PROVIDENCE, R.I. — Health insurers in Rhode Island are seeking double-digit increases in the premiums that individuals and small businesses will pay for coverage next year — the largest increases in years — as the federal health care law takes full effect.

Blue Cross Blue Shield of Rhode Island, the state's dominant insurer, has proposed an average increase of 18 percent for individuals and nearly 15 percent for small groups.

UnitedHealthcare of New England is seeking a hike of nearly 18 percent for its small group HMO plan and 13 percent for its preferred provider plan. Tufts Health Plan wants an average increase of 10 percent and 11 percent, respectively, for those plans.

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State Health Insurance Commissioner Christopher F. Koller is reviewing the proposed rate increases. His office has traditionally approved increases that are smaller than what insurers are asking for.

In filings with the state, Blue Cross and the other insurers say the increases are driven primarily by escalating medical costs. But they also attribute some of the higher premiums to costs associated with the federal health care overhaul, including taxes and fees and a higher volume of services for the previously uninsured.

Next year is the first year the Affordable Care Act will be in full effect. It requires most individuals to have insurance come Jan. 1, provides subsidies to help pay for it and penalizes those who don't get it. Rhode Islanders will be able to shop for and purchase insurance from an online marketplace known as an exchange.

The insurers say the health law is adding between 2 percent and nearly 6 percent to next year's premiums. That could spike in future years, they say, when a program expires that helps insurers cover the sickest individuals.

"There are taxes associated with the Affordable Care Act, and those are included," said Blue Cross CFO Michael Hudson. "At the end of the day, in any business, the customer pays for everything. That includes taxes. That's not different than anything else you buy."

But he said Blue Cross is working to address more systemic problems in the health care system that are driving up costs, with the goal being to emphasize high-quality care over a high volume of services.

Patrick Tigue, principal policy associate in the health insurance commissioner's office, said it's difficult to compare next year's plan costs — as proposed — with this year's because the health law is bringing so much change.

Tigue said the health law's impact on rates will vary. Some will see an increase; others will see a drop.

Of the insurers' rate proposals, he said: "We are going to analyze them critically, as we always do, with a dual goal of making sure that rates paid by Rhode Islanders are affordable while also making sure that the insurers have rates that ensure their ongoing solvency."

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