R.I. Gen. Laws § 27-19-58 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-58
§ 27-19-58. Reimbursement for orthotics and prosthetic services.
Status: in_force

(a) As used in this section:

(1) Federal reimbursement rates means the current listed fee schedule from the Centers for Medicare & Medicaid Services, listing the current Healthcare Common Procedure Coding system (HCPCS) and the corresponding reimbursement rates.

(2) Orthosis means a custom fabricated brace or support that is designed based on medical necessity. Orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this section, or any of the following assistive technology devices: commercially available knee orthoses used following injury or surgery; spastic muscle-tone inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; wrist gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar devices as determined by the director of the department of health, such as those commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility.

(3) Orthotics means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting, or servicing, as well as providing the initial training necessary to accomplish the fitting of, an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity. The practice of orthotics encompasses evaluation, treatment, and consultation; with basic observational gait and postural analysis, orthotists assess and design orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct a deformity or to improve the safety and efficiency of mobility or locomotion or both. Orthotic practice includes providing continuing patient care in order to assess its effect on the patients tissues and to ensure proper fit and function of the orthotic device by periodic evaluation.

(4) Private insurance company means any insurance company, or management company hired by an insurance company, that is any of the following:

(i) Based in the state of Rhode Island; or

(ii) Provides coverage for citizens for the state of Rhode Island; or

(iii) Allows subscribing patients to seek prosthetic or orthotic services in the state of Rhode Island.

(5) Prosthesis means an artificial limb that is alignable or, in lower-extremity applications capable of weight bearing. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, noses, dental appliances, osotmy products, or devices such as eyelashes or wigs.

(6) Prosthetics means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, aligning, adjusting, or servicing, as well as providing the initial training necessary to accomplish the fitting of, a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patients body or body segment and that requires rectification of dimensions, contours, and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize function, stability, and safety of the patient. The practice of prosthetics includes providing and continuing patient care in order to assess the prosthetic devices effect on the patients tissues and to ensure proper fit and function of the prosthetic device by periodic evaluation.

(b) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, that provides medical coverage that includes coverage for physician services in a physicians office and every policy that provides major medical or similar comprehensive type coverage shall provide coverage for benefits for orthotic and prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. §§ 1395k, 1395l, and 1395m and 42 C.F.R. §§ 414.202, 414.210, 414.228, and 410.100 as applicable to this section.

(c) A health insurance contract, plan, or policy may require prior authorization for orthotic and prosthetic devices in the same manner that prior authorization is required for any other covered benefit.

(d) Covered benefits for orthotic or prosthetic devices shall be limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insureds treating physician.

(e) The repair and replacement of orthotic or prosthetic devices also shall be covered subject to copayments and deductibles, unless necessitated by misuse or loss.

(f) An insurer may require, if coverage is provided through a managed care plan, that benefits mandated pursuant to this section be covered benefits only if the orthotic or prosthetic devices are provided by a vendor and orthotic or prosthetic services are rendered by a provider who is licensed by the state of Rhode Island to provide orthotics and prosthetics.
R.I. Gen. Laws § 27-29-4.6 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-4.6
§ 27-29-4.6. Reimbursement fee.
Status: in_force

The director of the department of business regulation may assess an insurer for reimbursement of the departments actual expenses for the investigation and hearing of significant auto body shop matters relating to insurers. In addition, an assessment may be sought in the event that an insurer does not prevail after a final judicial appeal.
R.I. Gen. Laws § 27-8-17 — RI Code / Title 27 / Chapter 27-8 / Section 27-8-17
§ 27-8-17. Payment on claim for fire coverage of motor vehicle  Statement required.
Status: in_force

No payment shall be made by the insurer of loss or damage to an insured vehicle on a claim for fire coverage as provided in § 27-8-1(6), until the insured has filed a statement in conformity with the provisions of § 27-8.1-2.1, and the insurer has, within a reasonable time, reviewed the statement and determined that no fraud was involved. If the insurer denies the fire coverage claim, then the insurer shall provide appropriate notice within a reasonable period of time of the denial of coverage to all lien holders, if any, of the insured motor vehicle.
R.I. Gen. Laws § 27-64-9 — RI Code / Title 27 / Chapter 27-64 / Section 27-64-9
§ 27-64-9. Remuneration of receivers.
Status: in_force

(a) With respect to orders of rehabilitation, conservation or liquidation directed at a protected cell company, the remuneration, expenses, and other compensation of the receiver shall be payable from the assets of the companys general account, in accordance with the priority of distribution set forth in §§ 27-14.3-46 and 27-14.4-20.

(b) With respect to orders of rehabilitation, conservation or liquidation directed at a protected cell, the remuneration, expenses, and other compensation of the receiver shall be payable from the protected cell assets attributable to that protected cell. In the case where more than one protected cell is the subject of the order, the receiver shall account for remuneration, expenses, and other compensation separately for each protected cell in accordance with actual time and expenses attributable to the rehabilitation, conservation or liquidation of each respective protected cell.

(c) With respect to orders of rehabilitation, conservation or liquidation directed at a protected cell company during a pending rehabilitation, conservation or liquidation of one or more protected cells, the remuneration, expenses, and other compensation of the receiver of the protected cells shall be satisfied from the protected cell assets of the protected cell or cells in accordance with the provisions of subsection (b) of this section, and the remuneration, expenses, and other compensation of the receiver of the protected cell company shall be satisfied from the assets of the companys general account.
R.I. Gen. Laws § 27-6-19 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-19
§ 27-6-19. Suspension of rates or filings after review period  Removal of discriminatory applications of rates.
Status: in_force

If, at any time subsequent to the applicable review period provided for in § 27-6-17 or § 27-6-18, the commissioner finds that a rate or filing does not meet the requirements of this chapter, the commissioner shall, after a hearing held upon not less than ten (10) days written notice, specifying the matters to be considered at the hearing, to every insurer and rating organization that used the rate or made the filing, issue an order specifying in what respects the commissioner finds that the rate or filing fails to meet the requirements of this chapter, and stating when, within a reasonable period after this, the rate shall no longer be used or the filing shall be deemed no longer effective. This order shall not affect any contract or policy made or issued prior to the expiration of the period set forth in the order. If the commissioner finds that an unfair discrimination exists in the application of a rate or filing to an individual risk the commissioner may, after a hearing held on like notice to the insurer affected and to any rating organization that made the filing, issue an order that the unfair discrimination be removed. Copies of any order issued under this section shall be sent to every affected insurer and rating organization.
R.I. Gen. Laws § 27-17-24 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-24
§ 27-17-24. Retaliatory laws.
Status: in_force

The retaliatory laws of this state shall be applicable to reciprocal or interinsurance exchanges.
R.I. Gen. Laws § 27-18-45 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-45
§ 27-18-45. Whistleblowers protection.
Status: in_force

No accident and sickness insurer pursuant to this chapter, or any other insurer offering and/or insuring health services on a prepaid basis as defined in § 42-62-4(7), shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member, or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule, or regulation promulgated under the laws of this state.
R.I. Gen. Laws § 27-17-7 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-7
§ 27-17-7. Reinsurance reserve.
Status: in_force

There shall be maintained at all times by the exchange a reinsurance reserve in cash or securities authorized by the laws of the state in which the principal office of the attorney is located for the investment of similar funds of insurance companies doing the same kind of business, in an amount equal to fifty percent (50%) of the net annual premium deposits collected and credited to the accounts of subscribers on policies having one year or less to run and pro rata on those for longer periods or, in lieu of this amount, one hundred percent (100%) of the net unearned premium deposits collected and credited to the accounts of subscribers calculated separately for each policy in force as of any given date.
R.I. Gen. Laws § 27-55-1 — RI Code / Title 27 / Chapter 27-55 / Section 27-55-1
§ 27-55-1. Definitions.
Status: in_force

For the purpose of this chapter, the following words and terms have the following meanings:

(1) Drug or drugs means any substance prescribed by a licensed healthcare provider acting within the scope of the providers license that is intended for use in the diagnosis, mitigation, treatment, or prevention of disease that is taken by mouth; injected into a muscle, the skin, a blood vessel, or cavity of the body; applied to the skin; or otherwise assimilated by the body. The term includes only those substances that are approved by the FDA for at least one indication.

(2) FDA means the federal Food and Drug Administration.

(3) Health insurer means all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense-incurred basis including, but not limited to, policies of accident or sickness insurance, as defined in chapter 18 of this title, nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, and any other entity that insures or reimburses for diagnostic, therapeutic, or preventive services to a determined population on the basis of a periodic premium.

(4) Medical literature means published scientific studies published in at least two (2) articles from major peer-reviewed medical journals that present data supporting the proposed off-label use, or uses, as generally safe and effective unless there is clear and convincing contradictory evidence presented in a major peer-reviewed medical journal.

(5) Peer-reviewed medical journals means a published study in a journal or other publication in which original manuscripts have been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts, and that has been determined by the International Committee of Medical Journal Editors to have met its Uniform Requirements for Manuscripts Submitted to Biomedical Journals. It does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or any health insurer, healthcare center, hospital service corporation, medical service corporation, or fraternal benefit society that delivers, issues for delivery, renews, amends, or continues a health insurance policy in this state.

(6) Standard reference compendia means: (i) The United States Pharmacopoeia drug information, (ii) The American Medical Association drug evaluations, or (iii) The American Hospital Formulary Service drug information.
R.I. Gen. Laws § 27-60-1 — RI Code / Title 27 / Chapter 27-60 / Section 27-60-1
§ 27-60-1. Short title.
Status: in_force

This chapter may be cited as the Unfair Discrimination Against Subjects of Abuse in Health Benefit Plans Act.
R.I. Gen. Laws § 27-41-7 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-7
§ 27-41-7. Fiduciary responsibilities.
Status: in_force

(a) Any director, officer, or employee of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the organization shall be responsible for those funds in a fiduciary relationship to the enrollees.

(b) A health maintenance organization shall maintain in force a fidelity bond on employees or officers in an amount not less than one hundred thousand dollars ($100,000) or any greater sum that may be prescribed by the director. All fidelity bonds shall be written with at least a one-year discovery period and if written with less than a three-year (3) discovery period shall contain a provision that no cancellation or termination of the bond, whether by or at the request of the insured or by the underwriter, shall take effect prior to the expiration of ninety (90) days after written notice of cancellation or termination has been filed with the director unless an earlier date of cancellation or termination is approved by the director.
R.I. Gen. Laws § 27-25-11 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-11
§ 27-25-11. Amendments to laws.
Status: in_force

(a) A domestic society may amend its laws in accordance with the provisions of those laws, by action of its supreme governing body at any regular or special meeting of that body or, if its laws provide, by referendum. A referendum may be held in accordance with the provisions of the domestic societys laws, by the vote of the voting members of the society, by the vote of delegates or representatives of voting members, or by the vote of local lodges. A society may provide for voting by mail. No amendment submitted for adoption by referendum shall be adopted unless, within six (6) months from the date of submission, a majority of the members voting shall have signified their consent to the amendment by one of the methods specified in this section.

(b) No amendment to the laws of any domestic society shall take effect unless approved by the commissioner of insurance who shall approve the amendment if the commissioner finds that it has been duly adopted and is not inconsistent with any requirement of the laws of the state or with the character, objects, and purposes of the society. Unless the commissioner of insurance shall disapprove an amendment within sixty (60) days after the filing of the amendment, it shall be considered approved. The approval or disapproval of the commissioner of insurance shall be in writing and mailed to the secretary or corresponding officer of the society at its principal office. In case the commissioner disapproves the amendment, the reasons shall be stated in the written notice.

(c) Within ninety (90) days from the approval by the commissioner of insurance, all amendments, or a synopsis of the amendments, shall be furnished to all of the members of the society either by mail or by publication, in full, in the official publication of the society. The affidavit of any officer of the society or of anyone authorized by it to mail any amendments or synopsis, stating facts that show that the amendments or a synopsis have been duly addressed and mailed, shall be prima facie evidence that the amendments or synopsis have been furnished to the addressee.

(d) Every foreign or alien society authorized to do business in this state shall file with the commissioner of insurance a duly certified copy of all amendments of, or additions to, its laws within ninety (90) days after their enactment.

(e) Printed copies of the laws, as amended, certified by the secretary or corresponding officer of the society, shall be prima facie evidence of their legal adoption.
R.I. Gen. Laws § 27-19-36 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-36
§ 27-19-36. Primary and preventive obstetric and gynecological care.
Status: in_force

Any insurer or nonprofit health service plan that provides obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health maintenance organization, shall permit a woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first obtain a referral from a primary care provider.
R.I. Gen. Laws § 27-78-5 — RI Code / Title 27 / Chapter 27-78 / Section 27-78-5
§ 27-78-5. Notice requirements.
Status: in_force

A person is entitled to notice of cancellation, nonrenewal, or any material change, and to any similar notice concerning a policy of insurance only if the person has such notice rights under the terms of the policy of insurance or any endorsement to the policy. The terms and conditions of the notice are governed by the policy of insurance or endorsement and may not be altered by a certificate of insurance.
R.I. Gen. Laws § 27-25-40 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-40
§ 27-25-40. Payments of commissions to other than agent or insurance producer forbidden.
Status: in_force

No society doing business in this state shall pay any commission or other compensation to any person for any services in obtaining in this state any new contract of life, accident, or health insurance, or any new annuity contract, except to a licensed insurance agent or producer of the society and except an agent or insurance producer exempted from licensing by this chapter.
R.I. Gen. Laws § 27-4-24.4 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-24.4
§ 27-4-24.4. Hearing on decisions of commissioner.
Status: in_force

Any organization or insurer aggrieved by any order or decision of the commissioner, or by any rule or regulation promulgated and adopted by the commissioner, may, within thirty (30) days after notice of the order or decision to the organization or insurer, make written request to the commissioner for a hearing on the order or decision. The commissioner shall provide a hearing and issue a decision in accordance with the Administrative Procedures Act, chapter 35 of title 42.
R.I. Gen. Laws § 27-18-7 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-7
§ 27-18-7. Third-party ownership.
Status: in_force

The word insured, as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under the policy to any indemnities, benefits, and rights provided in the policy.
R.I. Gen. Laws § 27-5-2 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-2
§ 27-5-2. Compliance with standard policy required.
Status: in_force

Except as provided in § 27-5-9.1 and § 27-65-1(e), no policy or contract of fire insurance shall be made, issued, or delivered by any insurer or by any insurance producer or representative of an insurance producer on any property in this state, unless it shall conform, as to all provisions, stipulations, agreements, and conditions, with the standard form of policy.
R.I. Gen. Laws § 27-58-2 — RI Code / Title 27 / Chapter 27-58 / Section 27-58-2
§ 27-58-2. Purpose.
Status: in_force

The purpose of this chapter is to regulate financial institutions in the conduct of the business of insurance in this state.
R.I. Gen. Laws § 27-20-83 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-83
§ 27-20-83. Acute mental health crisis mobile response and stabilization services. [Effective January 1, 2026.]
Status: in_force

(a) As used in this section, mobile response and stabilization services means a behavioral health crisis intervention system providing immediate de-escalation, stabilization services, and follow-up care, provided by a certified provider. These services are delivered to provide rapid response to, assessment of, and early intervention for a child or youth eighteen (18) years of age and younger experiencing an acute mental health crisis. Symptoms might include, but are not limited to:

(1) Aggression;

(2) Self-injury;

(3) Trauma;

(4) Acute depression/anxiety;

(5) Challenges at school; Suicidal or homicidal thoughts/behaviors; and

(6) Extreme parent/child conflict.

Mobile response and stabilization services are provided by certified providers meaning licensed behavioral health organizations providing outpatient services, which have demonstrated expertise in delivering child-specific mobile response and stabilization services, and have obtained relevant state licensure or certification.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2026, shall provide coverage for mobile response and stabilization services, consistent with the core components of the mobile crisis model, and in accordance with the insurers existing reimbursement, credentialing, and contracting processes, provided any utilization review processes do not limit timely access or fidelity to the model.

(c) This section shall not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited benefit policies.
R.I. Gen. Laws § 27-19-42 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-42
§ 27-19-42. Drug coverage.
Status: repealed

(a) Any nonprofit hospital service corporation that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the nonprofit hospital service corporations formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit hospital service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit hospital service corporations medical-exception criteria for the coverage of that medication.

(b) A nonprofit hospital service corporations medical-exception criteria for the coverage of non-formulary medications shall be developed in accordance with § 23-17.13-3(c)(3) [repealed].

(c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].

(d) Prior to removing a prescription drug from its plans formulary or making any change in the preferred or tiered cost-sharing status of a covered prescription drug, a nonprofit hospital service corporation must provide at least thirty (30) days notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days notice prior to the date such change becomes effective by a direct notification:

(1) The written or electronic notice must contain the following information:

(i) The name of the affected prescription drug;

(ii) Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered cost-sharing status; and

(iii) The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.

(2) A nonprofit hospital service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit hospital service corporation or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.
R.I. Gen. Laws § 27-18-31 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-31
§ 27-18-31. Insurance coverage for services of licensed midwives.
Status: in_force

(a) For the purposes of this section, licensed midwives means any midwife licensed under § 23-13-9.

(b) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for the services of licensed midwives in accordance with each health insurers respective principles and mechanisms of reimbursement credentialing and contracting if the services are within the licensed midwives area of professional competence as defined by regulations promulgated pursuant to § 23-13-9, and are currently reimbursed when rendered by any other licensed healthcare provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement, except when those requirements are also applicable to other categories of healthcare providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed midwife and any other healthcare provider. Direct payment for licensed midwives will be contingent upon services rendered in a licensed healthcare facility and for services rendered in accordance with rules and regulations promulgated by the department of health; provided, that this provision shall not prohibit payment for services pursuant to § 42-62-26 or for other services reimbursed by third-party payors.
R.I. Gen. Laws § 27-20-61 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-61
§ 27-20-61. Medical loss ratio reporting and rebates.
Status: in_force

(a) A nonprofit medical service corporation offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 of the Public Health Service Act as amended by the federal Patient Protection and Affordable Care Act [42 U.S.C. § 300gg-18], in accordance with regulations adopted thereunder.

(b) Nonprofit medical service corporations required to report medical loss ratio and rebate calculations and any other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with the commissioner.
R.I. Gen. Laws § 27-19-40 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-40
§ 27-19-40. Third-party reimbursement for services of certain healthcare workers.
Status: in_force

(a) Every individual or group health insurance contract, plan, or policy delivered, issued, or renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:

(1) The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with § 5-34.2-2;

(2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and

(3) The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the nonprofit hospital service corporation has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.

(b) It shall remain within the sole discretion of the nonprofit hospital service corporation as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation; provided, that no nonprofit hospital service corporation may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the nonprofit hospital service corporation from conducting managed care, medical necessity, or utilization review.

(c) Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that providers license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.
R.I. Gen. Laws § 27-41-88 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-88
§ 27-41-88. Unfair discrimination prohibited.
Status: in_force

Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35, and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35, and 37 of title 5.
R.I. Gen. Laws § 27-41-34 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-34
§ 27-41-34. Health maintenance organizations assessment.
Status: in_force

(a) Notwithstanding any other provisions of law, each domestic HMO shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.

(b) Each domestic HMO assessment shall be determined in accordance with the following ratio: (1) By dividing the HMO total direct premiums by the total direct premiums, including annuities, less policyholder dividends of all domestic insurance companies plus the total direct premiums of domestic companies licensed or regulated pursuant to chapters 19, 20, 20.1, 20.2, 20.3, 25, and 41 of this title, and chapter 62 of title 42; (2) And then by multiplying the resulting ratio times two hundred thousand dollars ($200,000).

(c) The minimum assessment charged shall be the greater of the sum determined by subsection (b) of this section or one thousand dollars ($1,000).
R.I. Gen. Laws § 27-69-7 — RI Code / Title 27 / Chapter 27-69 / Section 27-69-7
§ 27-69-7. Mandated benefit statement of intent.
Status: in_force

Notwithstanding any general law enacted after January 1, 2014, any legislation that would create a new state health benefit mandate, or expand upon an existing health benefit, shall contain a statement of intent that clearly provides the purpose and objectives of the health benefit mandate, including measurable goals expected to be achieved by the new or expanded benefit mandate. These goals should address both commercial insurance affordability and population health outcomes.
R.I. Gen. Laws § 27-60-7 — RI Code / Title 27 / Chapter 27-60 / Section 27-60-7
§ 27-60-7. Enforcement.
Status: in_force

Violations of this chapter are subject to the provisions of §§ 27-29-8 and 27-29-9 and may include injunctive relief and/or a requirement for restitution. The powers and duties set forth in this section are in addition to all other authority of the commissioner.
R.I. Gen. Laws § 27-41-99 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-99
§ 27-41-99. Epinephrine injectors.
Status: in_force

(a) The Rhode Island general assembly recognizes that epinephrine cartridges and injectors are life-saving devices that must be administered quickly to be effective. Such administration is often done by persons who are not healthcare professionals, and is done in an emergency situation. Accordingly, it is in the best interests of the people of the state to promote the widespread availability of epinephrine cartridges and injectors.

(b) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2025, shall provide coverage for at least one type of epinephrine auto-injectors and cartridges. There shall be no copayment required, and no deductible shall need to be met, to obtain a two (2) pack of the epinephrine auto-injectors or cartridges covered by the contract, plan, or policy, once every twelve-month (12) plan year. A deductible may be applied to health plans that are paired with a federally qualified health savings account pursuant to 26 U.S.C. § 223. Nothing in this section would prohibit a health plan from implementing this benefit prior to January 1, 2025.
R.I. Gen. Laws § 27-19-27 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-27
§ 27-19-27. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.
Status: in_force

(a) Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide coverage for the services of a certified registered nurse practitioner, practicing collaboratively, or in the employ of a physician licensed under chapter 37 of title 5, and psychiatric and mental health nurse clinical specialists, to subscribers if the services are within the certified registered nurse practitioners or psychiatric and mental health nurse clinical specialists area of professional competence as established by education and certification, and are currently reimbursed when rendered by any other licensed healthcare provider. No insurer or hospital or medical service corporation may require signature by any other healthcare provider as a condition of reimbursement. No insurer or hospital or medical service corporation may be required to pay for duplicative services actually rendered by both a certified nurse practitioner and any other healthcare provider.

(b) Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer or hospital or medical service corporation or health maintenance organization.

(c) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical service plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for certified registered nurse practitioners to provide primary care, intermediate, home, long-term, and inpatient care as primary care providers, when said certified registered nurse practitioner is a participating provider, consistent with, and practicing within, the scope of his or her professional license.

(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations, and health maintenance organizations shall provide subscribers with an opportunity to select a certified registered nurse practitioner, who is a participating provider, as a primary care provider.

(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations, and health maintenance organizations shall insure that all participating primary care provider certified registered nurse practitioners are included on any publicly accessible list of participating providers for the respective organization.
R.I. Gen. Laws § 27-30-3 — RI Code / Title 27 / Chapter 27-30 / Section 27-30-3
§ 27-30-3. Types of consumer credit insurance.
Status: in_force

The types of consumer credit insurance defined in § 27-30-2 may each be written separately or in combination with other types of consumer credit insurance on an individual policy or group policy basis. The commissioner may by regulation prohibit or limit any combination.
R.I. Gen. Laws § 27-1-1.1 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-1.1
§ 27-1-1.1. Telephone number  Toll-free or collect.
Status: in_force

Every third-party health insurer doing business within this state shall have a toll-free telephone number or provide collect charge telephone service for use by the general public when calling the insurer from any location within the state.
R.I. Gen. Laws § 27-20-19 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-19
§ 27-20-19. Pap smears  Quality assurance standards.
Status: in_force

A pap smear eligible for reimbursement under § 27-20-17 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association, at the time the pap smear is processed.
R.I. Gen. Laws § 27-4-24.3 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-24.3
§ 27-4-24.3. Suspension or revocation of licenses.
Status: in_force

(a) The commissioner may revoke or suspend the license of any organization or insurer that fails to comply with an order of the commissioner within the time limited by the order, or any extension of it which the commissioner may grant. The commissioner shall not revoke or suspend the license of any organization or insurer for failure to comply with an order until the time prescribed for an appeal has expired or, if an appeal has been taken, until the order has been affirmed.

(b) The commissioner may determine when a suspension of license shall become effective, and it shall remain in effect for the period fixed by the commissioner, unless the commissioner modifies or rescinds the suspension, or until the order upon which the suspension is based is modified, rescinded, or reversed.

(c) No license shall be suspended or revoked except upon a written order of the commissioner, stating the commissioners findings, made after a hearing held in accordance with § 42-35-9 upon not less than ten (10) days written notice to the insurer or organization.
R.I. Gen. Laws § 27-64-2 — RI Code / Title 27 / Chapter 27-64 / Section 27-64-2
§ 27-64-2. Purpose.
Status: in_force

This act is adopted to provide a basis for the creation of protected cells by a domestic insurer as one means of accessing alternative sources of capital and achieving the benefits of insurance securitization or voluntary restructuring as contemplated under chapter 14.5 of this title, including through effectuating insurance business transfers in accordance with the procedures promulgated by the commissioner under § 27-14.5-6. Investors in fully funded insurance securitization transactions provide funds that are available to pay the insurers insurance obligations or to repay the investors or both. The creation of protected cells is intended to be a means to achieve more efficiencies in conducting insurance securitizations or voluntary restructurings.
R.I. Gen. Laws § 27-18-56 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-56
§ 27-18-56. Prohibition against dentists being required to indemnify provider.
Status: in_force

No accident and sickness insurance provider may contract to require that a dentist indemnify or hold harmless the accident and sickness insurance provider for any expenses and liabilities, including, without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the accident and sickness insurance provider based on the accident and sickness insurance providers management decisions or utilization review provisions for any patient.
R.I. Gen. Laws § 27-19-34 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-34
§ 27-19-34. Mastectomy treatment.
Status: in_force

(a) All individual or group health insurance coverage and health-benefit plans delivered, issued for delivery, or renewed in this state on or after January 1, 2005, that provide medical and surgical benefits with respect to mastectomy shall provide, in a case of any person covered in the individual market or covered by a group health plan, coverage for:

(1) Reconstruction of the breast on which the mastectomy has been performed;

(2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

(3) Prostheses and treatment of physical complications, including lymphademas, at all stages of mastectomy; in a manner determined in consultation with the attending physician, physician assistant as defined in § 5-54-2, or an advance practice registered nurse as defined in § 5-34-3, and the patient. As used in this section, mastectomy means the removal of all or part of a breast. Written notice of the availability of this coverage shall be delivered to the participant upon enrollment and annually thereafter.

(b) Notice. A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall provide notice to each participant and beneficiary under the plan regarding the coverage required by this section in accordance with regulations promulgated by the United States Secretary of Health and Human Services. The notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted as part of any yearly informational packet sent to the participant or beneficiary.

(c) As used in this section, prosthetic devices means and includes the provision of initial and subsequent prosthetic devices pursuant to an order of the patients physician, physician assistant, advance practice registered nurse, or surgeon.

(d) [Deleted by P.L. 2018, ch. 114, § 2 and P.L. 2018, ch. 204, § 2].

(e) Nothing in this section shall be construed to prevent a group health plan or a health insurance carrier offering health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.

(f) Nothing in this section shall preclude the conducting of managed-care reviews and medical-necessity reviews by an insurer, hospital or medical service corporation, or health maintenance organization.

(g) Prohibitions. A group health plan and a health insurance carrier offering group or individual health insurance coverage may not:

(1) Deny to a patient eligibility, or continued eligibility, to enroll or renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; nor

(2) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
R.I. Gen. Laws § 27-5-17 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-17
§ 27-5-17. Restrictions on dividends  Payments into surplus and reserve funds.
Status: in_force

After the date of filing the resolution referred to in § 27-5-16 with the insurance commissioner, the company shall not make or declare or pay in any form any dividend upon its capital stock exceeding eight percent (8%) per annum and six percent (6%) per annum upon the surplus funds to be formed under this chapter until after its guaranty surplus fund and its special reserve fund shall have together accumulated to an amount equal to its capital stock. Any part of the surplus profits of the company above its annual dividend may be equally divided between and set apart to constitute the guaranty surplus fund and the special reserve fund, which funds shall be held and used as provided in this chapter and not otherwise. Any company doing business under this chapter that shall declare or pay any dividend contrary to the provisions contained in this section shall forfeit its charter and be liable to be proceeded against by the attorney general for its dissolution.
R.I. Gen. Laws § 27-19-19 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-19
§ 27-19-19. Changing coverage.
Status: in_force

No group health insurer subject to the provisions of this chapter shall change contract provisions as specified in the group plan master contract during the term of that contract without prior written agreement of the employer, except for changes mandated under state or federal legislative enactment and changes resulting from a labor/management collective bargaining agreement, or changes necessary to meet insurance regulations promulgated by the department of business regulation.
R.I. Gen. Laws § 27-4-23 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-23
§ 27-4-23. Rules and regulations.
Status: in_force

The insurance commissioner shall make reasonable rules and regulations necessary to effect the purposes of this chapter.
R.I. Gen. Laws § 27-25-29 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-29
§ 27-25-29. Foreign or alien society  Admission.
Status: in_force

No foreign or alien society shall transact business in this state without a license issued by the commissioner of insurance. A society desiring admission to this state shall comply substantially with the requirements and limitations of this chapter applicable to domestic societies. A society may be licensed to transact business in this state upon filing with the commissioner of insurance:

(1) A duly certified copy of its articles of incorporation;

(2) A copy of its bylaws, certified by its secretary or corresponding officer;

(3) A power of attorney to the commissioner of insurance as prescribed in § 27-25-35;

(4) A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the commissioner of insurance, duly verified by an examination made by the supervising insurance official of its home state or other state, territory, province, or country, satisfactory to the commissioner of insurance of this state;

(5) Certification from the proper official of its home state, territory, province, or country that the society is legally incorporated and licensed to transact business in its home state, territory, province, or country;

(6) Copies of its certificate forms;

(7) A showing that its assets are invested in accordance with the provisions of this chapter; and

(8) Any other information that the commissioner of insurance may deem necessary.
R.I. Gen. Laws § 27-72-1 — RI Code / Title 27 / Chapter 27-72 / Section 27-72-1
§ 27-72-1. Title.
Status: in_force

This chapter may be cited and shall be known as the Life Settlements Act.
R.I. Gen. Laws § 27-29-6 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-6
§ 27-29-6. Cease and desist orders and modifications of those orders.
Status: in_force

(a) If after a hearing the insurance commissioner shall determine that the method of competition or the act or practice in question is unfair and that the person complained of has engaged in a method of competition, act, or practice in violation of this chapter, the commissioner shall reduce his or her findings to writing and shall issue and cause to be served upon the person charged with the violation an order requiring the person to cease and desist from engaging in the method of competition, act, or practice. The commissioner may, at the commissioners discretion, order: (1) Payment of a monetary penalty of not more than five thousand dollars ($5,000) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000), unless the violation was committed flagrantly in a conscious disregard of this chapter, in which case the penalty shall not be more than twenty-five thousand dollars ($25,000) for each violation not to exceed an aggregate penalty of two hundred fifty thousand dollars ($250,000); or (2) Suspension or revocation of the insurers license if the insurer knew or reasonably should have known that it was in violation of this chapter.

(b) Until the expiration of the time allowed under § 27-29-7(a) for filing a petition for review, if no petition has been duly filed within that time, the insurance commissioner may at any time upon the notice and in the manner the commissioner shall deem proper, modify or set aside in whole or in part any order issued by the commissioner under this section.

(c) After the expiration of the time allowed for filing a petition for review, if no petition has been duly filed within that time, the insurance commissioner may at any time, after notice and opportunity for hearing, reopen and alter, modify, or set aside, in whole or in part, any order issued by the commissioner under this section whenever in his or her opinion conditions of fact or of law have changed as to require that action or if the public interest shall require.
R.I. Gen. Laws § 27-44-12 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-12
§ 27-44-12. Rating organization  Public information.
Status: in_force

Every rating organization shall file any amendment or modification made to supplementary rate information with the director within fifteen (15) days after it is distributed to members, subscribers, or others.
R.I. Gen. Laws § 27-1-16.2 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-16.2
§ 27-1-16.2. Court-approved settlements.
Status: in_force

Notwithstanding any provisions of law to the contrary, a person, corporation, or other entity who has resolved its liability to the receiver in a judicially-approved good faith settlement shall not be liable for claims for contribution or equitable indemnity regarding matters addressed in the settlement. The settlement does not discharge any other joint tortfeasors unless its terms provide for this discharge, but it reduces the potential liability of joint tortfeasors by the amount of the settlement.
R.I. Gen. Laws § 27-61-6 — RI Code / Title 27 / Chapter 27-61 / Section 27-61-6
§ 27-61-6. Insurance protocols for subjects of abuse.
Status: in_force

Insurers shall develop and adhere to written policies specifying procedures to be followed by employees, contractors, producers, agents, and brokers for the purpose of protecting the safety and privacy of a subject of abuse and implement the provisions of this chapter when taking an application, investigating a claim, pursuing subrogation, or taking any other action relating to a policy or claim involving a subject of abuse.
R.I. Gen. Laws § 27-18-33.1 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-33.1
§ 27-18-33.1. Insurance coverage for postpartum hospital stays.
Status: repealed

(a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state that provides maternity benefits shall provide coverage for a forty-eight-hour (48) time period in a hospital after a vaginal birth and ninety-six (96) hours after a Cesarean section for a mother and her newly born child. Any decision to shorten this minimum coverage shall be made by the attending healthcare provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) hours for a Cesarean delivery. In the case of early discharge, post-delivery care shall include: home visits, parent education, assistance and training in breast or bottle feeding, and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with these guidelines.

(b) For the purposes of this section, attending healthcare provider includes the attending obstetrician, pediatrician, family practitioner, general practitioner, or certified nurse midwife attending the mother and newly born child.

(c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23 [repealed]. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other healthcare provider who orders care consistent with the provisions of this section.
R.I. Gen. Laws § 27-29-7 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-7
§ 27-29-7. Judicial review of cease and desist orders.
Status: in_force

(a) Any person required by an order of the insurance commissioner under § 27-29-6 to cease and desist from engaging in any unfair method of competition or any unfair or deceptive act or practice may obtain a review of the order by filing in the superior court of Providence County, within twenty (20) days from the date of service of the order, a written petition praying that the order of the insurance commissioner be set aside. A copy of the petition shall be served upon the insurance commissioner, after which the insurance commissioner shall certify and file in the court his or her transcript of the entire record in the proceeding, including all of the evidence taken and the report and order of the insurance commissioner. Upon the filing of the petition and transcript, the court shall have jurisdiction of the proceeding and of the question determined in it, shall determine whether the filing of the petition shall operate as a stay of the order of the insurance commissioner, and shall have the power to make and enter upon the pleadings, evidence, and proceedings set forth in the transcript a decree modifying, affirming, or reversing the order of the insurance commissioner, in whole or in part. The findings of the insurance commissioner as to the facts, if supported by the weight of the evidence, shall be conclusive.

(b) To the extent that the order of the insurance commissioner is affirmed, the court shall issue its own order commanding obedience to the terms of the order of the insurance commissioner. If either party shall apply to the court for leave to adduce additional evidence, and shall show to the satisfaction of the court that the additional evidence is material and that there were reasonable grounds for the failure to adduce the evidence in the proceeding before the insurance commissioner, the court may order the additional evidence to be taken before the insurance commissioner and to be adduced upon the hearing in the manner and upon the terms and conditions as the court may deem proper. The insurance commissioner may modify his or her findings of fact, or make new findings by reason of the additional evidence taken, and the commissioner shall file the modified or new findings which, if supported by competent evidence, shall be conclusive, and the commissioners recommendation, if any, for the modification or setting aside of his or her original order, with the return of the additional evidence.

(c) A cease and desist order issued by the insurance commissioner under § 27-29-6 shall become final:

(1) Upon the expiration of the time allowed for filing a petition for review if no petition has been duly filed within that time, except that the insurance commissioner may after this modify or set aside his or her order to the extent provided in § 27-29-6(b); or

(2) Upon the final decision of the court if the court directs that the order of the insurance commissioner be affirmed or the petition for review dismissed.

(d) No order of the insurance commissioner under this chapter or order of a court to enforce the order of the insurance commissioner shall in any way relieve or absolve any person affected by the order from any liability under any other laws of this state.
R.I. Gen. Laws § 27-19-48 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-48
§ 27-19-48. FDA approved prescription contraceptive drugs and devices.
Status: in_force

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.

(b) Notwithstanding any other provision of this section, any hospital service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employers bona fide religious tenets.

(c) As used in this section, religious employer means an employer that is a church or a qualified church-controlled organization as defined in 26 U.S.C. § 3121.

(d) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons.

(e) Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time.
R.I. Gen. Laws § 27-19-25 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-25
§ 27-19-25. Discontinuance of coverage  Chronic disabilities.
Status: in_force

No nonprofit hospital service corporation subject to the provisions of this chapter shall discontinue reimbursement for or providing services for covered healthcare services of chronic disabilities unless the patient has exhausted benefits to which he or she is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period provided notice of the discontinuation is sent to subscribers who have been reimbursed for or utilized those services in the past three (3) years. The notice shall be mailed at least sixty (60) days prior to the beginning of the open enrollment period. For the purposes of this section, chronic disability means an impairment or illness that is likely to continue indefinitely.
R.I. Gen. Laws § 27-1-34 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-34
§ 27-1-34. Definitions.
Status: in_force

When used in §§ 27-1-28  27-1-36:

(1) Equity security means any stock or similar security, or any security convertible with or without consideration into a security, or carrying any warrant or right to subscribe to or purchase a security, or any warrant or right; or any other security that the commissioner shall deem to be of similar nature and consider necessary or appropriate, by the rules and regulations the commissioner may prescribe in the public interest or for the protection of investors, to treat as an equity security.

(2) Officer means a president, vice president, treasurer, actuary, secretary, controller, and any other person who performs for the company functions corresponding to those performed by the foregoing officers.
R.I. Gen. Laws § 27-74-12 — RI Code / Title 27 / Chapter 27-74 / Section 27-74-12
§ 27-74-12. Notice of change in name or address.
Status: in_force

Each discount medical plan organization shall provide the commissioner at least thirty (30) days advance notice of any change in the discount medical plan organizations name, address, principal business address or mailing address or Internet website address.
R.I. Gen. Laws § 27-18-11 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-11
§ 27-18-11. Application of provisions to policy issued to nonresident.
Status: in_force

If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of the other state has advised the commissioner that the policy is not subject to approval or disapproval by the official, the commissioner may by ruling require that the policy meet the standards set forth in §§ 27-18-2  27-18-10.
R.I. Gen. Laws § 27-74-4 — RI Code / Title 27 / Chapter 27-74 / Section 27-74-4
§ 27-74-4. Applicability and scope.
Status: in_force

(a) This chapter applies to all discount medical plan organizations doing business in or from this state.

(b) A discount medical plan organization that is a licensed health insurer or health maintenance organization or a nonprofit hospital and medical service corporation is not required to obtain a certificate of registration under § 27-74-5, except that any of its affiliates that operate as a discount medical plan organization in this state shall obtain a certificate of registration under § 27-74-5 and comply with all other provisions of this act; but such health insurer, health maintenance organization, or nonprofit hospital and medical service corporation is required to comply with §§ 27-74-8, 27-74-9, 27-74-10, and 27-74-11 and report, in the form and manner as the commissioner may require, any of the information described in § 27-74-13 that is not otherwise already reported.
R.I. Gen. Laws § 27-69-5 — RI Code / Title 27 / Chapter 27-69 / Section 27-69-5
§ 27-69-5. Severability.
Status: in_force

If any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and for this purpose the provisions of this chapter are severable.
R.I. Gen. Laws § 27-70-1 — RI Code / Title 27 / Chapter 27-70 / Section 27-70-1
§ 27-70-1. Short title.
Status: in_force

This chapter shall be known and may be cited as The Health Insurance Tax Incentive.
R.I. Gen. Laws § 27-18-3.2 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-3.2
§ 27-18-3.2. Rules and regulations.
Status: in_force

The department of business regulation shall promulgate rules and regulations necessary to effectuate the purpose of this chapter, including procedures for notice to covered persons, employers, and other organizations of the provisions of this chapter.
R.I. Gen. Laws § 27-29-4.4 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-4.4
§ 27-29-4.4. Auto body repair labor rate surveys.
Status: in_force

(a) Every insurance carrier authorized to sell motor vehicle liability insurance in the state shall conduct an auto body repair labor rate survey, subject to, and in accordance with, the following provisions:

(1) When used in this section the following definitions shall apply:

(i) Auto body labor rate survey is an analysis of information gathered from auto body repair shops regarding the rates of labor that repair shops charge in a certain geographic area.

(ii) Contract rate means any labor rate to which an auto body repair facility and an insurer have agreed in a formal agreement and/or written contract.

(iii) Direct repair program means any methods through which an insurer refers, suggests, or recommends a specific auto body repair facility, with whom the insurer has a formal agreement and/or contract to provide auto body repair services, to insureds and/or claimants.

(iv) Independent auto body repair facility means any auto body repair facility that does not have a formal agreement and/or written contract with an insurer to provide auto body repair services to insureds and/or claimants.

(v) Prevailing auto body labor rate means the rate determined and set by an insurer as a result of conducting an auto body labor rate survey in a particular geographic area and used by insurers as a basis for determining the cost to settle automobile property damage claims.

(2) Each insurer must annually conduct a separate and distinct written auto body labor rate survey for each classification of auto body shops as established by the department of business regulation pursuant to § 5-38-5, to determine a separate and distinct prevailing auto body labor rate for each classification of fully licensed auto body repair facilities.

(3) Insurers may not use an auto body labor rate survey; contract rates from auto body repair facilities with which it has a formal agreement or contract to provide auto body repair services to insureds and/or claimants; rates paid as a result of subrogation, rates obtained from auto body repair facilities in a different classification than that being surveyed, or rates from a repair shop facility holding a limited or special use license.

(4) Each auto body labor rate survey shall include the following:

(i) The name and address of each shop surveyed in the labor survey;

(ii) The total number of shops surveyed;

(iii) The prevailing rate established by the insurer for each classification of full collision licensed auto body repair facilities; and

(iv) A description of the formula or method used to calculate or determine the specific prevailing rate reported.

(5) Each insurer must report the results of their auto body labor rate survey to the department of business regulation insurance division.

(6) The department of business regulation must promulgate regulations related to auto body labor rate surveys by October 1, 2006, establishing the following:

(i) A questionnaire that must be used by all insurers in their labor rate survey;

(ii) Date of reporting; and

(iii) Number or percentage of shops to be surveyed.

(7) The department of business regulation shall review all surveys submitted for compliance with this section and any rules and regulations promulgated by the department.

(b) Nothing contained in this section shall require an insurer to establish the prevailing rate for each classification of full collision licensed auto body repair facilities based solely on the survey results.
R.I. Gen. Laws § 27-3-40 — RI Code / Title 27 / Chapter 27-3 / Section 27-3-40
§ 27-3-40. Limitations on placing insurance with approved surplus lines insurers.
Status: in_force

(a) Surplus lines insurance may be placed by a surplus lines broker if each insurer is authorized to write the type of insurance in its domiciliary jurisdiction.

(b) A surplus lines licensee shall not place coverage with a nonadmitted insurer, unless, at the time of placement, the nonadmitted insurer:

(1) Has established satisfactory evidence of good repute and financial integrity; and

(2) Qualifies under one of the following subparagraphs:

(i) Has capital and surplus or its equivalent under the laws of its domiciliary jurisdiction that equals the greater of:

(A) The minimum capital and surplus requirements under the law of this state; or

(B) Fifteen million dollars ($15,000,000); or

(ii) For an insurer not domiciled in the United States or its territories, the insurer is listed on the quarterly listing of alien insurers maintained by the NAIC international insurers department or its equivalent.

(c) The capital and surplus requirements of subsection (b)(2)(i) above may be satisfied by an insurer possessing less than the minimum capital and surplus upon an affirmative finding of acceptability by the commissioner. The finding shall be based upon such factors as quality of management, capital and surplus of any parent company, company underwriting profit and investment income trends, market availability, and company record and reputation within the industry. In no event shall the commissioner make an affirmative finding of acceptability when the nonadmitted insurers capital and surplus is less than four million five hundred thousand dollars ($4,500,000).

(d) The commissioner is authorized to enter into a multistate surplus lines agreement to establish additional and alternative nationwide uniform eligibility requirements that shall be applicable to nonadmitted insurers domiciled in another state or territory of the United States.
R.I. Gen. Laws § 27-9-11 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-11
§ 27-9-11. Special filings as to surety or guaranty bonds.
Status: in_force

Any special filing with respect to a surety or guaranty bond required by law, by court or executive order, or by order, rule, or regulation of a public body, not covered by a previous filing, shall become effective when filed and shall be deemed to meet the requirements of this chapter until the commissioner reviews the filing and so long after this as the filing remains in effect.
R.I. Gen. Laws § 27-19-9 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-9
§ 27-19-9. Examination of affairs of corporations.
Status: in_force

It is the duty of the insurance commissioner to make an examination of the financial condition and methods of doing business of every nonprofit hospital service corporation. The examination shall be performed, and the associated costs borne by the company, in accordance with all of the provisions of chapter 13.1 of this title.
R.I. Gen. Laws § 27-42-5 — RI Code / Title 27 / Chapter 27-42 / Section 27-42-5
§ 27-42-5. Subject to state laws.
Status: in_force

Any person or entity unable to show that the person or entity is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, shall be subject to all appropriate provisions of this title and of chapter 62 of title 42, regarding the conduct of the person or entitys business.
R.I. Gen. Laws § 27-5-7 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-7
§ 27-5-7. Combination standard form.
Status: in_force

Two (2) or more insurers authorized to do the business of fire insurance in this state may, with the approval of the director of business regulation, issue a combination standard form of fire insurance policy which shall contain the following provisions:

(1) A provision substantially to the effect that the insurers executing the policy shall be severally liable for the full amount of any loss or damage, according to the terms of the policy, or for specified percentages or amounts of loss or damage, aggregating the full amount of the insurance under the policy; and

(2) A provision substantially to the effect that service of process, or of any notice or proof of loss required by the policy, upon any of the insurers executing the policy, shall be deemed to be service upon all of the insurers.
R.I. Gen. Laws § 27-41-54 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-54
§ 27-41-54. Disassociation prohibited.
Status: in_force

Notwithstanding any provision of the general or public laws to the contrary, no individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides medical coverage for physician services in a physicians office, and no policy that provides major medical or similar comprehensive-type coverage for specified diseases or other supplemental policies, shall prohibit a medical provider from ceasing an association with and participation in one health maintenance organization and associating and participating with another health maintenance organization doing business in this state.
R.I. Gen. Laws § 27-29-9 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-9
§ 27-29-9. Penalty.
Status: in_force

(a) Any person who violates a cease and desist order of the insurance commissioner under § 27-29-6 after it has become final, and while the order is in effect, shall, upon proof of the violation to the satisfaction of the court, forfeit and pay to the state a sum not to exceed twenty-five thousand dollars ($25,000), which may be recovered in a civil action, except that, if the violation is found to be willful, the amount of the penalty shall be a sum not to exceed two hundred fifty thousand dollars ($250,000).

(b) Any person who violates a cease and desist order of the insurance commissioner under § 27-29-6 after it has become final, and while the order is in effect, may after notice and hearing and upon order of the commissioner, be subject at the discretion of the commissioner to suspension or revocation of the insurers license.
R.I. Gen. Laws § 27-74-1 — RI Code / Title 27 / Chapter 27-74 / Section 27-74-1
§ 27-74-1. Short title.
Status: in_force

This chapter shall be known as the Discount Medical Plan Organization Act.
R.I. Gen. Laws § 27-25-32 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-32
§ 27-25-32. Injunction.
Status: in_force

No application or petition for injunction against any domestic, foreign, or alien society, or lodge of a society, shall be recognized in any court of this state unless made by the attorney general upon the request of the commissioner of insurance.
R.I. Gen. Laws § 27-19-5 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-5
§ 27-19-5. Contracts with subscribers, hospitals, and other eligible entities.
Status: in_force

(a) Each nonprofit hospital service corporation may contract with its subscribers and with any eligible hospital for hospital service to be rendered by the contracting hospital to the subscribers and as to the nature and extent of those services. Each corporation may also contract with any of the following: (1) Any hospital or medical service corporation incorporated in this or another state for the joint administration of their business and may enter into reciprocal arrangements with those corporations for the mutual benefit of the subscribers of each; (2) Corporations paying or organized for payment of medical, dental, optometric, or legal benefits, for the administration of their business including, without limiting the generality of the foregoing, corporations organized under chapters 20, 20.1, 20.2, and 20.3 of this title; (3) The federal government, the state, county, city, town, or other quasi-municipal corporations or their agencies; and (4) Employers, associations, and other third parties for the administration and underwriting of stop-loss or catastrophe insurance, for fully and partially self-insured health benefit plans sponsored by such employers, associations, and third parties.

(b) Services for which coverage or benefits may be provided to subscribers by any of the corporations referred to in subsection (a)(2) of this section may also be provided for or underwritten by each nonprofit hospital service corporation.

(c) No contract between a nonprofit hospital service corporation and a dentist for the provisions of services to patients may require that the dentist indemnify or hold harmless the nonprofit hospital service corporation for any expenses and liabilities, including without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the nonprofit hospital service corporation based on the nonprofit hospital service corporations management decision, or utilization review provisions for any patient.

(d) The rates proposed to be charged by any corporation organized under this chapter for stop-loss or catastrophe insurance shall be filed by the corporation at the office of the health insurance commissioner. The health insurance commissioner shall review such rates to determine if they are actuarially sound and may hold a public hearing on such rates upon not less than ten (10) days written notice prior to the hearing. The health insurance commissioner, upon the hearing, may administer oaths, examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents that he or she deems relevant. The director shall issue a decision as soon as is reasonably possible following the completion of the hearing. The decision may approve, disapprove, or modify the rates proposed to be charged by the applicant.
R.I. Gen. Laws § 27-34-4 — RI Code / Title 27 / Chapter 27-34 / Section 27-34-4
§ 27-34-4. Construction.
Status: in_force

This chapter shall be liberally construed to effect the purpose under § 27-34-2 which will constitute an aid and guide to interpretation.
R.I. Gen. Laws § 27-1-14 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-14
§ 27-1-14. Decree of forfeiture  Receiver.
Status: in_force

If, upon the examination of the president, secretary, or treasurer and of any other witnesses and evidence as may be introduced by the insurance commissioner and defendants, the court is of the opinion that the charter of the company is forfeited at law, or that the company is managed in a manner that the public or those having funds in its custody or who hold policies of insurance issued by it are in danger of being defrauded, or the continued operation of its business would be hazardous to the public or its policyholders, or that the company has become insolvent, the court shall issue an injunction to the president, secretary, or treasurer and other officers of the corporation, enjoining them from proceeding further in transacting the business of the company, and shall appoint a discreet and proper person to be receiver of all the evidences of debt, goods, effects, and property of every description belonging to the corporation. The court may require the receiver to give bond with surety to the satisfaction of the court for the faithful execution of the receivers trusts. The person once appointed as the receiver may, subject to the discretion of the court, continue to be receiver for the duration of the receivership proceedings.
R.I. Gen. Laws § 27-78-2 — RI Code / Title 27 / Chapter 27-78 / Section 27-78-2
§ 27-78-2. Definitions.
Status: in_force

For purposes of this chapter:

(1) Certificate of insurance means a document or instrument, regardless of how titled or described, that is prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage. The term does not include a policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card.

(2) Insurance producer means a person required to be licensed under the laws of this state to sell, solicit, or negotiate property or casualty insurance.

(3) Insurer means any organization that issues property or casualty insurance.

(4) Person means any individual, partnership, corporation, association, or other legal entity, including any government or governmental subdivision or agency.
R.I. Gen. Laws § 27-66-14 — RI Code / Title 27 / Chapter 27-66 / Section 27-66-14
§ 27-66-14. No derogation of attorney general.
Status: in_force

(a) No provision of this chapter shall derogate from the common law or statutory authority of the attorney general nor shall any provision be construed as a limitation on the common law or statutory authority of the attorney general, including the authority to investigate at any time charitable trusts for the purpose of determining and ascertaining whether they are being administered in accordance with law and with the terms and purposes of those trusts.

(b) No provision of this chapter shall be construed as a limitation on the application of the doctrine of cy pres or any other legal doctrine applicable to charitable assets and/or charitable trusts.
R.I. Gen. Laws § 27-58-9 — RI Code / Title 27 / Chapter 27-58 / Section 27-58-9
§ 27-58-9. No discrimination against nonaffiliated agents.
Status: in_force

No financial institution may:

(1) Require as a condition of providing any product or service to any customer, or any renewal of any contract for providing the product or service, that the customer acquire, finance, or negotiate any policy or contract of insurance through a particular insurer or insurance producer;

(2) In connection with a loan or extension of credit that requires a borrower to obtain insurance, reject an insurance policy because that policy has been issued or underwritten by any person who is not associated with that institution;

(3) Impose any requirement on any insurance producer who is not associated with the financial institution that is not imposed on any insurance producer who is associated with that institution; or

(4) Unless otherwise authorized by any applicable federal or state law, require any debtor, insurer, or producer to pay a separate charge in connection with the handling of insurance that is required under a contract.
R.I. Gen. Laws § 27-19-47 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-47
§ 27-19-47. Acupuncture services.
Status: in_force

(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery, or renewed in this state that provides medical coverage, and every group policy that provides for treatment of persons for the prevention, cure, or correction of any illness or physical or mental condition, shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services.

(b) For the purposes of this section:

(1) Coverage for the services of a doctor of acupuncture as a provider of acupuncture services means coverage for acupuncture as defined in § 5-37.2-2(1).

(2) Doctor of acupuncture means a practitioner licensed under chapter 37.2 of title 5.

(c) It remains within the sole discretion of the nonprofit hospital service corporation as to which doctor of acupuncture it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation; provided, that no nonprofit hospital service corporation is required to pay for duplicative services actually rendered by a doctor of acupuncture and any other healthcare provider. Nothing contained in this section precludes the nonprofit hospital service corporations from conducting managed care, medical necessity, or utilization review.
R.I. Gen. Laws § 27-9-7.3 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-7.3
§ 27-9-7.3. Rating for nonbusiness policies.
Status: in_force

(a) Notwithstanding the requirements of § 27-9-7, a filing made by an insurer under this section that provides for an overall statewide rate increase or decrease of no more than five percent (5%) in the aggregate for all coverages that are subject to the filing may take effect the date it is filed. The five percent (5%) limitation does not apply on an individual insured basis. No more than one rate filing may be made by an insurer pursuant to the expedited process provided in this subsection during any twelve-month (12) period, unless a rate filing, when combined with any other rate filing or filings made by an insurer within the preceding twelve (12) months, does not result in an overall statewide increase or decrease of more than five percent (5%) in the aggregate for all coverages that are subject to the filing.

(b) Rate filings falling outside of the limitation provided for in subsection (a) of this section shall be subject to § 27-9-9, unless those filings are other exempt from those provisions pursuant to another section of the insurance code.

(c) A filing submitted pursuant to subsection (a) of this section is considered to comply with state law. However, if the commissioner of insurance determines that the filing is inadequate or unfairly discriminatory, the commissioner shall issue a written order specifying in detail the provisions of the insurance code the insurer has violated and the reasons the filing is inadequate or unfairly discriminatory and stating a reasonable future date on which the filing is to be considered no longer effective. An order by the commissioner pursuant to this subsection that is issued more than thirty (30) days from the date on which the commissioner received the rate filing is prospective only and does not affect any contract issued or made before the effective date of the order. For purposes of this act, unfairly discriminatory means a rate for a risk that is classified in whole or in part on the basis of race, color, creed, or national origin.

(d) No rate increase within the limitation specified in subsection (a) of this section may be implemented with regard to an individual existing policy, unless the increase is applied at the time of a renewal or conditional renewal of an existing policy and the insurer, at least thirty (30) days in advance of the end of the insureds policy period, mails or delivers to the named insured, at the address shown in the policy, a written notice that clearly and conspicuously discloses its intention to change the rate. A notice of renewal or conditional renewal that clearly and conspicuously discloses the renewal premium applicable to the policy shall be deemed to be in compliance with this subsection.
R.I. Gen. Laws § 27-20-6.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-6.1
§ 27-20-6.1. Uniform explanation of benefits and coverage.
Status: repealed

(a) A nonprofit medical service corporation shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required by, the federal regulations adopted under section 2715 of the Public Health Service Act, as amended by the federal Affordable Care Act [42 U.S.C. § 300gg-15]. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.

(b) The provisions of this section shall apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.

(c) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.
R.I. Gen. Laws § 27-54-8 — RI Code / Title 27 / Chapter 27-54 / Section 27-54-8
§ 27-54-8. Disclosure of arson conviction.
Status: in_force

(a) Every insurance provider doing business within this state shall require applicants for property insurance, real or personal, to disclose whether or not the applicant or applicants have been convicted of any degree of the crime of arson as described in chapter 4 of title 11 within ten (10) years of the application date.

(b) An insurance provider may use the existence of an arson conviction within ten (10) years as a reason to deny coverage.

(c) Failure to disclose the existence of an arson conviction when requested upon an insurance application shall be a misdemeanor punishable by a sentence of not more than one year imprisonment.

(d) The insurance application form shall indicate the existence of a criminal penalty for failure to disclose a conviction for arson.

(e) For the purpose of this section, applicant means a natural person, trust, partnership, association, corporation, or other form of business organization; provided, that if the applicant is a trust, the beneficiaries of the trust shall be included, and if the applicant is a partnership, association, corporation, or other form of business organization, each member, director, shareholder owning more than twenty percent (20%) of the common stock issued by the corporation, and the principal officer of the corporation shall be included.

(f) The provisions of this section do not apply to any policy with respect to highly protected risks. A highly protected risk means a fire resistive building that meets the highest standards of fire safety according to insurance company underwriting requirements.
R.I. Gen. Laws § 27-64-6 — RI Code / Title 27 / Chapter 27-64 / Section 27-64-6
§ 27-64-6. Reach of creditors and other claimants.
Status: repealed

(a)(1) Protected cell assets shall only be available to the creditors of the protected cell company that are creditors in respect to that protected cell and shall be entitled, in conformity with the provisions of this chapter, to have recourse to the protected cell assets attributable to that protected cell, and shall be absolutely protected from the creditors of the protected cell company that are not creditors in respect of that protected cell and who, accordingly, shall not be entitled to have recourse to the protected cell assets attributable to that protected cell. Creditors with respect to a protected cell shall not be entitled to have recourse against the protected cell assets of other protected cells or the assets of the protected cell companys general account.

(2) Protected cell assets shall only be available to creditors of a protected cell company after all protected cell liabilities have been extinguished or provided for in accordance with the plan of operation relating to that protected cell.

(b) When an obligation of a protected cell company to a person arises from a transaction, or is imposed, in respect of a protected cell: (1) That obligation of the protected cell company shall extend only to the protected cell assets attributable to that protected cell, and the person shall, with respect to that obligation, be entitled to have recourse only to the protected cell assets attributable to that protected cell; and (2) That obligation of the company shall not extend to the protected cell assets of any other protected cell or the assets of the protected cell companys general account, and that person shall not, with respect to that obligation, be entitled to have recourse to the protected cell assets of any other protected cell or the assets of the protected cell companys general account.

(c) When an obligation of a protected cell company relates solely to the general account, the obligation of the protected cell company shall extend only to, and that creditor shall, with respect to that obligation, be entitled to have recourse only to the assets of the protected cell companys general account.

(d) Other than with regard to the application of this section, the activities, assets, and obligations relating to a protected cell are not subject to the provisions of chapters 34, 34.1 [repealed], and 34.3 of this title and neither a protected cell nor a protected cell company shall be assessed by or be required to contribute to any guaranty fund or guaranty association in this state with respect to the activities, assets, or obligations of a protected cell. Nothing in this section shall affect the activities or obligations of an insurers general account.

(e) In no event shall the establishment of one or more protected cells alone constitute or be deemed to be a fraudulent conveyance; an intent by the protected cell company to defraud creditors; or the carrying out of business by the protected cell company for any other fraudulent purpose.
R.I. Gen. Laws § 27-50-16 — RI Code / Title 27 / Chapter 27-50 / Section 27-50-16
§ 27-50-16. Risk adjustment mechanism.
Status: in_force

The director may establish a payment mechanism to adjust for the amount of risk covered by each small employer carrier. The director may appoint an advisory committee composed of individuals that have risk adjustment and actuarial expertise to help establish the risk adjusters.
R.I. Gen. Laws § 27-2-17 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-17
§ 27-2-17. Reciprocal fees and charges.
Status: in_force

(a) Whenever, by the laws of any other state of the United States, any fees, charges, taxes, deposits of money or of securities, or other obligations or prohibitions are imposed on insurance companies incorporated or organized under the laws of this state or on the insurance producers of the insurance companies, so long as the laws continue in force, the fees, charges, taxes, deposits, and obligations shall be imposed on the insurance companies doing business in this state that are incorporated or organized under the laws of the other state and on their insurance producers.

(b) Whenever, by the laws of any other state of the United States, insurance companies incorporated or organized under the laws of this state are required to provide a countersignature as a precondition to the issuance, delivery, or making of any contract of insurance in the other state, and whenever the insurance producer of the company is required to pay any fee or commission for placing any insurance coverage in the other state, then the same requirements for countersignatures and fee or commission shall be imposed upon the insurance companies doing business in this state that are incorporated and organized under the laws of the other states and/or their insurance producers.

(c) Whenever insurance companies that are authorized to do business in this state issue, deliver, or make any contract of insurance on a person or property in this state, the companies shall place the business through a licensed resident insurance producer or licensed nonresident insurance producer as permitted under § 27-2-3 or any other provision of Rhode Island law; provided, if the insurance to be issued in this state is part of an insurance contract written on a risk whose principal place of business is located in another state, and the insurance contract is placed through an insurance producer of the domiciliary state of the primary insured, it shall be permitted only if that state allows the placement of the business by a licensed nonresident insurance producer of Rhode Island in similar circumstances.

(d) The provisions of this section shall not apply to insurance companies incorporated or organized under the laws of a state or country whose laws do not impose retaliatory taxes or other charges or that grant, on a reciprocal basis, exemptions from those taxes or other charges to insurance companies incorporated or organized under the laws of this state.
R.I. Gen. Laws § 27-7-2 — RI Code / Title 27 / Chapter 27-7 / Section 27-7-2
§ 27-7-2. Remedies of injured party against insurer.
Status: in_force

An injured party, or, in the event of that partys death, the party entitled to sue for that death, in the partys suit against the insured, shall not join the insurer as a defendant. If the officer serving any process against the insured shall return that process non est inventus, or where before suit has been brought and probate proceedings have not been initiated the insured has died, or where a suit is pending against an insured in his or her own name and the insured died prior to judgment, or where a nonresident had been involved in an automobile accident in Rhode Island as an operator or owner and died before suit has been brought, the injured party, and, in the event of that partys death, the party entitled to sue for that death, may proceed directly against the insurer. The injured party, or, in the event of that partys death, the party entitled to sue for that death, after having obtained judgment against the insured alone, may proceed on that judgment in a separate action against the insurer; provided, the payment in whole or in part of the liability by either the insured or the insurer shall, to the extent of the payment, be a bar to recovery against the other of the amount paid. The time limitations for filing such actions shall be governed by the provisions of § 9-1-14 as appropriate, including, but not limited to, any extension of the statute of limitations for injuries to the person provided by § 9-1-14(c).
R.I. Gen. Laws § 27-68-1 — RI Code / Title 27 / Chapter 27-68 / Section 27-68-1
§ 27-68-1. Legislative findings.
Status: in_force

The general assembly hereby finds and declares that:

(1) Although Rhode Island has one of the highest rates of health insurance coverage in the nation, gaps in coverage remain and the rate of coverage dropped significantly during the past year.

(2) From 2001 to 2002, the states uninsured rate for working age adults went from eight percent (8%) to eleven percent (11%), one of eighteen (18) states in the country with a significant increase.

(3) Significant health insurance premium rate increases over the past two (2) years especially for small businesses and the self-insured are contributing to an increase in the rate of the uninsured.

(4) The largest segment of uninsured Rhode Island residents are adults with low incomes, many of whom are employed.

(5) Individuals without health coverage often resort to expensive emergency room care that ultimately drives up the overall cost of care for everyone and adds to the states uncompensated care burden.

(6) Rhode Island residents use of emergency room services is greater than that of the nation.

(7) The institute of medicine defines primary care as the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.

(8) Access to primary health care should be available to every resident of the state regardless of income and whether or not they have access to health insurance.
R.I. Gen. Laws § 27-58-3 — RI Code / Title 27 / Chapter 27-58 / Section 27-58-3
§ 27-58-3. Definitions.
Status: in_force

For the purposes of this chapter:

(1) Financial institution includes:

(i) A bank, savings bank, or trust company, as defined in title 19, its affiliates or subsidiaries, or any of its officers, agents, representatives, or employees, or any bank, savings bank, or savings and loan association chartered pursuant to federal law and located in Rhode Island, its affiliates or subsidiaries, or any of its officers, agents, representatives, or employees;

(ii) A bank holding company as defined in 12 U.S.C. § 1841, except any bank holding company that is exempt as provided in 12 U.S.C. § 1843(d), its affiliates or subsidiaries, or any of its officers, agents, representatives, or employees; or

(iii) Any other individual, corporation, partnership, or association authorized to take deposits and to make loans of money under the provisions of chapters 5, 14, 14.1, and 14.2 of title 19 or any of its officers, agents, representatives, or employees.

(2) Insurance includes all products defined or regulated as insurance by the department of business regulation except:

(i) Credit life, credit accident and health, credit involuntary unemployment insurance; group credit insurance, forced, placed or voluntary credit personal property insurance; group mortgage cancellation life insurance, or group mortgage accident and health insurance and annuities;

(ii) Insurance placed by a financial institution in connection with collateral pledged as security for a loan when the debtor breaches the contractual obligation to provide that insurance; and

(iii) Private mortgage insurance.
R.I. Gen. Laws § 27-39-1 — RI Code / Title 27 / Chapter 27-39 / Section 27-39-1
§ 27-39-1. Definitions.
Status: in_force

As used in this chapter:

(1) Elective surgical procedure means any non-emergency surgical procedure that may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patients life or causing serious impairment to the patients bodily functions.

(2) Eligible physician means a physician licensed to practice medicine and surgery who holds the rank of diplomate of an American board (M.D.) or certified specialist (D.O.) in the surgical or medical specialty for which surgery is proposed.

(3) Second surgical opinion means an opinion of an eligible physician based on that physicians examination of a person for the purpose of evaluating the medical advisability of that person undergoing an elective surgical procedure. The examinations must be performed after another physician licensed to practice medicine and surgery has proposed to perform the surgical procedure on the person but prior to the performance of the surgical procedure.
R.I. Gen. Laws § 27-9-25 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-25
§ 27-9-25. Cooperation among organizations and insurers  Review of cooperative practices.
Status: in_force

Cooperation among rating organizations or among rating organizations and insurers and concert of action among insurers under the same general management or control in ratemaking or in other matters within the scope of this chapter are authorized, provided the filings resulting from that cooperation are subject to all of the provisions of this chapter that are applicable to filing generally. The commissioner may review cooperative activities and practices and if, after a hearing, the commissioner finds that any cooperative activity or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, the commissioner may issue a written order specifying in what respects that activity or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, and requiring the discontinuance of that activity or practice.
R.I. Gen. Laws § 27-17-18 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-18
§ 27-17-18. Insertion of provisions in standard policies.
Status: in_force

The attorney may insert in any form of policy prescribed by the laws of this state or adopted by this state, any provisions or conditions required by the plan of reciprocal or interinsurance; provided, that the provisions or conditions shall not be in conflict with the laws of this state.
R.I. Gen. Laws § 27-20-8 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-8
§ 27-20-8. Annual and quarterly statements.
Status: in_force

(a) Every nonprofit medical service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of its condition on the thirty-first day of December then next preceding, which statement shall be in general form and context as approved by the National Association of Insurance Commissioners and contain any matters as the director of business regulation shall prescribe and shall be available for inspection by the public.

(b) Every nonprofit medical service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners guidelines and procedures, and shall be available for inspection by the public.

(c) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.
R.I. Gen. Laws § 27-13-1 — RI Code / Title 27 / Chapter 27-13 / Section 27-13-1
§ 27-13-1. Examination into affairs of company.
Status: in_force

The insurance commissioner, either personally or by a committee appointed by the commissioner consisting of one or more persons not directors, officers, or agents of any life, fire, marine, fire and marine, or casualty insurance company, doing business in this state, may at any time examine into the affairs of any life, fire, marine, fire and marine, casualty, or other insurance company, incorporated by or doing business in this state. The officers or agents of any insurance company shall exhibit its books to the insurance commissioner or committee, and facilitate its examination, and the insurance commissioner or the committee may examine, under oath, the officers and agents of any insurance company in relation to its affairs. The insurance commissioner shall, if the commissioner deems it advisable, publish the result of the investigation in one or more newspapers published in the state. The total cost of those examinations shall be borne by the examined companies and shall be one hundred fifty percent (150%) of the total salaries paid to the examining personnel of the banking and insurance division engaged in those examinations less any salary reimbursements and shall be paid to the insurance commissioner to and for the use of the state. That assessment shall be in addition to any taxes and fees payable to the state.
R.I. Gen. Laws § 27-5-5 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-5
§ 27-5-5. Inclusion of regulations of mutual insurer.
Status: in_force

If the policy is issued by a mutual insurer having special regulations with respect to the payment by the policyholder of assessments, those regulations shall be printed upon the policy, and any mutual insurer may print upon the policy any regulations that may be appropriate to or required by its form of organization.
R.I. Gen. Laws § 27-20-37.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-37.1
§ 27-20-37.1. Specialty drugs.
Status: in_force

(a) The general assembly makes the following findings:

(1) In 2015, an estimated six hundred thirty-five thousand (635,000) Rhode Island residents had at least one chronic disease, and an estimated two hundred forty-nine thousand (249,000) residents had two (2) or more chronic diseases, which significantly increases their likelihood to depend on prescription specialty drugs;

(2) In 2016, twenty-five percent (25%) of Rhode Island residents stopped taking a prescription drug as prescribed due to cost;

(3) Most specialty drugs do not have biosimilars, generic equivalents, or substitutes to create competition and help lower their prices; and

(4) In 2022, the Centers for Medicare & Medicaid Services define any drug for which the negotiated price is six hundred seventy dollars ($670) per month or more, as a specialty drug.

(b) As used in this section, the following words shall have the following meanings:

(1) Complex or chronic medical condition means a physical, behavioral, or developmental condition that is persistent or otherwise long-lasting in its effects or a disease that advances over time, and:

(i) May have no known cure;

(ii) Is progressive; or

(iii) Can be debilitating or fatal if left untreated or undertreated.

Complex or chronic medical condition includes, but is not limited to, multiple sclerosis, hepatitis c, and rheumatoid arthritis.

(2) Pre-service authorization means a cost containment method that an insurer, a nonprofit health service plan, or a health maintenance organization uses to review and preauthorize coverage for drugs prescribed by a healthcare provider for a covered individual to control utilization, quality, and claims.

(3) Rare medical condition means a disease or condition that affects fewer than:

(i) Two hundred thousand (200,000) individuals in the United States; or

(ii) Approximately one in one thousand five hundred (1,500) individuals worldwide.

Rare medical condition includes, but is not limited to, cystic fibrosis, hemophilia, and multiple myeloma.

(4) Specialty drug means a prescription drug that exceeds the threshold for a specialty drug under the Medicare Part D program (Medicare Prescription Drug Improvement and Modernization Act of 2003 (Public Law 108-173)).

(5) Specialty drug tier means a formulary tier in the pharmacy benefit that imposes a cost-sharing obligation for a specialty drug.

(c) Every individual or group health insurance contract, plan, or policy that provides prescription drug coverage and is delivered, issued for delivery, or renewed in this state on or after January 1, 2025, shall limit any required copayment or coinsurance applicable to covered drugs on a specialty drug tier to an amount not to exceed one hundred fifty dollars ($150) per month for each drug up to a thirty-day (30) supply of any single drug. This limit shall be inclusive of any copayment or coinsurance. This limit shall be applicable after any deductible is reached and until the individuals maximum out-of-pocket limit has been reached.

(d) Nothing in this section shall prevent an entity subject to this section from reducing a covered individuals cost sharing for a specialty drug to an amount less than that described in subsection (c) of this section.

(e) The health insurance commissioner may promulgate any rules and regulations necessary to implement and administer this section in accordance with any federal requirements and shall use the commissioners enforcement powers to obtain compliance with the provisions of this section.
R.I. Gen. Laws § 27-9-9 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-9
§ 27-9-9. Review of filings.
Status: in_force

The commissioner shall review filings as soon as reasonably possible after they have been made in order to determine whether they meet the requirements of this chapter.
R.I. Gen. Laws § 27-30-1 — RI Code / Title 27 / Chapter 27-30 / Section 27-30-1
§ 27-30-1. Purpose.
Status: in_force

The purpose of this chapter is to promote the public welfare by regulating consumer credit insurance. Nothing in this chapter is intended to prohibit or discourage reasonable competition. The provisions of this chapter shall be liberally construed.
R.I. Gen. Laws § 27-41-48 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-48
§ 27-41-48. Additional relief and damages  Reinstatement.
Status: in_force

(a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages, and costs, including reasonable attorney fees.

(b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides, or the county in which the insurer maintains its principal place of business.

(c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement.
R.I. Gen. Laws § 27-37-1 — RI Code / Title 27 / Chapter 27-37 / Section 27-37-1
§ 27-37-1. Notice of cancellation.
Status: in_force

No policy of group insurance issued in this state shall be canceled by the insurer unless written notice of cancellation is mailed to the group contract holder by certified or registered mail at least thirty (30) days prior to the cancellation date in order for the cancellation to be effective.
R.I. Gen. Laws § 27-41-96 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-96
§ 27-41-96. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection.
Status: in_force

(a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. Each long-acting injectable drug with a different duration shall constitute a separate method of administration.

(b) The healthcare benefits outlined in this section apply only to services delivered within the health insurers provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this section outside of the health insurers provider network where it can be established that the required services are not available from a provider in the health insurers network.

(c) A health insurer shall provide access to at least one pre-exposure (PrEP) drug in each method of administration and at least one of the Centers for Disease Control and Prevention preferred post-exposure (PEP) drug treatment regimen, without any prior authorization or step therapy requirement. There shall be no copayment required, and no deductible shall need to be met, to obtain the prescription covered by the contract, plan, or policy.
R.I. Gen. Laws § 27-54-7 — RI Code / Title 27 / Chapter 27-54 / Section 27-54-7
§ 27-54-7. Whistleblower protections.
Status: in_force

(a) Prohibition against discrimination. No person subject to the provisions of this chapter may discharge, demote, threaten, or otherwise discriminate against any person or employee with respect to compensation, terms, conditions, or privileges of employment as a reprisal because the person or employee (or any person acting pursuant to the request of the employee) provided or attempted to provide information to the director, or the directors designee, regarding possible violation of this chapter.

(b) Enforcement. Any person or employee or former employee subject to the provisions of this chapter who believes that he or she has been discharged or discriminated against in violation of subsection (a) of this section may file a civil action within three (3) years of the date of the discharge or discrimination.

(c) Remedies. If the court determines that a violation has occurred, the court may order the person who committed the violation to:

(1) Reinstate the employee to the employees former position;

(2) Pay compensatory damages, costs of litigation, and attorneys fees; and/or

(3) Take other appropriate actions to remedy any past discrimination.

(d) Limitation. The protections of this section shall not apply to any person or employee who:

(1) Deliberately causes or participates in the alleged violation of law or regulation; or

(2) Knowingly or recklessly provides substantially false information to the director or the directors designee.
R.I. Gen. Laws § 27-20-31 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-31
§ 27-20-31. Primary and preventive obstetric and gynecological care.
Status: in_force

Any insurer or nonprofit health service plan that provides obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health maintenance organization, shall permit a woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first obtain a referral from a primary care provider.
R.I. Gen. Laws § 27-10-2 — RI Code / Title 27 / Chapter 27-10 / Section 27-10-2
§ 27-10-2. Persons exempt.
Status: in_force

The provisions of this chapter shall not apply to the following:

(1) An attorney at law admitted to practice in this state, acting in their professional capacity as an attorney;

(2) Either an insurance producer of a domestic insurance company or an insurance producer duly licensed by the insurance commissioner, when the insurance producer adjusts, or assists in the adjustment of, claims arising only under policies of insurance or fidelity or surety bonds negotiated, solicited, or effected by the insurance producer, whether the insurance producer is a person, partnership, or corporation, for which they act;

(3) A person who negotiates or settles claims arising under a life or health insurance policy or an annuity contract;

(4) A person employed only for the purpose of obtaining facts surrounding a loss or furnishing technical assistance to a licensed adjuster, including photographers, estimators, private investigators, engineers, and handwriting experts;

(5) An individual who is employed to investigate suspected fraudulent insurance claims but who does not adjust losses or determine claims payments;

(6) A person who solely performs executive, administrative, managerial, or clerical duties, or any combination thereof, and who does not investigate, negotiate, or settle claims with policyholders, claimants, or their legal representative;

(7) A licensed healthcare provider or its employee who provides managed care services as long as the services do not include the determination of compensability;

(8) A managed care organization or any of its employees or an employee of any organization providing managed care services so long as the services do not include the determination of compensability;

(9) A person who settles only reinsurance or subrogation claims;

(10) A person who investigates, negotiates, or settles life, accident and health, annuity, or disability insurance claims;

(11) An individual employee, under a self-insured arrangement, who adjusts claims on behalf of their employer;

(12) A person authorized to adjust disability claims under the authority of a third-party administrator (TPA) license pursuant to chapter 20.7 of this title;

(13) A person who adjusts claims for portable electronic insurance offered pursuant to chapter 2.7 of this title.
R.I. Gen. Laws § 27-20-21 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-21
§ 27-20-21. Nonprofit medical service corporation assessment.
Status: in_force

(a) Notwithstanding any other provisions of law, each domestic nonprofit medical service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulations.

(b) The minimum assessment charged shall be one thousand dollars ($1,000).
R.I. Gen. Laws § 27-41-31 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-31
§ 27-41-31. Mammograms  Quality assurance standards.
Status: in_force

A mammogram eligible for reimbursement under § 27-41-30 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram both meet state-approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.
R.I. Gen. Laws § 27-1-11 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-11
§ 27-1-11. Visitation and examination of insurance companies.
Status: in_force

The insurance commissioner shall, whenever requested by the governor, visit any insurance company incorporated in this state. The insurance commissioner shall have free access to its vaults and all of its books and papers, and shall, if the insurance commissioner deems it expedient, thoroughly inspect and examine all of the affairs of the company and make all inquiries as may in the commissioners opinion be necessary to ascertain the condition of the company and its ability to fulfill all of its engagements, and whether it has complied with the provisions of law applicable to its transactions.
R.I. Gen. Laws § 27-9-53 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-53
§ 27-9-53. Motor vehicle insurance rate increases relating to violations and accidents.
Status: in_force

Any insurance group, carrier, or company, in establishing any rate of insurance or rating system relative to a motor vehicle policy that provides for premium or rate increases based on accidents or moving or other chargeable violations, shall consider and include in those rates or rating system only those accidents or moving or other chargeable violations, that have occurred within three (3) years of the most recent accident or moving or other chargeable violation.
R.I. Gen. Laws § 27-34-2 — RI Code / Title 27 / Chapter 27-34 / Section 27-34-2
§ 27-34-2. Purpose.
Status: in_force

The purpose of this chapter is to provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to the extent provided in this chapter, minimize financial loss to claimants or policyholders because of the insolvency of an insurer, and to provide an association to assess the cost of such protection among insurers.
R.I. Gen. Laws § 27-1-9 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-9
§ 27-1-9. Examinations to ascertain market value of securities deposited  Deficiencies.
Status: in_force

Whenever it becomes necessary, on application of any company, for the general treasurer or any person appointed by the general treasurer to examine and ascertain the value and condition of any stocks or other securities deposited with the general treasurer by any insurance company, the expenses of the examination shall be borne by the company applying, and the general treasurer shall be allowed to charge for the general treasurers time and expense or for the time and expense of the person the general treasurer shall appoint to make the examination; the examination shall be made annually by the general treasurer. In case it appears at any time that the stocks or other securities deposited in this manner amount to less than the sum required for the purposes for which the deposit has been made, the general treasurer shall notify the company, and unless the deficiency is made up within thirty (30) days, the general treasurer shall countermand all of the certificates the general treasurer may have issued and notify the treasurer, comptroller, or other financial officer of the states to which the general treasurer has transmitted the general treasurers certificate, and shall, as soon as possible, publish notice of the general treasurers actions in one newspaper published in the city of Providence for three (3) weeks.
R.I. Gen. Laws § 27-41-38.1 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-38.1
§ 27-41-38.1. Medication synchronization.
Status: in_force

(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days supply for the purpose of synchronizing the patients medications and the insureds or enrollees maintenance-prescription drug(s) to be synchronized meets all of the following requirements:

(1) Is covered by the policy, certificate, or contract described in this chapter;

(2) Is used for the management and treatment of a chronic, long-term care condition and has authorized refills that remain available to the insured or enrollee;

(3) Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;

(4) Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insureds or enrollees multiple maintenance-prescription drugs;

(5) Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and

(6) Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insureds or enrollees multiple maintenance-prescription drugs.

(b) The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insureds or enrollees multiple maintenance-prescription drugs.

(c) The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.

(d) A synchronization shall only occur once per year per maintenance-prescription drug.
R.I. Gen. Laws § 27-1-2 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-2
§ 27-1-2. Special stockholders meetings  Notice  Quorum.
Status: in_force

The board of directors or the president and secretary of any insurance company may call special meetings of the stockholders of the company whenever they may deem it expedient so to do, first giving thirty (30) days notice of the time, place, and purpose of the meeting in a newspaper published in the county where the company is established, or, if there is no newspaper published in the county, then in a newspaper published in an adjoining county. At all of these special meetings, not less than two-thirds ( ) of the shares shall be represented either in person or by proxy in order to constitute a quorum for doing business. The stockholders of the company, when so assembled, may act on the business for which they were specially called together, and also on any other business as may be transacted by law at any regular meeting of the company.
R.I. Gen. Laws § 27-2-8 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-8
§ 27-2-8. Statement as to type of company, investments, and risks.
Status: in_force

Every company, before making any contract of insurance, shall deposit with the insurance commissioner a statement, signed and sworn to by the president and secretary of the company, specifying that the company is a fire, marine, or fire and marine, life, health, accident, or other insurance company, stating the amount of its capital and the manner of its investment, designating the amount invested respectively in mortgages, public securities, and in the stock of incorporated companies, stating what companies, and also the amount invested in other securities, particularizing each item of investment, the amount of marine risks not terminated and the premium paid on those risks, the amount of fire risks not terminated and the premium paid on those risks, and the amount of liabilities, specifying the amount of outstanding claims adjusted or unadjusted, due or not due. In case the company is incorporated on the mutual principle, the statement shall set forth, in addition to this information, the amount of risks insured by the company, the amount of premium on the risks, what portion of it has been paid in cash, what security has been taken for the remainder, and what is the largest sum insured in any one risk. The statement required to be made in this section, so far as applicable, shall be made of each class in companies authorized to take risks in classes, and in all cases the returns may be varied by the insurance commissioner to obtain more definite information of the company; provided, that not more than one statement needs to be filed on behalf of the company.
R.I. Gen. Laws § 27-68-2 — RI Code / Title 27 / Chapter 27-68 / Section 27-68-2
§ 27-68-2. Pilot primary care program established.
Status: in_force

To increase access to primary care for those state residents who do not have access to health insurance coverage or who are unable to afford health insurance coverage, the director of the state department of human services in collaboration with the director of the department of health shall develop a plan for a pilot primary care program for uninsured residents of the state. The pilot program may include enrollee premiums and co-insurance payments that are income-based with premiums and/or co-insurance subsidized by the state. The pilot program may also include catastrophic or reinsurance coverage provided under the auspices of the state. In designing the pilot program, the director may consider a variety of service delivery and financing models including capitation payments to private physicians, a buy-in program under RIte Care, and coverage arrangements purchased from qualified community health centers. In developing the pilot program, the director may seek available federal grant monies, including Medicaid, and private foundation grants. The director shall submit the plan for the pilot primary care program to the governor, the speaker of the house, the president of the senate, the majority leaders of the house and senate, and the chairpersons of the house and senate finance committees by January 15, 2005. The plan shall include eligibility criteria for participation in the pilot program, the scope of services to be offered, the geographic area and population to be served, and cost estimates to implement the program.
R.I. Gen. Laws § 27-18-33 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-33
§ 27-18-33. Drug coverage.
Status: in_force

No group health insurer subject to the provisions of this chapter that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.
R.I. Gen. Laws § 27-33-10 — RI Code / Title 27 / Chapter 27-33 / Section 27-33-10
§ 27-33-10. Basic property insurance defined.
Status: in_force

Basic property insurance for the purposes of this chapter means fire, extended coverage, vandalism, malicious mischief, broad and special form dwelling coverage commonly referred to as DP-2 and DP-3, and sprinkler leakage insurance. It shall also include homeowners package coverages that include dwelling and tenant forms, as well as the general liability coverages for one (1) to four (4) family owner and nonowner occupied dwellings, either by endorsement or as a stand-alone policy. The FAIR Plan shall be authorized to make rate filings using the standard that rates shall not be excessive, inadequate, or unfairly discriminatory, giving due consideration to the past and prospective loss and expense experience for basic property insurance, written in this state, trends in the frequency and severity of losses, the investment income of the FAIR Plan, and such other information as the director of business regulation may require. All rates shall be calculated to be self-supporting consistent with sound actuarial principles. Rates for basic property insurance shall be approved by the department of business regulation, notwithstanding any limits on rate approval authority. Nothing in this section shall be deemed to affect the duty of licensed insurers in the state of Rhode Island to participate, as needed, on a direct basis, in the program pursuant to §§ 27-33-2 and 27-33-11 and any rules and regulations promulgated thereunder, and to pay their proportionate share of losses and expenses incurred by the program upon assessment by the program.
R.I. Gen. Laws § 27-18-78 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-78
§ 27-18-78. Primary care provider designation requirement.
Status: in_force

(a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, primary care provider means the physician, practice, or other medical provider considered by the insured to be the insureds usual source of medical care.

(b) Requirements for designating a primary care provider enumerated in subsection (a) shall not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; or

(9) Other limited benefit policies.
R.I. Gen. Laws § 27-18-47 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-47
§ 27-18-47. Additional relief and damages  Reinstatement.
Status: in_force

(a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages, and costs, including reasonable attorney fees.

(b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides, or the county in which the insurer maintains its principal place of business.

(c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement.
R.I. Gen. Laws § 27-19-77 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-77
§ 27-19-77. Prohibition on discrimination in organ transplants.
Status: in_force

Pursuant to chapter 95 of title 23, any nonprofit hospital that provides for anatomical gifts, organ transplants, or related treatment and services shall not:

(1) Deny coverage to a covered person solely on the basis of the persons disability;

(2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;

(3) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce the provider to provide care to an insured or enrollee in a manner inconsistent with this section; or

(4) Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.
R.I. Gen. Laws § 27-50-12 — RI Code / Title 27 / Chapter 27-50 / Section 27-50-12
§ 27-50-12. Standards to assure fair marketing.
Status: in_force

(a) Each small employer carrier shall actively market and offer all health benefit plans sold by the carrier to eligible small employers in the state.

(b)(1) Except as provided in subsection (b)(2) of this section, no small employer carrier or producer shall, directly or indirectly, engage in the following activities:

(i) Encouraging or directing small employers to refrain from filing an application for coverage with the small employer carrier because of any health status-related factor, age, gender, industry, occupation, or geographic location of the small employer; or

(ii) Encouraging or directing small employers to seek coverage from another carrier because of any health status-related factor, age, gender, industry, occupation, or geographic location of the small employer.

(2) The provisions of subsection (b)(1) of this section do not apply with respect to information provided by a small employer carrier or producer to a small employer regarding the established geographic service area or a restricted network provision of a small employer carrier.

(c)(1) Except as provided in subsection (c)(2) of this section, no small employer carrier shall, directly or indirectly, enter into any contract, agreement, or arrangement with a producer that provides for or results in the compensation paid to a producer for the sale of a health benefit plan to be varied because of any initial or renewal, industry, occupation, or geographic location of the small employer.

(2) Subsection (c)(1) of this section does not apply with respect to a compensation arrangement that provides compensation to a producer on the basis of percentage of premium, provided that the percentage shall not vary because of any health status-related factor, industry, occupation, or geographic area of the small employer.

(d) A small employer carrier shall provide reasonable compensation, as provided under the plan of operation of the program, to a producer, if any, for the sale of any health benefit plan subject to §27-50-10.

(e) No small employer carrier may terminate, fail to renew, or limit its contract or agreement of representation with a producer for any reason related to health status-related factor, occupation, or geographic location of the small employers placed by the producer with the small employer carrier.

(f) No small employer carrier or producer shall induce or encourage a small employer to separate or exclude an employee or dependent from health coverage or benefits provided in connection with the employees employment.

(g) Denial by a small employer carrier of an application for coverage from a small employer shall be in writing and shall state the reason or reasons for the denial.

(h) The director may establish regulations setting forth additional standards to provide for the fair marketing and broad availability of health benefit plans to small employers in this state.

(i)(1) A violation of this section by a small employer carrier or a producer is an unfair trade practice under chapter 13 of title 6.

(2) If a small employer carrier enters into a contract, agreement, or other arrangement with a third-party administrator to provide administrative, marketing, or other services related to the offering of health benefit plans to small employers in this state, the third-party administrator is subject to this section as if it were a small employer carrier.
R.I. Gen. Laws § 27-16-12 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-12
§ 27-16-12. Discretionary postponement of proceedings.
Status: in_force

The court in any action, suit, or proceeding in which service is made in the manner provided in § 27-16-6 or § 27-16-7 may, in its discretion, order any postponement as may be necessary to afford the defendant reasonable opportunity to comply with the provisions of § 27-16-10 and to defend the action.
R.I. Gen. Laws § 27-6-40 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-40
§ 27-6-40. Reports on examinations  Hearing and filing.
Status: in_force

The commissioner shall prepare a report of any examination held pursuant to § 27-6-39 and shall, within a reasonable time following completion of that report, furnish each rating organization, group, association, or other organization examined with a copy of it. Any rating organization, advisory organization, group, association, or other organization may, within thirty (30) days after the receipt of a copy of the report, request the commissioner for a hearing on the report, which shall be held by the commissioner upon ten (10) days written notice to the rating organization, advisory organization, group, association, or other organization. Following that hearing the commissioner may affirm, modify, or withdraw the report. Any report or modification of the report shall be filed in the office of the commissioner as a public record, or if no hearing is requested within the period of thirty (30) days, the report shall be filed at the expiration of that period.
R.I. Gen. Laws § 27-18-14 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-14
§ 27-18-14. Copies of applications.
Status: in_force

The insured shall not be bound by any statement made in an application for a policy unless a copy of the application is attached to or endorsed on the policy when issued as a part of the policy. If the policy delivered or issued for delivery to any person in this state shall be reinstated or renewed, and the insured or the beneficiary or assignee of the policy shall make written request to the insurer for a copy of the application, if any, for the reinstatement or renewal, the insurer shall within fifteen (15) days after the receipt of the request at its home office or any branch office of the insurer, deliver or mail to the person making the request a copy of the application. If the copy shall not be delivered or mailed in this manner, the insurer shall be precluded from introducing the application as evidence in any action or proceeding based upon or involving the policy or its reinstatement or renewal.
R.I. Gen. Laws § 27-25-14 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-14
§ 27-25-14. Consolidations and mergers.
Status: in_force

(a) A domestic society may consolidate or merge with any other society by complying with the provisions of this section. It shall file with the commissioner of insurance:

(1) A certified copy of the written contract containing, in full, the terms and conditions of the consolidation or merger;

(2) A sworn statement by the president and secretary or corresponding officers of each society showing the financial condition of the society on a date fixed by the commissioner of insurance but not earlier than December thirty-first, next preceding the date of the contract;

(3) A certificate of the officers, duly verified by their respective oaths, that the consolidation or merger has been approved by a two-thirds ( ) vote of the supreme governing body of each society, the vote being conducted at a regular or special meeting of the body, or, if the societys laws so permit, by mail; and

(4) Evidence that at least sixty (60) days prior to the action of the supreme governing body of each society, the text of the contract has been furnished to all of the members of each society either by mail or by publication, in full, in the official publication of each society.

(b) If the commissioner of insurance finds that the contract is in conformity with the provisions of this section, that the financial statements are correct, and that the consolidation or merger is just and equitable to the members of each society, the commissioner shall approve the contract and issue a certificate to that effect. Upon that approval, the contract shall be in full force and effect unless any society that is a party to the contract is incorporated under the laws of any other state or territory. In that event, the consolidation or merger shall not become effective unless and until it has been approved as provided by the laws of that state or territory and a certificate of the approval filed with the commissioner of insurance of this state or, if the laws of that state or territory contain no such provision, then the consolidation or merger shall not become effective unless and until it has been approved by the commissioner of insurance of that state or territory and a certificate of the approval filed with the commissioner of insurance of this state.

(c) Upon the consolidation or merger becoming effective, all of the rights, franchises, and interest of the consolidated or merged societies in and to every species of property, real, personal, or mixed, and things in action belonging to the societies shall be vested in the society resulting from or remaining after the consolidation or merger without any other instrument, except that conveyance of real property may be evidenced by proper deeds, and the title to any real estate or interest in real estate, vested under the laws of this state in any of the societies consolidated or merged, shall not revert or be in any way impaired by reason of the consolidation or merger, but shall vest absolutely in the society resulting from or remaining after the consolidation or merger.

(d) The affidavit of any officer of the society or of anyone authorized by it to mail any notice or document, stating that the notice or document has been duly addressed and mailed, shall be prima facie evidence that the notice or document has been furnished to the addressees.
R.I. Gen. Laws § 27-41-18.1 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-18.1
§ 27-41-18.1. Summary orders and supervision.
Status: in_force

(a) Whenever the director determines that the financial condition of a health maintenance organization is such that its continued operation must be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this chapter, the director may, after notice and hearing, order the health maintenance organization to take action reasonably necessary to rectify the condition or violation, including, but not limited to, one or more of the following:

(1) Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the director;

(2) Reduce the volume of new business being accepted;

(3) Reduce expenses by specified methods;

(4) Suspend or limit the writing of new business for a period of time;

(5) Increase the health maintenance organizations capital and surplus by contribution;

(6) Initiate administrative supervision proceedings against the health maintenance organization in accordance with chapter 14.1 of this title; or

(7) Take other steps the director may deem appropriate under the circumstances.

(b) For purposes of this section, the violation by a health maintenance organization of any law of this state to which the health maintenance organization is subject shall be deemed a violation of this chapter.

(c) The director is authorized to adopt regulations to set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public and to set standards for evaluating the financial condition of any health maintenance organization.

(d) The remedies and measures available to the director under this section shall be in addition to, and not in lieu of, the remedies and measures available to the director under the provisions of chapters 14.1, 14.2, and 14.3 of this title.
R.I. Gen. Laws § 27-34-1 — RI Code / Title 27 / Chapter 27-34 / Section 27-34-1
§ 27-34-1. Short title.
Status: in_force

This chapter shall be known and may be cited as the Rhode Island Property & Casualty Insurance Guaranty Association Act.
R.I. Gen. Laws § 27-19-36.1 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-36.1
§ 27-19-36.1. Hysterectomy or myomectomy treatment.
Status: in_force

Commencing January 1, 2023, any insurer or healthcare plan, nonprofit health medical service plan, or nonprofit hospital service plan that provides coverage for obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health plan offered by a health insurance carrier or a health maintenance organization, shall provide coverage for a hysterectomy, myomectomy and laparoscopic removal of uterine fibroids, including uterine artery embolization, intraoperative ultrasound guidance and monitoring and radiofrequency ablation.
R.I. Gen. Laws § 27-16-5 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-5
§ 27-16-5. Acts constituting appointment of attorney to receive process.
Status: in_force

Any of the following acts in this state, effected by mail or otherwise, by an unauthorized foreign or alien insurer is equivalent to and shall constitute an appointment by the insurer of the insurance commissioner and the commissioners successor or successors in office to be the insurers true and lawful attorney, upon whom may be served all lawful process in any action, suit, or proceeding instituted by or on behalf of an insured or beneficiary arising out of the contract of insurance, and the act shall be signification of its agreement that service of process is of the same legal force and validity as personal service of process in this state upon the insurer: (1) The issuance or delivery of contracts of insurance or reinsurance to residents of this state or to corporations authorized to do business in this state; (2) The solicitation of applications for the contracts; (3) The collection of premiums, membership fees, assessments, or other considerations for the contracts; or (4) Any other transaction of insurance business.
R.I. Gen. Laws § 27-18-58 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-58
§ 27-18-58. Prostate and colorectal examinations  Coverage mandated  The Maryellen Goodwin Colorectal Cancer Screening Act.
Status: in_force

(a) Every accident and sickness insurance policy, medical expense insurance policy, or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for prostate and colorectal preventive screening examinations and laboratory tests for cancer for any nonsymptomatic person covered under that policy or contract. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal. Provided, this section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specific disease indemnity; (8) Sickness or bodily injury or death by accident, or both; and (9) Other limited benefit policies.

(b) An insurer may not impose cost sharing on the coverage required by subsection (a) of this section when the services are delivered within the health insurers provider network.
R.I. Gen. Laws § 27-9-36 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-36
§ 27-9-36. Examination of rating and advisory organizations and underwriting and reinsurance groups.
Status: in_force

The commissioner may, as often as the commissioner may deem it necessary, make or cause to be made an examination of each rating organization licensed in this state as provided in § 27-9-22 and the commissioner may, as often as the commissioner may deem it expedient, make or cause to be made an examination of each advisory organization referred to in § 27-9-30 and of each group, association, or other organization referred to in § 27-9-34, including any workers compensation assigned risk servicing carrier or carriers. All such examinations shall be performed in accordance with the requirements of § 27-13.1-1 et seq. The officers, managers, agents, and employees of any rating organization, advisory organization, or group, association, or other organization of insurers, including workers compensation assigned risk servicing carrier or carriers, may be examined at any time under oath and shall exhibit all books, records, accounts, documents, or agreements governing its method of operation. In lieu of any examination the commissioner may accept the report of an examination made by the insurance supervisory official of another state, pursuant to the laws of that state.
R.I. Gen. Laws § 27-65-2 — RI Code / Title 27 / Chapter 27-65 / Section 27-65-2
§ 27-65-2. Risk manager defined.
Status: in_force

As used in this chapter, risk manager means a full-time employee of, or a person certified and licensed and retained by, an exempt commercial policyholder who is qualified through: (1) education and experience; or (2) training and experience; to assess an exempt commercial policyholders insurance needs and analyze and negotiate a policy of insurance and having primary responsibility or oversight of the risk management activities/function of an exempt commercial policyholder. A risk manager shall not receive commission, fees, or other consideration from the insurer in connection with the purchase of a commercial policy of insurance by the exempt commercial policyholder.
R.I. Gen. Laws § 27-16-2.2 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-2.2
§ 27-16-2.2. Penalty.
Status: in_force

Any unauthorized insurer who transacts any unauthorized act of an insurance business as set forth in §§ 27-16-1.1  27-16-2.6 may be fined not more than ten thousand dollars ($10,000).
R.I. Gen. Laws § 27-72-18 — RI Code / Title 27 / Chapter 27-72 / Section 27-72-18
§ 27-72-18. Effective date.
Status: in_force

(a) A provider lawfully transacting business in this state prior to the effective date of this act may continue to do so pending approval or disapproval of that persons application for a license as long as the application is filed with the commissioner not later than thirty (30) days after publication by the commissioner of an application form and instructions for licensure of providers. If the publication of the application form and instructions is prior to the effective date of this act, then the filing of the application shall not be later than thirty (30) days after the effective date of this act. During the time that such an application is pending with the commissioner, the applicant may use any form of life settlement contract that has been filed with the commissioner pending approval thereof, provided that such form is otherwise in compliance with the provisions of this chapter. Any person transacting business in this state under this provision shall be obligated to comply with all other requirements of this chapter.

(b) A person who has lawfully negotiated life settlement contracts between any owner residing in this state and one or more providers for at least one year immediately prior to the effective date of this act may continue to do so pending approval or disapproval of that persons application for a license as long as the application is filed with the commissioner not later than thirty (30) days after publication by the commissioner of an application form and instructions for licensure of brokers. If the publication of the application form and instructions is prior to the effective date of this chapter, then the filing of the application shall not be later than thirty (30) days after the effective date of this act. Any person transacting business in this state under this provision shall be obligated to comply with all other requirements of this chapter.
R.I. Gen. Laws § 27-41-20 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-20
§ 27-41-20. Administrative procedures.
Status: in_force

(a) When the director of business regulation has cause to believe that grounds for the denial of an application for a license exist, or that grounds for the suspension or revocation of a license exist, the director shall notify the health maintenance organization and the director of health, in writing, specifically stating the grounds for denial, suspension, or revocation and fixing a time for a hearing on the matter.

(b) The director of health, or his or her designated representative, shall be in attendance at the hearing and shall participate in the proceedings. The recommendation and findings of the director of health, with respect to matters relating to the quality of healthcare services provided by the health maintenance organization in connection with any decision regarding the denial, suspension, or revocation of a license, shall be conclusive and binding upon the director of business regulation. After the hearing, or upon the failure of the health maintenance organization to appear at the hearing, the director of business regulation shall take any action that is deemed advisable on written findings that shall be mailed to the health maintenance organization with a copy to the director of health. The action of the director of business regulation and the recommendation and findings of the director of health shall be subject to review by the superior court for the county of Providence.

(c) The provisions of chapter 35 of title 42 shall apply to proceedings under this section to the extent they are not in conflict with subsections (a) and (b) of this section.
R.I. Gen. Laws § 27-19-23.1 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-23.1
§ 27-19-23.1. Insurance coverage for postpartum hospital stays.
Status: repealed

(a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state shall provide coverage for a forty-eight (48) hour time period in a hospital after a vaginal birth and ninety-six (96) hours for a Cesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending healthcare provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) hours for a cesarean delivery. In the case of early discharge, post-delivery care shall include home visits, parent education, assistance and training in breast or bottle feeding, and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with the above guidelines.

(b) For the purposes of this section, attending healthcare provider includes the attending obstetrician, pediatrician, family practitioner, general practitioner, or certified nurse midwife attending the mother and newly born child.

(c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23 [repealed]. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other healthcare provider who orders care consistent with the provisions of this section.
R.I. Gen. Laws § 27-66-7.1 — RI Code / Title 27 / Chapter 27-66 / Section 27-66-7.1
§ 27-66-7.1. Certain financial incentives prohibited.
Status: in_force

It being generally contrary to the public interest to lose local control of a nonprofit health insurer providing the majority of private health insurance coverage within the state, and such payments as are herein forbidden providing inducements to do so for personal gain, no officer, director, or senior management employee of a nonprofit hospital and/or medical service corporation or of any subsidiary of such corporation shall solicit, accept, receive, or maintain claim of right to any financial incentive, including any pecuniary reward, based in whole or in part on the contingency of, or as a result of, the completion of a conversion. For purposes of this section, pecuniary award includes, but is not limited to, bonuses, cash payouts, deferred payments, stock options, and enhanced retirement packages. Nothing in this section shall be deemed to prohibit the employment of such an officer, director, or employee by a successor corporation or entity following the completion of a conversion, nor to prohibit reasonable severance payments where no conversion is involved.
R.I. Gen. Laws § 27-19-51 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-51
§ 27-19-51. Hearing aids.
Status: in_force

(a)(1) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2026, shall provide coverage for one thousand seven hundred fifty dollars ($1,750) per individual hearing aid, per ear.

(2) Every group health insurance contract or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2026, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.

(b) For the purposes of this section, hearing aid means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to, FM systems.

(c) It shall remain within the sole discretion of the nonprofit hospital service corporation as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation. Nothing contained in this section precludes the nonprofit hospital service corporation from conducting managed care, medical necessity, or utilization review.
R.I. Gen. Laws § 27-19-49 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-49
§ 27-19-49. Prostate and colorectal examinations  Coverage mandated  The Maryellen Goodwin Colorectal Cancer Screening Act.
Status: in_force

(a) Subscribers to any nonprofit hospital service corporation plan shall be afforded coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.

(b) An insurer or the corporation may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurers provider network.
R.I. Gen. Laws § 27-41-36 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-36
§ 27-41-36. Services of midwives.
Status: in_force

Every health maintenance organization plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for the services of licensed midwives in accordance with each health maintenance organizations respective principles and mechanisms of reimbursement, credentialing, and contracting if the services are within the licensed midwives area of professional competence as defined by regulations promulgated pursuant to § 23-13-9 and are currently reimbursed when rendered by any other licensed healthcare provider. No health maintenance organization may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement to a licensed midwife whose services are provided pursuant to § 27-41-5(a)(6)(ii), except when the requirements are also applicable to other categories of healthcare providers. No health maintenance organization or patient may be required to pay for duplicate services actually rendered by both a licensed midwife and any other healthcare provider. Direct payment for licensed midwives will be contingent upon services rendered in a licensed healthcare facility and for services rendered in accordance with rules and regulations promulgated by the department of health; provided, that this provision shall not prohibit payment for services pursuant to § 42-62-26 or for other services reimbursed by third-party payors.
R.I. Gen. Laws § 27-50-2 — RI Code / Title 27 / Chapter 27-50 / Section 27-50-2
§ 27-50-2. Purpose.
Status: in_force

(a) The purpose and intent of this chapter are to enhance the availability of health insurance coverage to small employers regardless of their health status or claims experience; to prevent abusive rating practices; to prevent segmentation of the health insurance market based upon health risk; to spread health insurance risk more broadly; to require disclosure of rating practices to purchasers; to establish rules regarding renewability of coverage; to limit the use of preexisting condition exclusions; to provide for development of economy, standard, and basic health benefit plans to be offered to all small employers; and to improve the overall fairness and efficiency of the small group health insurance market.

(b) This chapter is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance.
R.I. Gen. Laws § 27-20-77 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-77
§ 27-20-77. Coverage for biomarker testing.
Status: in_force

(a) As used in this section:

(1) Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include, but are not limited to, gene mutations or protein expression.

(2) Biomarker testing is the analysis of a patients tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing includes, but is not limited to, single-analyte tests, multi-plex panel tests, and whole genome sequencing.

(3) Clinical utility means the test result provides information that is used in the formulation of a treatment or monitoring strategy that informs a patients outcome and impacts the clinical decision. The most appropriate test may include both information that is actionable and some information that cannot be immediately used in the formulation of a clinical decision.

(4) Consensus statements as used here are statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure and with a conflict of interest policy. These statements are aimed at specific clinical circumstances and base the statements on the best available evidence for the purpose of optimizing the outcomes of clinical care.

(5) Nationally recognized clinical practice guidelines as used here are evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. Clinical practice guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options and include recommendations intended to optimize patient care.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2024, shall provide coverage for the services of biomarker testing in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting. Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollees disease or condition to guide treatment decisions, when the test provides clinical utility as demonstrated by medical and scientific evidence, including, but not limited to:

(1) Labeled indications for an FDA-approved or -cleared test or indicated tests for an FDA-approved drug;

(2) Centers for Medicare Services (CMS) national coverage determinations or Medicare Administrative Contractor (MAC) local coverage determinations; or

(3) Nationally recognized clinical practice guidelines and consensus statements.

(c) Coverage as defined in subsection (b) is provided in a manner that limits disruptions in care including the need for multiple biopsies or biospecimen samples.

(d) The patient and prescribing practitioner shall have access to clear, readily accessible, and convenient processes to request an exception to a coverage policy of a health insurer, nonprofit health service plan, and health maintenance organization. The process shall be made readily accessible on the health insurers, nonprofit health service plans, or health maintenance organizations website.
R.I. Gen. Laws § 27-20-59 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-59
§ 27-20-59. Annual and lifetime limits.
Status: in_force

(a) Annual limits.

(1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health insurance carrier and health benefit plan subject to the jurisdiction of the commissioner under this chapter may establish an annual limit on the dollar amount of benefits that are essential health benefits provided the restricted annual limit is not less than the following:

(i) For a plan or policy year beginning after September 22, 2011, but before September 23, 2012  one million two hundred fifty thousand dollars ($1,250,000); and

(ii) For a plan or policy year beginning after September 22, 2012, but before January 1, 2014  two million dollars ($2,000,000).

(2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier and health benefit plan shall not establish any annual limit on the dollar amount of essential health benefits for any individual, except:

(i) A health flexible spending arrangement, as defined in section 106(c)(2) of the federal Internal Revenue Code, a medical savings account, as defined in section 220 of the federal Internal Revenue Code, and a health savings account, as defined in section 223 of the federal Internal Revenue Code, are not subject to the requirements of subsections (a)(1) and (a)(2) of this section; and

(ii) The provisions of this subsection (a) shall not prevent a health insurance carrier from placing annual dollar limits for any individual on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable federal law or the laws and regulations of this state.

(3) In determining whether an individual has received benefits that meet or exceed the allowable limits, as provided in subsection (a)(1) of this section, a health insurance carrier shall take into account only essential health benefits.

(b) Lifetime limits.(1) A health insurance carrier and health benefit plan offering group or individual health insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits for any individual.

(2) Notwithstanding subsection (b)(1) above, a health insurance carrier and health benefit plan is not prohibited from placing lifetime dollar limits for any individual on specific covered benefits that are not essential health benefits, as designated pursuant to a state determination and in accordance with federal laws and regulations.

(c)(1) Except as provided in subsection (c)(2) of this section, this section applies to any health insurance carrier providing coverage under an individual or group health plan.

(2)(i) The prohibition on lifetime limits applies to grandfathered health plans.

(ii) The prohibition and limits on annual limits apply to grandfathered health plans providing group health insurance coverage, but the prohibition and limits on annual limits do not apply to grandfathered health plans providing individual health insurance coverage.

(d) This section shall not apply to a plan or to policy years prior to January 1, 2014, for which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant to 45 C.F.R. §147.126(d)(3). This section also shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.

(e) [Deleted by P.L. 2024, ch. 201, § 3 and P.L. 2024, ch. 202, § 3.]
R.I. Gen. Laws § 27-20-41 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-41
§ 27-20-41. Magnetic resonance imaging  Quality assurance standards.
Status: in_force

(a) Except as otherwise provided in subsection (b) of this section, a magnetic resonance imaging examination eligible for reimbursement under the provisions of any individual or group health insurance contract, plan, or policy delivered in this state shall be reimbursed only if the facility at which the examination has been conducted and processed is accredited by either the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), or an alternate nationally recognized accrediting organization whose accreditation standards are substantially similar to and no less stringent than current or subsequent ACR or IAC standards and have been reviewed and deemed adequate by the department of health. All accreditation standards under this section, whether promulgated by the ACR, IAC, or an alternate nationally recognized accrediting organization, shall include, but shall not be limited to: provisions for establishing the qualifications of the physician; standards for quality control and routine performance monitoring by a medical physicist; qualifications of the technologist, including minimum standards of supervised clinical experience; personnel and patient safety guidelines; and standards for initial and ongoing quality control using clinical image review and quantitative testing.

(b) Any facility conducting and processing magnetic resonance imaging examinations that, as of June 30, 2006, is receiving reimbursement for such services by a health insurer, health maintenance organization, or health plan but is not accredited pursuant to subsection (a), shall file its application for accreditation within eighteen (18) months of June 28, 2007. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. A facility that begins conducting and processing, of magnetic resonance imaging examinations after June 30, 2006, shall file its application for accreditation within twelve (12) months of the date of initiation of the magnetic resonance imaging examinations. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. After such accreditation is obtained, a facility conducting and processing magnetic resonance imaging examinations shall, at all times, maintain accreditation with the appropriate accrediting body. Notwithstanding anything herein to the contrary, any facility that has filed for accreditation pursuant to this subsection (b) and that has not been refused accreditation or withdrawn its application, will be deemed provisionally accredited for the twelve-month (12) period dating from the application filing date. Provided, further, that notwithstanding any provisions of the general or public laws to the contrary, any facility conducting and processing magnetic resonance imaging examinations shall conform to the standards of the appropriate accrediting body at all times, including during the accreditation process, and shall certify said conformance to any reimbursing health insurer, health maintenance organization, or health plan.
R.I. Gen. Laws § 27-8-5 — RI Code / Title 27 / Chapter 27-8 / Section 27-8-5
§ 27-8-5. Nonassessable insurance by mutual companies.
Status: in_force

A mutual company incorporated by this or any other state may also issue policies insuring property and risks in this state without the contingent mutual liability of the policyholders for assessment; provided, that it shall have at all times net assets over all liabilities of not less than one hundred thousand dollars ($100,000) and, if incorporated by this state, shall maintain a deposit with the general treasurer for the benefit and protection of all of its policyholders of at least one hundred thousand dollars ($100,000), or, if incorporated by any other state, it shall maintain that deposit in its home state, which deposit in each case shall be in cash or securities that are legal investments by that company in its home state.
R.I. Gen. Laws § 27-41-13.2 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-13.2
§ 27-41-13.2. Ongoing net worth and capital requirements.
Status: in_force

(a) A health maintenance organization shall maintain minimum net worth equal to the greater of two million five hundred thousand dollars ($2,500,000) or the amount necessary to maintain capital required pursuant to chapter 4.7 of this title.

(b) The amount in subsection (a) may be adjusted annually for inflation at the directors discretion.
R.I. Gen. Laws § 27-56-1 — RI Code / Title 27 / Chapter 27-56 / Section 27-56-1
§ 27-56-1. Report.
Status: in_force

(a) Every insurer domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements unless the acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements have been submitted to the commissioner for review, approval, or information purposes pursuant to other provisions of the insurance code, laws, regulations, or other requirements.

(b) The report required in subsection (a) of this section is due within fifteen (15) days after the end of the calendar month in which any of the foregoing transactions occur.

(c) One complete copy of the report, including any exhibits or other attachments, shall be filed with:

(1) The insurance department of the insurers state of domicile; and

(2) The National Association of Insurance Commissioners.

(d) All reports obtained by or disclosed to the commissioner pursuant to this chapter shall be given confidential treatment and shall not be subject to subpoena and shall not be made public by the commissioner, the National Association of Insurance Commissioners, or any other person, except to insurance departments of other states, without the prior written consent of the insurer to which it pertains unless the commissioner, after giving the insurer who would be affected notice and an opportunity to be heard, determines that the interest of policyholders, shareholders, or the public will be served by publication, in which event the commissioner may publish all or any part in the manner the commissioner may deem appropriate.
R.I. Gen. Laws § 27-70-2 — RI Code / Title 27 / Chapter 27-70 / Section 27-70-2
§ 27-70-2. Definitions.
Status: in_force

As used in this chapter:

(1) Employee has the meaning set forth in § 28-42-3.

(2) Employer has the meaning set forth in § 28-42-3.
R.I. Gen. Laws § 27-20-18 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-18
§ 27-20-18. Mammograms  Quality assurance standards.
Status: in_force

A mammogram eligible for reimbursement under § 27-20-17 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram, both meet state-approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.
R.I. Gen. Laws § 27-50-12.1 — RI Code / Title 27 / Chapter 27-50 / Section 27-50-12.1
§ 27-50-12.1. Renewal rating.
Status: in_force

To ensure ease of understanding of renewal rate calculation and related information, the health insurance commissioner may, by regulation, prescribe the presentation formats for delivery of renewal rates to small employers.
R.I. Gen. Laws § 27-69-1 — RI Code / Title 27 / Chapter 27-69 / Section 27-69-1
§ 27-69-1. Purpose.
Status: in_force

The purpose of this chapter is to provide for the availability of health plans that qualify as high deductible health plans that may be purchased for use with a health savings account and all similar plans that may be tax-favored under title 26 of the United States Code, as amended from time to time, and under those laws of this state that provide for taxation. This chapter shall be liberally construed to allow employers, employees, and individuals to receive maximum tax benefits provided in federal or state law through use of high deductibles and other cost sharing by a beneficiary.
R.I. Gen. Laws § 27-18-48 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-48
§ 27-18-48. Third-party reimbursement for services of certain healthcare workers.
Status: in_force

(a) Every individual or group hospital or medical services plan contract delivered, issued, or renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:

(1) The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by, and in accordance with, § 5-34.2-2;

(2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and

(3) The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the accident and sickness insurer has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.

(b) It shall remain within the sole discretion of the health maintenance organization as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity, or utilization review.

(c) Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that providers license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.
R.I. Gen. Laws § 27-4-24.5 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-24.5
§ 27-4-24.5. Judicial review of orders and decisions.
Status: in_force

Any final order or decision of the commissioner, including any order made after a hearing under the provisions of § 27-4-24.3 or 27-4-24.4, shall be subject to review in accordance with the Administrative Procedures Act, chapter 35 of title 42.
R.I. Gen. Laws § 27-19-26.3 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-26.3
§ 27-19-26.3. Patient choice in dispensing of clinician-administered drugs.
Status: in_force

(a) As used in this section,

(1) Clinician-administered drug means an outpatient infused prescription drug other than a vaccine that:

(i) Cannot reasonably be self-administered by the patient to whom the drug is prescribed or by a non-clinician individual assisting the patient with the self-administration; and

(ii) Is typically administered:

(A) By a healthcare professional authorized under the laws of this state to administer the drug, including when acting under a physicians delegation and supervision; and

(B) In a physicians office, hospital outpatient infusion center, or other clinical setting.

(b) A health insurer or a third party acting on its behalf shall not refuse to authorize, approve, or pay a provider for a covered clinician-administered drug that was administered and dispensed by any in-network hospital or clinic; provided that:

(1) The dispensing and administering and any associated authorizations and approvals are consistent with the provider contract and the issuers medical and payment policies provided such policies do not prohibit the procurement, administration, and dispensing by an in-network hospital or clinic; and

(2) The reimbursement to the provider shall be negotiated between the health insurer and provider at a rate equal to payments between the insurer and a preferred pharmacy.

(c) After January 1, 2025, the office of the health insurance commissioner, in consultation with health insurers and providers, shall conduct an analysis of the payment for clinician-administered drugs under this section.

(1) In conducting the analysis, the office of the health insurance commissioner may:

(i) Gather data from providers regarding potentially inaccurate payments; and

(ii) Obtain necessary information from health insurers to understand how reimbursements to providers for clinician-administered drugs are calculated.

(2) The office of the health insurance commissioner shall publish on its website a summary of its analysis, without identifying any health insurers or providers.

(3) The office of the health insurance commissioner may include in its analysis legislative recommendations to improve the reimbursement process for clinician-administered drugs under this section, as necessary. Any recommendations shall include a description of the recommendations potential costs to consumers, health insurers, providers, and the state.

(4) The office of the health insurance commissioner shall provide the general assembly with their analysis no later than February 28, 2026.
R.I. Gen. Laws § 27-20-55 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-55
§ 27-20-55. Licensed ambulance service.
Status: in_force

(a) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for ground ambulance services in excess of fifty dollars ($50.00).

(b) As used in this section, the term ground ambulance services shall mean those services provided by an ambulance service licensed to operate in Rhode Island in accordance with § 23-4.1-6. The term excludes air and water ambulance services and ambulance services provided outside of Rhode Island.

(c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident, or both; and (9) Other limited benefit policies.
R.I. Gen. Laws § 27-41-68 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-68
§ 27-41-68. Coverage for early intervention services.
Status: in_force

(a) Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no later than January 1, 2005. The coverage shall be limited to a benefit of five thousand dollars ($5,000) per dependent child per policy or calendar year and shall not be subject to deductibles and coinsurance factors. Any amount paid by an insurer under this section for a dependent child shall not be applied to any annual or lifetime maximum benefit contained in the policy or contract. For the purpose of this section, early intervention services means, but is not limited to: speech and language therapy, occupational therapy, physical therapy, evaluation, case management, nutrition, service plan development and review, nursing services, and assistive technology services and devices for dependents from birth to age three (3) who are certified by the department of human services as eligible for services under part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1431 et seq.).

(b) Subject to the annual limits provided in this section, insurers shall reimburse certified early intervention providers, who are designated as such by the department of human services, for early intervention services as defined in this section at rates of reimbursement equal to or greater than the prevailing integrated state/Medicaid rate for early intervention services as established by the department of human services.

(c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
R.I. Gen. Laws § 27-18-69 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-69
§ 27-18-69. Licensed ambulance service.
Status: in_force

(a) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for ground ambulance services in excess of fifty dollars ($50.00).

(b) As used in this section, the term ground ambulance services shall mean those services provided by an ambulance service licensed to operate in Rhode Island in accordance with § 23-4.1-6. The term excludes air and water ambulance services and ambulance services provided outside of Rhode Island.

(c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
R.I. Gen. Laws § 27-20-1.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-1.1
§ 27-20-1.1. Applicability.
Status: in_force

This chapter shall apply to any nonprofit hospital service corporation which provides coverage or benefits for medical services under the provisions of chapter 19 of this title or otherwise.
R.I. Gen. Laws § 27-20-70 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-70
§ 27-20-70. Healthcare provider credentialing.
Status: repealed

(a) For applications received on or after January 1, 2018, a healthcare entity or health plan operating in the state shall be required to issue a decision regarding the credentialing of a healthcare provider as soon as practicable, but no later than forty-five (45) calendar days after the date of receipt of a complete credentialing application.

(b) For minor changes to the demographic information of an individual healthcare provider who is already credentialed with a particular healthcare entity or health plan, the healthcare entity or health plan shall complete the change within seven (7) business days of receipt of the healthcare providers request. Minor changes to demographic information requested by individual providers shall be submitted in the timeframe, and manner required by the healthcare entity or health plan, and shall include all supporting documentation required by the particular healthcare entity or health plan. For purposes of this section, minor changes to the information profile of a healthcare provider shall include, but not be limited to, changes of address and changes to a healthcare providers tax identification number.

(c) Each healthcare entity or health plan shall establish a written standard defining what elements constitute a complete credentialing application and shall distribute this standard with the written version of the credentialing application and make the standard available on the healthcare entitys or health plans website.

(d) Each healthcare entity or health plan shall respond to inquiries by the applicant regarding the status of an application.

(1) Each healthcare entity or health plan shall provide the applicant with automated application status updates, at least once every fifteen (15) calendar days, informing the applicant of any missing application materials until the application is deemed complete;

(2) Each healthcare entity or health plan shall inform the applicant within five (5) business days that the credentialing application is complete; and

(3) If the healthcare entity or health plan denies a credentialing application, the healthcare entity or health plan shall notify the healthcare provider in writing and shall provide the healthcare provider with any and all reasons for denying the credentialing application.

(e) The effective date for billing privileges for healthcare providers under a particular healthcare entity or health plan shall be the next business day following the date of approval of the credentialing application.

(f) For applications received from resident graduates on or after January 1, 2018, a healthcare entity or health plan shall offer a transitional or conditional approval process such that a resident graduate who has submitted an otherwise complete application and met all other criteria, may be conditionally approved, effective upon successful graduation from the training program.

(g) For the purposes of this section, the following definitions apply:

(1) Complete credentialing application means all the requested material has been submitted.

(2) Date of receipt means the date the healthcare entity or health plan receives the completed credentialing application whether via electronic submission or as a paper application.

(3) Healthcare entity means a licensed insurance company or nonprofit hospital or medical or dental service corporation or plan or health maintenance organization, or a contractor as defined in § 23-17.13-2 [repealed] that operates a health plan.

(4) Healthcare provider means a healthcare professional.

(5) Health plan means a plan operated by a healthcare entity that provides for the delivery of healthcare services to persons enrolled in those plans through:

(i) Arrangements with selected providers to furnish healthcare services; and

(ii) Financial incentives for persons enrolled in the plan to use the participating providers and procedures provided for by the health plan.
R.I. Gen. Laws § 27-66-25 — RI Code / Title 27 / Chapter 27-66 / Section 27-66-25
§ 27-66-25. Applicability.
Status: repealed

The acquirors shall be subject to the provisions of chapters 17.12 [repealed] and 17.13 [repealed] of title 23.