Commissioner (OHIC) certifies health care entities in the fully insured market to include medical, vision and dental products. The Network Plan Certification Application documents are located in the System for Electronic Rates and Forms Filings (SERFF). Prior to submitting a formal application in SERFF please reach out to OHIC via email at ohic.cert@ohic.ri.gov

What is a Health Care Entity?

Health care entity means an insurance company licensed, or required to be licensed, by the state of Rhode Island or other entity subject to the jurisdiction of the Commissioner or the jurisdiction of the department of business regulation that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation: a for-profit or nonprofit hospital, medical or dental service corporation or plan, a health maintenance organization, a health insurance company, or any other entity providing health insurance, accident and sickness insurance, health benefits, or healthcare services.

What is a Network Plan?

Network plan means a health benefit plan or health plan that either requires a beneficiary to use, or creates incentives, including financial incentives, for a beneficiary to use the providers managed, owned, under contract with, or employed by the health care entity.

For additional regulatory information, please refer to OHIC’s Regulation Page.

Rhode Island OHIC Portal Training

Click here to view the training video.