R.I. Gen. Laws § 27-52-1 — RI Code / Title 27 / Chapter 27-52 / Section 27-52-1
§ 27-52-1. Short title.
Status: in_force

This chapter may be cited as the Reinsurance Intermediary Act.
R.I. Gen. Laws § 27-25-23 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-23
§ 27-25-23. Exemptions.
Status: in_force

Except as provided in this chapter, societies shall be governed by this chapter and are exempt from all other insurance law provisions unless they are expressly designated therein, or unless it is specifically made applicable by this chapter.
R.I. Gen. Laws § 27-20-29.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-29.1
§ 27-20-29.1. Insurance coverage for mastectomy hospital stays.
Status: repealed

(a) The Rhode Island General Assembly recognizes that breast cancer is a unique illness with both a physical and emotional impact on patients. Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a minimum forty-eight-hour (48) time period in a hospital after the surgical procedures known as a mastectomy, and a minimum twenty-four (24) hours after an axillary node dissection. Any decision to shorten this minimum coverage shall be made by the attending physician in consultation with and upon agreement by the patient. If the patient participates in an early discharge, defined as in-patient care following a mastectomy that is less than forty-eight (48) hours and in-patient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one home visit conducted by a physician or registered nurse.

(b) 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with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23 [repealed].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.

(c) All plans subject to this section shall provide notice to each enrollee:

(1) In the next mass mailing made by the plan to the employee; or

(2) As part of any informational packet sent to the enrollee.
R.I. Gen. Laws § 27-20-51 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-51
§ 27-20-51. Post-payment audits.
Status: in_force

(a) Except as otherwise provided herein, any review, audit, or investigation by a nonprofit medical service corporation of a healthcare providers claims that results in the recoupment or set-off of funds previously paid to the healthcare provider in respect to such claims shall be completed no later than eighteen (18) months after the completed claims were initially paid, except that the period for recoupment or set-off for claims submitted by a mental health and/or substance use disorder provider, for those services, licensed by this state, and participating with the health insurer or health plan, shall be no later than twelve (12) months. This section shall not restrict any review, audit, or investigation regarding claims that are submitted fraudulently; are known, or should have been known, by the healthcare provider to be a pattern of inappropriate billing according to the standards for provider billing of their respective medical or dental specialties; are related to coordination of benefits; are duplicate claims; or are subject to any federal law or regulation that permits claims review beyond the period provided herein.

(b) No healthcare provider shall seek reimbursement from a payer for underpayment of a claim later than eighteen (18) months from the date the first payment on the claim was made, except if the claim is the subject of an appeal properly submitted pursuant to the payers claims appeal policies or the claim is subject to continual claims submission.

(c) For the purposes of this section, healthcare provider means an individual clinician, either in practice independently or in a group, who provides healthcare services, and any healthcare facility, as defined in § 27-20-1, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.

(d) Except for those contracts where the health insurer or plan has the right to unilaterally amend the terms of the contract, the parties shall be able to negotiate contract terms that allow for different time frames than are prescribed herein.
R.I. Gen. Laws § 27-30-11 — RI Code / Title 27 / Chapter 27-30 / Section 27-30-11
§ 27-30-11. Existing insurance  Choice of insurer.
Status: in_force

When consumer credit insurance is required as additional security for any indebtedness, the debtor shall, upon request to the creditor, have the option of furnishing the required amount of insurance through existing policies of insurance owned or controlled by the debtor or procuring and furnishing the required coverage through any insurer authorized to transact an insurance business within this state.
R.I. Gen. Laws § 27-52-8 — RI Code / Title 27 / Chapter 27-52 / Section 27-52-8
§ 27-52-8. Prohibited acts.
Status: in_force

The RM shall not:

(1) Cede retrocessions on behalf of the reinsurer, except that the RM may cede facultative retrocessions pursuant to obligatory facultative agreements if the contract with the reinsurer contains reinsurance underwriting guidelines for the retrocessions. The guidelines shall include a list of reinsurers with which the automatic agreements are in effect, and for each reinsurer, the coverages and amounts or percentages that may be reinsured, and commission schedules;

(2) Commit the reinsurer to participate in reinsurance syndicates;

(3) Appoint any producer without assuring that the producer is lawfully licensed to transact the type of reinsurance for which he or she is appointed;

(4) Without prior approval of the reinsurer, pay or commit the reinsurer to pay a claim, net of retrocessions, that exceeds the lesser of an amount specified by the reinsurer or one percent (1%) of the reinsurers policyholders surplus as of December 31 of the last complete calendar year;

(5) Collect any payment from a retrocessionaire or commit the reinsurer to any claim settlement with a retrocessionaire, without prior approval of the reinsurer. If prior approval is given, a report must be promptly forwarded to the reinsurer;

(6) Jointly employ an individual who is employed by the reinsurer unless the RM is under common control with the reinsurer subject to chapter 35 of this title; and

(7) Appoint a sub-RM.
R.I. Gen. Laws § 27-20-27.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-27.1
§ 27-20-27.1. Reliable evidence defined. [Repealed on effective date of § 27-20-64.]
Status: in_force

Reliable evidence means:

(1) Evidence including published reports and articles in authoritative, peer reviewed medical and scientific literature;

(2) A written informed consent used by the treating facility or by another facility studying substantially the same service; or

(3) A written protocol or protocols used by the treating facility or protocols of another facility studying substantially the same service.
R.I. Gen. Laws § 27-2-18 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-18
§ 27-2-18. Life insurance companies offices.
Status: in_force

Every life insurance company doing business in this state, and whose premium income received from the inhabitants of this state in any one year shall exceed twenty-five thousand dollars ($25,000), shall equip and maintain an office in this state, satisfactory to the insurance commissioner, for the transaction of business in this state.
R.I. Gen. Laws § 27-29-4.1 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-4.1
§ 27-29-4.1. Cancellation of insurance prohibited.
Status: in_force

No insurance company authorized to do business in this state shall cancel or refuse to issue any type of insurance coverage for an owner-occupied dwelling or personal property of every nature and description solely because of the area in which the property is situated.
R.I. Gen. Laws § 27-20-3 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-3
§ 27-20-3. Qualifications of directors.
Status: in_force

A majority of the directors of a nonprofit medical service corporation, other than a corporation organized pursuant to the provisions of chapter 19 of this title, must at all times be doctors of medicine duly licensed to practice under the laws of this state. The directors of any nonprofit medical service corporation formed after January 1, 1964, shall consist of an equal number of representatives of the public, doctors of medicine duly licensed to practice under the laws of this state, and subscribers.
R.I. Gen. Laws § 27-18-35 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-35
§ 27-18-35. Certified counselors in mental health and therapists in marriage and family practice.
Status: in_force

Every health insurance contract plan or policy delivered, issued for delivery, or renewed in this state, except policies that only provide coverage for specified diseases, fix indemnity, Medicare supplement long-term care disability income, or other limited benefit policies, shall provide coverage for the services of counselors in mental health licensed pursuant to § 5-63.2-9 and therapists in marriage and family practice licensed pursuant to § 5-63.2-10 excluding marital and family therapy unless the individual is diagnosed with a mental disorder.
R.I. Gen. Laws § 27-81-6 — RI Code / Title 27 / Chapter 27-81 / Section 27-81-6
§ 27-81-6. Rules and regulations.
Status: in_force

The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.
R.I. Gen. Laws § 27-52-11 — RI Code / Title 27 / Chapter 27-52 / Section 27-52-11
§ 27-52-11. Penalties and liabilities.
Status: in_force

(a) A reinsurance intermediary, insurer, or reinsurer found by the commissioner, after a hearing conducted in accordance with the Administrative Procedures Act, chapter 35 of title 42, to be in violation of any provision(s) of this chapter, shall:

(1) For each separate violation, pay a penalty in an amount not exceeding five thousand dollars ($5,000);

(2) Be subject to revocation or suspension of its license; and

(3) If a violation was committed by the reinsurance intermediary, the reinsurance intermediary shall make restitution to the insurer, reinsurer, rehabilitator, or liquidator for the net losses incurred by the insurer or reinsurer attributable to the violation.

(b) The decision, determination, or order of the commissioner pursuant to subsection (a) of this section shall be subject to judicial review pursuant to the Administrative Procedures Act, chapter 35 of title 42.

(c) Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided in the insurance law.

(d) Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, creditors, or other third parties or confer any rights to those persons.
R.I. Gen. Laws § 27-19-41 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-41
§ 27-19-41. Human leukocyte antigen testing.
Status: in_force

Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C. § 263a. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.
R.I. Gen. Laws § 27-43-5 — RI Code / Title 27 / Chapter 27-43 / Section 27-43-5
§ 27-43-5. Minimum surplus.
Status: in_force

(a)(1) No captive insurance company shall be issued a license unless it shall possess and after this maintain free surplus of:

(i) In the case of a subsidiary captive insurance company, not less than one hundred fifty thousand dollars ($150,000);

(ii) In the case of an association captive insurance company incorporated as a stock insurance company, not less than three hundred fifty thousand dollars ($350,000);

(iii) In the case of an industrial insured captive insurance company incorporated as a stock insurance company, not less than three hundred thousand dollars ($300,000);

(iv) In the case of an association captive insurance company incorporated as a mutual insurance company, not less than seven hundred fifty thousand dollars ($750,000); and

(v) In the case of an industrial insured captive insurance company incorporated as a mutual insurance company, not less than five hundred thousand dollars ($500,000).

(2) The surplus may be in the form of cash or an irrevocable letter of credit issued by a bank chartered by the state of Rhode Island or a member bank of the Federal Reserve System and approved by the commissioner.

(b) The commissioner may prescribe additional surplus based upon the type, volume, and nature of insurance business transacted, which surplus may be in the form of a irrevocable letter of credit issued by a bank chartered by the state of Rhode Island, or a member bank of the Federal Reserve System.

(c) No captive insurance company may pay a dividend out of, or other distribution with respect to, surplus, in excess of the limitations set forth in §27-43-12, without the prior approval of the commissioner. Approval of an ongoing plan for the payment of dividends or other distributions shall be conditioned upon the retention, at the time of each payment, of the capital or surplus in excess of amounts specified by, or determined in accordance with formulas approved by, the commissioner.
R.I. Gen. Laws § 27-25-28 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-28
§ 27-25-28. Examination of societies  No adverse publication.
Status: in_force

(a) The commissioner of insurance, or any person he or she may appoint, may examine any domestic, foreign, or alien society transacting or applying for admission to transact business in this state in the same manner as authorized for examination of domestic, foreign, or alien insurers.

(b) The expense of each examination and of each valuation, including compensation and the actual expense of examiners, shall be paid by the society examined or whose certificates are valued in accordance with the laws of this state governing the examination of life insurers.
R.I. Gen. Laws § 27-82-3 — RI Code / Title 27 / Chapter 27-82 / Section 27-82-3
§ 27-82-3. Reporting.
Status: in_force

Notwithstanding any provision of the general laws to the contrary, dental health insurance carriers shall, on or before March 1, 2025, for reporting years 2023 and 2024, and on or before March 1, 2026, for reporting year 2025 (the transition period), file with the commissioner, in a format prescribed by the commissioner, an actuarial memorandum disclosing its incurred claims and earned premiums for the preceding calendar reporting year, together with such additional information as may be provided for in regulations promulgated by the commissioner in accordance with this chapter.
R.I. Gen. Laws § 27-78-7 — RI Code / Title 27 / Chapter 27-78 / Section 27-78-7
§ 27-78-7. Enforcement and penalties.
Status: in_force

(a) The commissioner of insurance shall have the power to examine and investigate the activities of any person that the commissioner reasonably believes has been or is engaged in an act or practice prohibited by this chapter.

(b) The commissioner of insurance shall have the power to enforce the provisions of this chapter in accordance with § 42-14-16.

(c) The commissioner of insurance may adopt reasonable rules and regulations as are necessary or proper to carry out the provisions of this chapter.
R.I. Gen. Laws § 27-54-10 — RI Code / Title 27 / Chapter 27-54 / Section 27-54-10
§ 27-54-10. Limitation on actions.
Status: in_force

The statute of limitations for offenses under this chapter shall be ten (10) years.
R.I. Gen. Laws § 27-66-16 — RI Code / Title 27 / Chapter 27-66 / Section 27-66-16
§ 27-66-16. Powers and duties of the board.
Status: in_force

The board is vested with full power, authority, and jurisdiction over the foundation and may perform all acts necessary or convenient in the exercise of any power, authority, or jurisdiction over the foundation; including the power to intervene in any cy pres proceeding involving the transfer of proceeds from healthcare conversion in order to seek their transfer to the foundation, or as an amicus curiae.
R.I. Gen. Laws § 27-20-36 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-36
§ 27-20-36. Human leukocyte antigen testing.
Status: in_force

Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C. § 263a. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.
R.I. Gen. Laws § 27-78-6 — RI Code / Title 27 / Chapter 27-78 / Section 27-78-6
§ 27-78-6. Applicability.
Status: in_force

(a) The provisions of this chapter shall apply to all certificates of insurance issued in connection with property, operations, or risks located in this state, regardless of where the policyholder, insurer, insurance producer, or person requesting or requiring the issuance of a certificate of insurance is located.

(b) A certificate of insurance or any other document or correspondence prepared, issued, requested, or required in violation of this chapter shall be null and void.
R.I. Gen. Laws § 27-18-50.1 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-50.1
§ 27-18-50.1. 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 have 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 § 27-54-1 — RI Code / Title 27 / Chapter 27-54 / Section 27-54-1
§ 27-54-1. Crimes by or affecting persons engaged in the business of insurance.
Status: in_force

(a) Any person who knowingly and with intent to deceive the director of business regulation (referred to in this section as director) about the financial condition of an insurance company, makes any false statement, representation, or report to the director concerning an insurance company; or who knowingly and with intent to deceive the director about the financial condition of the company testifies or affirms falsely under oath or affirmation to any material fact relative to an insurance company in any matter that would materially affect the financial condition of the company; or who knowingly and with intent to deceive the director about the financial condition of the company makes any false entry or memorandum upon any book, paper, report, or statement of any insurance company; or who knowingly and with intent to deceive the director or his or her designee or any agent appointed to examine the affairs of an insurance company, or knowingly and with intent to deceive, defraud, or injure the stockholders, policyholders, or any officer or director of an insurance company about the financial condition of the company makes a statement, representation, or report to the director or the directors designee that the individual knows materially overvalues any asset, property, or security of an insurance company; or who knowingly and with intent to deceive the director about the financial condition of the company fails to disclose material information; and any person who, with like intent, aids or abets another in any violation of any provision of this section, shall, upon conviction, be fined not exceeding fifty thousand dollars ($50,000) or imprisoned not exceeding twenty (20) years, or both.
R.I. Gen. Laws § 27-44-2 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-2
§ 27-44-2. Definitions.
Status: in_force

As used in this chapter:

(1) Advisory organization means any person or organization other than a rating organization that assists insurers in the authorized activities enumerated in § 27-44-11, except no advisory organization may make any filings on behalf of insurers.

(2) Competitive market means a market that has not been found to be noncompetitive pursuant to § 27-44-4.

(3) Director means the director of department of business regulation.

(4) Market means the interaction between buyers and sellers consisting of a product market component. A product market component consists of identical or readily substitutable products including, but not limited to, consideration of coverage, policy terms, rate classifications, and underwriting. A geographic market component is a geographical area in which buyers have a reasonable degree of access to the insurance product through sales outlets and other marketing mechanisms. Determination of a geographic market component shall consider existing marketing patterns.

(5) Noncompetitive market means a market for which there is a ruling in effect pursuant to § 27-44-4 that a reasonable degree of competition does not exist.

(6) Pool means a voluntary arrangement, established on an on-going basis, pursuant to which two (2) or more insurers participate in the sharing of risks on a predetermined basis. The pool may operate through an association, syndicate, or other pooling agreement.

(7) Rating organization means any entity that either has two (2) or more member insurers or is controlled either directly or indirectly by two (2) or more insurers and that assists insurers in ratemaking. Two (2) or more insurers having a common ownership or operating in this state under common management or control constitute a single insurer for the purpose of this definition.

(8) Residual market mechanism means an arrangement, either voluntary or mandated by law, involving participation by insurers in the equitable apportionment among them of insurance that may be afforded applicants who are unable to obtain insurance through ordinary methods.

(9) Supplementary rate information includes any manual or plan of rates, classification, rating schedule, minimum premium, policy fee, rating rule, and any other similar information needed to determine the applicable rate in effect or to be in effect.

(10) Supporting information means: (i) The experience and judgment of the filer and the experience or data of other insurers or organizations relied upon by the filer; (ii) The interpretation of any statistical data relied upon by the filer; and (iii) Description of methods used in making the rates, and other similar information required by the director to be filed.
R.I. Gen. Laws § 27-74-10 — RI Code / Title 27 / Chapter 27-74 / Section 27-74-10
§ 27-74-10. Marketing requirements.
Status: in_force

(a) A discount medical plan organization may market directly or contract with other marketers for the distribution of its product.

(b) The discount medical plan organization shall have an executed written agreement with a marketer prior to the marketers marketing, promoting, selling, or distributing the discount medical plan. The agreement between the discount medical plan organization and the marketer shall prohibit the marketer from using advertising, marketing materials, brochures, and discount medical plan cards without the discount medical plan organizations approval in writing.

(c) The discount medical plan organization shall be bound by and responsible for the activities of a marketer that are within the scope of the marketers agency relationship with the organization.

(d) A discount medical plan organization shall approve in writing all advertisements, marketing materials, brochures, and discount cards used by marketers to market, promote, sell, or distribute the discount medical plan prior to their use.

(e) Upon request, a discount medical plan organization shall submit to the commissioner all advertising, marketing materials, and brochures regarding a discount medical plan.
R.I. Gen. Laws § 27-41-37 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-37
§ 27-41-37. Discontinuance of coverage  Chronic disabilities.
Status: in_force

No health maintenance organization 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 of reimbursement for the services 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 § 27-4-12 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-12
§ 27-4-12. Provision for exemption from encumbrance, transfer, or claims of creditors.
Status: in_force

Any policy of life or endowment insurance or any annuity contract may provide that the proceeds of or payments under it shall not be subject to transfer, anticipation, or commutation or encumbrance by any beneficiary other than the insured or the purchaser of the annuity, and shall not be subject to the claims of a creditor of any beneficiary or any legal process against the beneficiary.
R.I. Gen. Laws § 27-54-9 — RI Code / Title 27 / Chapter 27-54 / Section 27-54-9
§ 27-54-9. Other law enforcement authority, powers, and duties not affected or impaired.
Status: in_force

This chapter shall not:

(1) Preempt the authority or relieve the duty of other law enforcement agencies to investigate and prosecute suspected violations of the law.

(2) Limit any of the powers granted elsewhere in this title or other laws granting authority to the director, or the directors designee, to investigate possible violations of this chapter and take appropriate action against wrongdoers.
R.I. Gen. Laws § 27-6-9 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-9
§ 27-6-9. Filings by rating organizations.
Status: in_force

An insurer may satisfy its obligation to make the filings referred to in § 27-6-8 by becoming a member of, or subscriber to, a licensed rating organization which makes those filings, and by authorizing the commissioner to accept those filings on its behalf; provided, that nothing contained in this chapter shall be construed as requiring any insurer to become a member of or a subscriber to any rating organization.
R.I. Gen. Laws § 27-19-26.2 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-26.2
§ 27-19-26.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.
Status: in_force

(a) Definitions. As used herein:

(1) Maximum-allowable cost or MAC means the maximum amount that a pharmacy benefits manager will reimburse toward the cost of a drug.

(2) Nationally available means that there is an adequate supply available from regional or national wholesalers and that the product is not obsolete or temporarily unavailable.

(3) Pharmacy benefit manager or PBM means an entity doing business in this state that contracts to administer or manage prescription drug benefits on behalf of any carrier that provides prescription drug benefits to residents of this state.

(b) Upon each contract execution or renewal, a PBM shall, with respect to contracts between a PBM and a pharmacy or, alternatively, a PBM and a pharmacys contracting representative or agent, such as a pharmacy services administrative organization (PSAO):

(1) Include in such contracts a requirement to update pricing information on the MAC list at least every ten (10) calendar days; and

(2) Maintain a procedure to eliminate products from the list of drugs subject to such pricing, or modify MAC rates when such drugs do not meet the standards and requirements of this section as set forth in order to remain consistent with pricing changes in the marketplace.

(c) PBM requirements for inclusion of products on a list of drugs subject to MAC pricing. In order to place a particular prescription drug on a MAC list, the PBM must, at a minimum, ensure that:

(1) The product must be listed as A, AB, or B rated in the most recent version of the United States Food and Drug Administrations approved drug products with therapeutic equivalence evaluations, also known as the orange book, or have an NR or NA rating or similar rating by a nationally recognized reference; and

(2) The product must be nationally available.

(d) Standards for pharmacy appeals. All contracts between a PBM, a contracted pharmacy or, alternatively, a PBM and a pharmacys contracting representative or agent, such as a pharmacy services administrative organization (PSAO), shall include a process to appeal, investigate, and resolve disputes regarding MAC pricing. The process shall include the following provisions:

(1) The right to appeal shall be limited to fifteen (15) days following the initial claim;

(2) The appeal shall be investigated and resolved within fifteen (15) days following receipt of the appeal;

(3) A process by which a network pharmacy may contact the PBM regarding the appeals process;

(4) If the appeal is denied, the PBM shall provide the reason for the denial and identify the national drug code of a drug product that is available in adequate supply;

(5) If an appeal is upheld, the PBM shall make an adjustment to the list effective no later than one day after the date of determination; and

(6) The department of health shall exercise oversight and enforcement of this section.
R.I. Gen. Laws § 27-2-16 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-16
§ 27-2-16. Filing fees  Certificates of compliance.
Status: in_force

(a) Every insurance company not incorporated in this state applying for admission to transact business in the state shall pay to the insurance commissioner, for the use of the state, for filing a copy of its charter or deed of settlement, the sum of thirty dollars ($30.00), and for filing a statement preliminary to admission, and for filing each annual statement after admission payable prior to April 1 of each year, the sum of one hundred dollars ($100).

(b) A certificate of compliance issued under this chapter shall continue in force as long as the insurer is entitled to it under this chapter and until suspended, revoked, or terminated at the request of the insurer; subject, to continuance of the certificate by the insurer each year by:

(1) Payment prior to April 1 of an annual license fee of one hundred dollars ($100); and

(2) Due filing by the insurer of its annual statement for the preceding calendar year as required under this section.

(c) If not continued in this manner by the insurer, its certificate of compliance shall expire at midnight on June 1 next following the failure of the insurer to continue it in force.

(d) The commissioner may, in the commissioners discretion, reinstate a certificate of compliance that the insurer has inadvertently permitted to expire, after the insurer has fully cured all its failures that resulted in the expiration, and upon payment by the insurer of the fee in the amount provided in subsection (b)(1). Otherwise, the insurer shall be granted another certificate of compliance only after filing an application and meeting all other requirements as for an original certificate of compliance in this state.

(e) The commissioner may amend a certificate of compliance at any time to accord with changes in the insurers charter or insuring powers.

(f) The commissioner may assess a late fee of one hundred dollars ($100) per day for each day the insurer is late in filing its annual statement, and ten dollars ($10.00) per day for each day the insurer is late in remitting its annual license fee, except that the insurer may request and receive an extension of the filing date without penalty.
R.I. Gen. Laws § 27-18-10 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-10
§ 27-18-10. Compliance by domestic insurer with laws of other states.
Status: in_force

Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of that other state or country.
R.I. Gen. Laws § 27-41-66 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-66
§ 27-41-66. Dental insurance assignment of benefits.
Status: in_force

Every entity licensed under this chapter shall allow, as a provision of any evidence of coverage of dental services, any person covered by the entity to direct, in writing, that benefits from a health benefit plan, policy, or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by the entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to the entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.
R.I. Gen. Laws § 27-64-8 — RI Code / Title 27 / Chapter 27-64 / Section 27-64-8
§ 27-64-8. Rehabilitation and liquidation of protected cells.
Status: in_force

(a) If in relation to one or more protected cells of a protected cell company, the commissioner is satisfied that the protected cell assets attributable to that protected cell are insufficient to discharge the claims of creditors or other claimants with respect to that protected cell, the commissioner may place under administrative supervision or apply for an order of conservation, rehabilitation or liquidation with respect to that protected cell. In carrying out the administrative supervision, conservation, rehabilitation, or liquidation of a protected cell, the receiver shall follow generally the provisions of chapters 1, 12.2, and 14.1  14.4 of this title, as applicable, and any rules and regulations promulgated under those chapters, except that at all times the receiver shall be bound to deal with the protected cell assets and protected cell liabilities in accordance with the requirements of this chapter.

(b) An order of rehabilitation or conservation may not be requested or made with respect to any protected cell of a protected cell company if a receiver has been appointed to act in respect of a protected cell company and the commissioner may still apply for an order of liquidation with respect to that protected cell. Any prior order of rehabilitation or conservation with respect to a protected cell shall cease to be of effect upon an order of rehabilitation with respect to the protected cell company, without prejudice to the prior acts of the receiver or its agents.

(c) An order of rehabilitation, conservation or liquidation may not be requested or made with respect to any protected cell of a protected cell company if a liquidator has been appointed to act in respect of the protected cell company. Any prior order of rehabilitation, conservation or liquidation with respect to a protected cell shall cease to be of effect upon an order of liquidation with respect to the protected cell company, without prejudice to the prior acts of the receiver or its agent.

(d) During any period of conservation or rehabilitation, or upon an order of liquidation, with respect to a protected cell, the directors of the protected cell company shall cease in respect of the business of, and the protected cell assets and protected cell liabilities attributable to, the protected cell, which is the subject of the rehabilitation, conservation or liquidation.

(e) In the event that a petition for an order of rehabilitation, conservation or liquidation of a protected cell is challenged, prior to the entry or denial of the order, the directors of the protected cell company shall cease in respect of the business of, and the protected cell assets and protected cell liabilities attributable to, the protected cell which is the subject of the petition and the commissioner shall carry out the business of the protected cell until the order has been entered or denied. In the event the order is denied, the commissioner shall immediately return possession and control of the protected cell to the directors of the protected cell company.

(f) No resolution for the voluntary winding up of a protected cell company with any protected cell which has been placed under administrative supervision or is the subject of an order of rehabilitation, conservation or liquidation shall be effective without permission of the commissioner and, in the case of rehabilitation, conservation or liquidation, the court supervising the rehabilitation, conservation or liquidation.
R.I. Gen. Laws § 27-20-37 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-37
§ 27-20-37. Drug coverage.
Status: repealed

(a) Any nonprofit medical 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 medical service corporations formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit medical service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit medical service corporations medical-exception criteria for the coverage of that medication.

(b) A nonprofit medical 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 medical 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 medical service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit medical 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 § 27-7-2.2 — RI Code / Title 27 / Chapter 27-7 / Section 27-7-2.2
§ 27-7-2.2. Interest on judgment  Payment by insurer.
Status: in_force

In any civil action in which the defendant is covered by liability insurance and in which the plaintiff makes a written offer to the defendants insurer to settle the action in an amount equal to or less than the coverage limits on the liability policy in force at the time the action accrues, and the offer is rejected by the defendants insurer, then the defendants insurer shall be liable for all interest due on the judgment entered by the court even if the payment of the judgment and interest totals a sum in excess of the policy coverage limitation. This written offer shall be presumed to have been rejected if the insurer does not respond in writing within a period of thirty (30) days.
R.I. Gen. Laws § 27-41-29.2 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-29.2
§ 27-41-29.2. Filing of policy forms.
Status: in_force

(a) A health maintenance organization shall file all policy forms and rates used by it in the state with the commissioner, including the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance. No such form shall be used if disapproved by the commissioner under this section, or if the commissioners approval has been withdrawn after notice and an opportunity to be heard, or until the expiration of sixty (60) days following the filing of the form. Such a company shall comply with its filed and approved forms. If the commissioner finds from an examination of any form that it is contrary to the public interest or the requirements of this code or duly promulgated regulations, he or she shall forbid its use, and shall notify the corporation in writing.

(b) Each rate filing shall include a certification by a qualified actuary that to the best of the actuarys knowledge and judgment, the entire rate filing is in compliance with applicable laws and that the benefits offered or proposed to be offered are reasonable in relation to the premium to be charged. A health insurance carrier shall comply with its filed and approved rates and forms.
R.I. Gen. Laws § 27-41-49.1 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-49.1
§ 27-41-49.1. Third-party reimbursement for services of registered nurse first assistants.
Status: in_force

(a) Every individual or group health insurance contract, plan, or policy delivered, issued, or renewed by an insurer, health maintenance organization, 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 registered nurse first assistant designated as such; provided, that the following conditions are met:

(1) The registered nurse first assistant provides certain healthcare services under the supervision of a licensed physician; is currently licensed as a registered nurse in Rhode Island; has successfully completed a course in preparing the registered nurse as a first assistant in accordance with the Association of Operating Room Nurses core curriculum guide for the registered nurse first assistant and includes a minimum of one academic year in a college or university with didactic instruction and clinical internship programs; and is certified in perioperative nursing by the Certification Board of Perioperative Nursing (minimum of two years perioperative experience);

(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 registered nurse first assistant is not a salaried employee of the licensed hospital or facility for which the health maintenance organization has an alternative contractual relationship to fund the services of a registered nurse first assistant.

(b) It remains within the sole discretion of the health maintenance organization as to which registered nurse first assistant it contracts with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization is required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant and any other healthcare provider. Nothing contained in this section precludes the health maintenance organization from conducting managed care, medical necessity, or utilization review.
R.I. Gen. Laws § 27-5-24 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-24
§ 27-5-24. Maintenance of surplus fund equal to reserve fund.
Status: in_force

If, in consequence of the payment of losses by fires, or of the expenses of the business, or of the interest or dividends payable under the provisions of this chapter to stockholders, or from any cause, the guaranty surplus fund shall be reduced in amount below the amount of the special reserve fund, the directors of the corporation shall make no additions to the special reserve fund until the guaranty surplus fund is equal to the special reserve fund.
R.I. Gen. Laws § 27-41-38.2 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-38.2
§ 27-41-38.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.
Status: in_force

(a) Definitions. As used herein:

(1) Maximum-allowable cost or MAC means the maximum amount that a pharmacy benefits manager will reimburse toward the cost of a drug;

(2) Nationally available means that there is an adequate supply available from regional or national wholesalers and that the product is not obsolete or temporarily unavailable;

(3) Pharmacy benefit manager means an entity doing business in this state that contracts to administer or manage prescription drug benefits on behalf of any carrier that provides prescription drug benefits to residents of this state.

(b) Upon each contract execution or renewal, a PBM shall, with respect to contracts between a PBM and a pharmacy or, alternatively, a PBM and a pharmacys contracting representative or agent, such as a pharmacy services administrative organization (PSAO):

(1) Include in these contracts a requirement to update pricing information on the MAC list at least every ten (10) calendar days;

(2) Maintain a procedure to eliminate products from the list of drugs subject to this pricing, or modify MAC rates when the drugs do not meet the standards and requirements of this section as set forth in order to remain consistent with pricing changes in the marketplace.

(c) PBM requirements for inclusion of products on a list of drugs subject to MAC pricing. In order to place a particular prescription drug on a MAC list, the PBM must, at a minimum, ensure that:

(1) The product must be listed as A, AB, or B rated in the most recent version of the United States Food and Drug Administrations approved drug products with therapeutic equivalence evaluations, also known as the orange book, or have an NR or NA rating or similar rating by a nationally recognized reference; and

(2) The product must be nationally available.

(d) Standards for pharmacy appeals. All contracts between a PBM, a contracted pharmacy or, alternatively, a PBM and a pharmacys contracting representative or agent, such as a pharmacy services administrative organization (PSAO), shall include a process to appeal, investigate, and resolve disputes regarding MAC pricing. The process shall include the following provisions:

(1) The right to appeal shall be limited to fifteen (15) days following the initial claim;

(2) The appeal shall be investigated and resolved within fifteen (15) days following receipt of the appeal;

(3) A process by which a network pharmacy may contact the PBM regarding the appeals process;

(4) If the appeal is denied, the PBM shall provide the reason for the denial and identify the national drug code of a drug product that is available in adequate supply;

(5) If an appeal is upheld, the PBM shall make an adjustment to the list effective no later than one day after the date of determination; and

(6) The department of health shall exercise oversight and enforcement of this section.
R.I. Gen. Laws § 27-29-2 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-2
§ 27-29-2. Definitions.
Status: in_force

When used in this chapter:

(1) Commissioner means the director of the department of business regulation.

(2) Consultant means an individual, partnership, or corporation who or that, for a fee, holds himself, herself, or itself out to the public as engaged in the business of offering any advice, counsel, opinion, or service with respect to the benefits, advantages, or disadvantages promised under any policy of insurance that could be issued in this state.

(3) Domestic partnership means two (2) people who are in an exclusive, intimate, and committed relationship with each other, and who certify by affidavit that their relationship meets the following qualifications:

(i) Both persons are at least eighteen (18) years of age and are mentally competent to contract;

(ii) Neither person is currently married to someone else;

(iii) The persons are not related by blood to a degree that would prohibit marriage in the state of Rhode Island;

(iv) The persons reside together and have resided together for at least one year prior to the date of the certified affidavit;

(v) The persons are financially interdependent as evidenced by two (2) of the following:

(A) A domestic partnership agreement or relationship contract;

(B) A joint mortgage or joint ownership of a primary residence;

(C) Two (2) of the following:

(I) Joint ownership of a motor vehicle;

(II) A joint checking account;

(III) A joint credit account;

(IV) A joint lease; and/or

(D) One person has been designated as a beneficiary for the other persons will, retirement contract, or life insurance.

(4) Insured means the party named on a policy or certificate as the individuals with legal rights to the benefits provided by the policy.

(5) Insurer means any person, reciprocal exchange, interinsurer, Lloyds insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance, including agents, brokers, insurance producers, adjusters, and third-party administrators. Notwithstanding any other provision of law, insurer shall also mean a nonprofit hospital and/or medical service corporation, a nonprofit dental service corporation, a nonprofit optometric service corporation, a nonprofit legal service corporation, a health maintenance organization as defined in the general laws, or any other entity providing a plan of health benefits. For the purposes of this act, the entities in this subdivision shall be deemed to be engaged in the business of insurance and subject to this chapter.

(6) License means any license, certificate of authority, certificate of compliance, or other formal approval or authorization granted by the department of business regulation, division of insurance.

(7) Person means any natural or artificial entity, including but not limited to: an individual, corporation, association, partnership, trust, or any other legal entity.

(8) Policy or certificate means any contract of insurance, indemnity, medical, health, or hospital service, suretyship, or annuity issued, proposed for issuance, or intended for issuance, by any insurer.
R.I. Gen. Laws § 27-17-3 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-3
§ 27-17-3. Execution by attorney  Office in state.
Status: in_force

The contracts shall be executed by an attorney in fact, designated in this chapter as attorney, duly authorized and acting for the subscribers, and the attorney may be a foreign corporation. An office or offices of the attorney, referred to in this chapter as a reciprocal exchange or interinsurer, acting for subscribers in issuing contracts or policies insuring property or interests in this state, shall be maintained in this state.
R.I. Gen. Laws § 27-17-2 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-2
§ 27-17-2. Power of subscribers to exchange reciprocal and interinsurance contracts.
Status: in_force

(a) Individuals, partnerships, trustees, and all corporations of this state, designated throughout this chapter as subscribers, are authorized to exchange reciprocal or interinsurance contracts with each other and with individuals, partnerships, trustees, and corporations of other states.

(b) The right of a corporation to exchange those contracts is declared to be incidental to the purpose for which the corporation is organized and as much granted as the rights and powers expressly conferred. Whenever a trustee acting in a representative capacity insures property held in trust at a reciprocal exchange, the trustee may assume the liability and be entitled to the rights of a subscriber, but in doing this shall not personally or individually be liable under the power of attorney executed on behalf of the trust.

(c) The contracts and the exchange of contracts and the subscribers, their attorneys in fact, and representatives, shall be regulated by this chapter and by no other statute of this state relating to insurance, except as otherwise specifically provided in this chapter.
R.I. Gen. Laws § 27-39-2 — RI Code / Title 27 / Chapter 27-39 / Section 27-39-2
§ 27-39-2. Insurance benefits for second opinion.
Status: in_force

(a) Any insurer issuing an individual insurance policy that provides coverage of surgical operations performed on a person while confined in a hospital as an inpatient shall make available under the policy benefits for a second surgical opinion for elective surgical procedures performed in a hospital either on an inpatient or outpatient basis or in a licensed surgical facility.

(b) Benefits for a second surgical opinion shall include payment for the second surgical opinion services of an eligible physician and for essential laboratory and X-ray services incidental to those services, either as a benefit under the individual policy or, at the insurers option, as an additional benefit offered to the prospective policyholder at issue of a policy. Benefit payments may be limited to second surgical opinion services of eligible physicians who have agreed to participate in an insurers second surgical opinion program. The benefits shall be equal to amounts payable under the policy for covered in-hospital consultations. As a condition of eligibility for a second surgical opinion benefit, the subscriber shall notify the insurer in advance to verify eligibility and compliance with the provisions in this section.
R.I. Gen. Laws § 27-5-16 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-16
§ 27-5-16. Resolution to establish surplus and reserve funds  Certification of funds.
Status: in_force

Any state fire insurance company desiring to create guaranty surplus and special reserve funds may do so upon the adoption of a resolution by its board of directors, at a regular meeting of its board of directors, to that effect, and filing with the insurance commissioner a copy declaring the intention of the company to create those funds and to do business under the provisions of this chapter. As soon after the filing of a copy of the resolution as is convenient, the insurance commissioner shall make, or cause to be made, an examination of the company, and the commissioner shall make a certificate of the result which shall particularly set forth the amount of surplus funds held by the company at the date of the examination, the whole or any part of which under the provisions of this chapter may be equally divided between and set apart to constitute guaranty surplus and special reserve funds, which certificate shall be recorded in the office of the insurance commissioner.
R.I. Gen. Laws § 27-17-16 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-16
§ 27-17-16. Penalty for doing business without compliance.
Status: in_force

Any attorney who exchanges any contracts of insurance of the kind and character specified in this chapter, or any attorney or representative of the attorney who solicits or negotiates any applications for the attorney without the attorney first complying with the provisions of this chapter, shall be deemed guilty of a misdemeanor, and upon conviction shall be subjected to a fine of not less than one hundred dollars ($100) nor more than one thousand dollars ($1,000).
R.I. Gen. Laws § 27-2-23 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-23
§ 27-2-23. Discrimination in rates prohibited.
Status: in_force

(a) No foreign insurance company licensed to do or doing business in this state shall make any distinction or discrimination as to the premiums or rates charged for policies of casualty, fire, home owners, accident and health, or marine insurance, nor shall any company make or permit the rejection of an individuals application for insurance coverage, and the determination of the rate class for the individual, solely on the basis of a disability unless the disability is relevant to the risk of loss, nor shall any company make or require any rebate, diminution, or discount upon the sum to be paid on any policy based on any disability discrimination, nor insert in the policy any condition, nor make any stipulation, where the person insured shall bind himself or herself, his or her heirs, executors, administrators, and assigns, to accept any less sum than the full value or amount of the policy in case of a claim accruing on the policy by reason of the claim of the person insured, other than conditions or stipulations as are imposed upon all persons in similar cases, and any stipulation or condition made in this manner or inserted shall be void.

(b) No foreign insurance company licensed to do or doing business in this state shall make any distinction or discrimination as to the premiums or rates charged for automobile insurance policies, nor shall the company make or permit the rejection of an individuals application for insurance coverage, and the determination of the rate class of the individual, solely on the basis of a disability or the modification of the automobile with specialized equipment that permits an individual with a disability to operate the automobile, unless the disability or modification of the automobile is relevant to the risk of loss, nor shall any insurance company make or require any rebate, diminution, or discount upon the sum to be paid on any policy based on any disability discrimination, nor insert in the policy any condition, nor make any stipulation, where the person insured shall bind himself or herself, his or her heirs, executors, administrators, and assigns, to accept any less sum than the full value or amount of the policy in case of a claim accruing on the policy by reason of the claim of the person insured, other than conditions or stipulations as are imposed upon all persons in similar cases, and any stipulation or condition made or inserted shall be void. The department of business regulation shall enforce the provisions of this section.
R.I. Gen. Laws § 27-41-40 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-40
§ 27-41-40. Certified counselors in mental health and therapists in marriage and family practice.
Status: in_force

(a) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall, when deemed medically necessary by the health maintenance organization in accordance with its standard medical management protocols as approved by the health department and within the contractual benefit limits, provide coverage for the services of counselors in mental health licensed pursuant to § 5-63.2-9 and therapists in marriage and family practice licensed pursuant to § 5-63.2-10.

(b) It shall remain within the sole discretion of the health maintenance organization as to which certified counselors in mental health and certified therapists in marriage and family practice it shall contract with. Nothing contained in this section shall require the health maintenance organization to provide coverage other than in conjunction with a related medical illness.
R.I. Gen. Laws § 27-19-39 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-39
§ 27-19-39. Additional relief and damages  Reinstatement.
Status: in_force

(a) A physician or other medical provider who alleges a violation of this chapter 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 chapter shall order, as the court considers appropriate, reinstatement of the provider agreement.
R.I. Gen. Laws § 27-2-2 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-2
§ 27-2-2. Applicability.
Status: in_force

The general provisions of law relating to the duties, obligations, prohibitions, or penalties that appertain to insurance companies not incorporated under the authority of this state, and defining the powers and duties of the insurance commissioner in reference to those companies, shall be and are applicable to all corporations, companies, and associations not incorporated under the authority of this state, and to all partnerships and individuals, doing, as principals or otherwise, in this state, any insurance business of any name, kind, or description.
R.I. Gen. Laws § 27-20-4 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-4
§ 27-20-4. Approval of articles of association.
Status: in_force

No articles of association of a nonprofit medical service corporation shall be filed in the office of the secretary of state unless and until the governor shall have certified in writing upon those articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation and that the filing of the articles has the approval of the Rhode Island Medical Society as evidenced by an affidavit of the president and secretary of the society. No articles of association of a nonprofit medical service corporation formed after January 1, 1964, shall be filed in the office of the secretary of state unless and until the governor shall have certified in writing upon the articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation.
R.I. Gen. Laws § 27-44-1 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-1
§ 27-44-1. Purposes.
Status: in_force

The purposes of this chapter are:

(1) To prohibit price fixing agreements and other anticompetitive behavior by insurers;

(2) To protect policyholders and the public against the adverse effects of excessive, inadequate, or unfairly discriminatory rates;

(3) To promote price competition among insurers to provide rates that are responsive to competitive market conditions;

(4) To provide regulatory assurance that price competition exists;

(5) To improve availability, fairness, and reliability of insurance;

(6) To authorize essential cooperative action among insurers in the ratemaking process and to regulate that activity to prevent practices that tend to substantially lessen competition or create a monopoly;

(7) To encourage the most efficient and economic marketing practices; and

(8) To foster competitive insurance markets.
R.I. Gen. Laws § 27-25-39 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-39
§ 27-25-39. Reciprocal fees and charges.
Status: in_force

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 fraternal benefit societies incorporated or organized under the laws of this state or on the agents or insurance producers of fraternal benefit societies, so long as those laws continue in force, the fees, charges, taxes, deposits, and obligations shall be imposed on the fraternal benefit societies doing business in this state that are incorporated or organized under the laws of the other state and on their agents or insurance producers.
R.I. Gen. Laws § 27-8-3 — RI Code / Title 27 / Chapter 27-8 / Section 27-8-3
§ 27-8-3. Reciprocal powers of foreign companies.
Status: in_force

Any insurance company of another state or country authorized to transact the business of fire or marine insurance, or both, in this state may, if, by the provisions of its charter or act of incorporation or articles of association, it has the power, and if similar companies of this state may transact the classes of insurance enumerated in § 27-8-1 and this section in the state or country of that companys domicile, be authorized by the insurance commissioner to transact in this state the like classes of insurance.
R.I. Gen. Laws § 27-17-19 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-19
§ 27-17-19. Fees and taxes.
Status: in_force

The exchanges shall be subject to the same fees and taxes provided by the laws of this state, now or after this enacted, applicable to insurance companies organized or admitted to do the same kind or kinds of business under the laws of this state.
R.I. Gen. Laws § 27-25-24 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-24
§ 27-25-24. Taxation.
Status: in_force

Every society organized or licensed under this chapter is declared to be a charitable and benevolent institution, and all of its funds shall be exempt from all and every state, county, district, municipal, and school tax, other than taxes on real estate and office equipment.
R.I. Gen. Laws § 27-1-8 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-8
§ 27-1-8. Return of deposit on termination of business.
Status: in_force

Whenever any insurance company that has deposited stocks or other securities with the general treasurer desires to relinquish its business, the general treasurer shall, on application of the company, under the oath of the president or principal officer and secretary, give notice of that intention in two (2) newspapers published in this state, to be inserted at least twice a week for six (6) months. After the publication, the general treasurer, on being satisfied by an examination of the books and of the officers of the company under oath that all of its debts and liabilities are paid or extinguished upon any contract or agreement, shall deliver up to the company from whom the general treasurer received the securities, the stocks or other securities held by the general treasurer belonging to the company.
R.I. Gen. Laws § 27-18-13 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-13
§ 27-18-13. Effect of policies inconsistent with chapter.
Status: in_force

A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured, and the beneficiary shall be governed by the provisions of this chapter.
R.I. Gen. Laws § 27-20-12 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-12
§ 27-20-12. Corporation deemed public charitable institution.
Status: in_force

Every nonprofit medical service corporation is declared to be and shall be deemed to be a charitable corporation and an incorporated public charitable institution.
R.I. Gen. Laws § 27-54-5 — RI Code / Title 27 / Chapter 27-54 / Section 27-54-5
§ 27-54-5. Disqualification of officer and directors.
Status: in_force

No person may serve as a director, officer, or senior management official of an insurance company who has been convicted of a felony involving fraud, dishonesty, or a breach of trust.
R.I. Gen. Laws § 27-41-74 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-74
§ 27-41-74. Enteral nutrition products.
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, 2009, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and that are medically necessary for the treatment of malabsorption caused by Crohns disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.

(b) Benefit plans offered by a health maintenance organization may impose a copayment or deductible, or both, for the benefits mandated by this section, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for prescription enteral formulas or nutritional aids. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer. Nothing contained in this section precludes the accident and sickness insurer from conducting managed care, medical necessity, or utilization review.

(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 § 27-62-8 — RI Code / Title 27 / Chapter 27-62 / Section 27-62-8
§ 27-62-8. Delivery of illustration and record retention.
Status: in_force

(a)(1) If a basic illustration is used by an insurance producer or other authorized representative of the insurer in the sale of a life insurance policy and the policy is applied for as illustrated, a copy of that illustration, signed in accordance with this chapter, shall be submitted to the insurer at the time of policy application. A copy also shall be provided to the applicant.

(2) If the policy is issued other than as applied for, a revised basic illustration conforming to the policy as issued shall be sent with the policy. The revised illustration shall conform to the requirements of this regulation, shall be labeled Revised Illustration and shall be signed and dated by the applicant or policy owner and producer or other authorized representative of the insurer no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner.

(b)(1) If no illustration is used by an insurance producer or other authorized representative in the sale of a life insurance policy or if the policy is applied for other than as illustrated, the producer or representative shall certify to that effect in writing on a form provided by the insurer. On the same form the applicant shall acknowledge that no illustration conforming to the policy applied for was provided, and shall further acknowledge an understanding that an illustration conforming to the policy as issued will be provided no later than at the time of policy delivery. This form shall be submitted to the insurer at the time of policy application.

(2) If the policy is issued, a basic illustration conforming to the policy as issued shall be sent with the policy and signed no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner.

(c) If the basic illustration or revised illustration is sent to the applicant or policy owner by mail from the insurer, it shall include instructions for the applicant or policy owner to sign the duplicate copy of the numeric summary page of the illustration for the policy issued and return the signed copy to the insurer. The insurers obligation under this subsection shall be satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the numeric summary page. The requirement to make a diligent effort shall be deemed satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed numeric summary page.

(d) A copy of the basic illustration and a revised basic illustration, if any, signed as applicable, along with any certification that either no illustration was used or that the policy was applied for other than as illustrated, shall be retained by the insurer until three (3) years after the policy is no longer in force. A copy need not be retained if no policy is issued.
R.I. Gen. Laws § 27-19-7 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-7
§ 27-19-7. Rates charged by hospitals.
Status: in_force

(a) The rates charged by contracting hospitals to any nonprofit hospital service corporation for hospital services rendered by the hospitals to the subscribers of the corporation shall be established from time to time by agreement between the contracting hospitals and the corporation.

(b) Upon completion of its services, each contracting hospital shall, upon request, provide a copy of an itemized bill for each patient; provided, that nothing contained in this subsection shall be construed to apply to any hospital operated by the state of Rhode Island, its departments, or agencies.
R.I. Gen. Laws § 27-1-1 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-1
§ 27-1-1. Site of principal office and records.
Status: in_force

(a) Every insurance company organized after May 3, 1956, under the laws of this state shall have its principal office and maintain all of its records, or duplicates of those records, in this state; provided, that the director of business regulation may, after a public hearing, allow any insurance company, upon application, to locate its principal office and maintain certain original records outside of this state if it is determined that it is not inconsistent with the public interest of the people of the state of Rhode Island. In determining what is not inconsistent with the public interest of the people of the state of Rhode Island, the director shall make findings of fact, reduced to writing and filed with the secretary of state, which findings shall include, but are not limited to the following:

(1) The number of full-time employees currently located within the state, and the number of full-time employees anticipated to be located within the state if the petition is granted;

(2) That no detriment nor prejudice will inure to any current or anticipated future policyholders of the company by granting the application;

(3) That the granting of the application is not inimical to the ability of policyholders to file claims with and against the company, and, in furtherance of this finding, may require that the company maintain a toll-free number for registering claims, and may require a claims office to be located within the state, staffed by a person authorized to issue payment on behalf of the company on approved claims; and

(4) That a review of the financial records of the company and the records relied upon by the director in making the determination have satisfied the director that the company is able to meet its obligations to current policyholders. In the event that there is any risk associated with granting the application the director may deny the application or may, in furtherance of the application, require the posting of bonds and/or securities with the general treasurer, in an amount to be determined by the director, sufficient to protect the interest of the policyholders within the state.

(b) The director is authorized to promulgate regulations as provided for by the Administrative Procedures Act, chapter 35 of title 42, not inconsistent with this section, in furtherance of the authority granted in this section.
R.I. Gen. Laws § 27-32-3 — RI Code / Title 27 / Chapter 27-32 / Section 27-32-3
§ 27-32-3. Gains or losses allocated to each account.
Status: in_force

The income, if any, and gains and losses, realized or unrealized on each account shall be credited to or charged against the amounts allocated to the account in accordance with the agreement, without regard to other income, gains, or losses of the company.
R.I. Gen. Laws § 27-20-81 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-81
§ 27-20-81. Dispensing and administration of HIV PrEP or PEP drugs.
Status: in_force

(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode Island board of pharmacy (the board) in accordance with rules and regulations adopted under subsection (e) of this section, a pharmacist may prescribe, dispense, and administer HIV PrEP or PEP drugs (hereinafter sometimes referred to as prevention drugs) as described in § 27-20-79(a) of this section pursuant to a standing order or collaborative practice agreement or to protocols developed by the board for when there is no prescription drug order, standing order, or collaborative practice agreement in accordance with the requirements in this subsection and may also order laboratory testing for HIV infection as necessary.

(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a training program approved by the board on the use of protocols developed by the board for prescribing, dispensing, and administering an HIV prevention drug; on the requirements for any laboratory testing for HIV infection; and on guidelines for prescription adherence and best practices to counsel patients prescribed an HIV prevention drug.

(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty-day (30) supply, and up to a sixty-day (60) supply, as long as all of the following conditions are met:

(1) The patient tests negative for HIV infection, as documented by a negative HIV test result obtained within the previous seven (7) days. If the patient does not provide evidence of a negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted directly to the pharmacist, the pharmacist shall verify the test results to the pharmacists satisfaction. If the patient tests positive for HIV infection, the pharmacist or person administering the test shall direct the patient to a primary care provider and provide a list of primary care providers and clinics within a reasonable travel distance of the patients residence;

(2) The patient does not report any signs or symptoms of acute HIV infection on a self-reporting checklist of acute HIV infection signs and symptoms;

(3) The patient does not report taking any contraindicated medications;

(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and that a pharmacist shall not dispense or administer more than a sixty-day (60) supply of a PrEP or PEP drug to a single patient once every two (2) years without a prescription;

(5) The pharmacist documents, to the extent possible, the services provided by the pharmacist in the patients record in the patient profile record system maintained by the pharmacy. The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each patient;

(6) The pharmacist does not dispense or administer more than a sixty-day (60) supply of a PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a practitioner; and

(7) The pharmacist notifies the patients primary care provider that the pharmacist completed the requirements specified in this subsection. If the patient does not have a primary care provider, or refuses consent to notify the patients primary care provider, the pharmacist shall provide the patient a list of physicians, clinics, or other healthcare providers to contact regarding follow-up care.

(d) A pharmacist shall dispense or administer a complete course of a post-exposure prophylaxis drug as long as all of the following conditions are met:

(1) The pharmacist screens the patient and determines that the exposure occurred within the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-exposure prophylaxis drug under CDC guidelines;

(2) The pharmacist provides HIV testing to the patient or determines that the patient is willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, the pharmacist may dispense or administer a post-exposure prophylaxis drug;

(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

(4) The pharmacist notifies the patients primary care provider of the dispensing or administering of the post-exposure prophylaxis drug. If the patient does not have a primary care provider, or refuses consent to notify the patients primary care provider, the pharmacist shall provide the patient a list of physicians, clinics, or other healthcare providers to contact regarding follow-up care.

(e) The board shall promulgate rules and regulations establishing standards for authorizing pharmacists to prescribe, dispense, and administer HIV prevention drugs in accordance with this section, including adequate training requirements and protocols for when there is no prescription drug order, standing order, or collaborative practice agreement.
R.I. Gen. Laws § 27-4-0.1 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-0.1
§ 27-4-0.1. Definitions.
Status: in_force

(a) Annuities means all agreements to make periodic payments for a certain period or where the making or continuance of all or some of a series of the payments, or the amount of any payment, depends on the continuance of human life, except payments made in connection with a life insurance policy. Amounts paid the insured to provide annuities and proceeds applied under optional modes of settlement or under dividend options may be allocated by the insurer to one or more separate accounts pursuant to provisions of the annuity contract.

(b)(1) Funding agreements means agreements where an insurer may accept and accumulate funds and make one or more payments at future dates in amounts that are not based on mortality or morbidity contingencies. Funding agreements do not constitute annuities as defined in subsection (a) of this section or life insurance as defined in subsection (c) of this section.

(2) Any insurer authorized to issue annuity contracts in Rhode Island may issue one or more funding agreements, in fixed or variable dollar amounts or in both. The issuance of a funding agreement under this section is deemed to be doing insurance business. Funding agreements may be issued to fund:

(i) Benefits under any employee benefit plan as defined in the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002;

(ii) The activities of any organization exempt from taxation under § 501(c) of the Internal Revenue Code, 26 U.S.C. § 501(c), or any similar organization in any foreign country;

(iii) Any program of the government of the United States, the government of any state or political subdivision of the state, or of a foreign country, or any agency or instrumentality of any foreign government, political subdivision, or foreign country;

(iv) Any agreement providing for periodic payments in satisfaction of a claim; or

(v) Any program of any institution that has assets in excess of twenty-five million dollars ($25,000,000).

(3) A funding agreement shall be for a total amount of not less than one million dollars ($1,000,000). An amount under a funding agreement shall not be guaranteed or credited except upon reasonable assumptions as to investment income and expenses and on a basis equitable to all holders of the funding agreement of a given class. Funding agreements shall not provide for payments to or by the insurer based on mortality or morbidity contingencies.

(4) Amounts paid to the insurer under funding agreements may be allocated by the insurer to its general account or to one or more separate accounts pursuant to § 27-32-1.

(5) A funding agreement is a Class 3 claim under § 27-14.3-46.

(6) Notwithstanding any provision in this title to the contrary, no funding agreement or portion of it, except to the extent the funding agreement may be considered an unallocated annuity contract, in accordance with the definition found in § 27-34.3-5, and except to the extent the funding agreement or portion of it has been issued to or in connection with a specific employee, union or association of natural persons benefit plan, not protected under the federal Pension Benefit Guaranty Corporation, or a government lottery, and except to the extent the funding agreement or portion of it is not limited or excluded under § 27-34.3-3(b)(2), shall qualify as a policy or contract as to which coverage is provided pursuant to chapter 34.3 of this title.

(7) The commissioner shall have the authority to regulate the sale and issuance of funding agreements and to promulgate regulations governing the sale and issuance of funding agreements.

(c) Life insurance means every insurance upon the lives of human beings and every insurance appertaining to that life, including the granting of endowment benefits, additional benefits in the event of death by accident, additional benefits to safeguard the contract from lapse, accelerated payments of part or all of the death benefit, or a special surrender value upon diagnosis of terminal illness, defined as a life expectancy of twelve (12) months or less, or of a medical condition requiring extraordinary medical care or treatment regardless of life expectancy, or a special surrender value upon total and permanent disability of the insured, and optional modes of settlement of proceeds. Amounts paid the insurer for life insurance and proceeds applied under optional modes of settlement or under dividend options may be allocated by the insurer to one or more separate accounts pursuant to provisions contained in the policy.
R.I. Gen. Laws § 27-58-1 — RI Code / Title 27 / Chapter 27-58 / Section 27-58-1
§ 27-58-1. Short title.
Status: in_force

This act may be cited as the Financial Institution Insurance Sales Act.
R.I. Gen. Laws § 27-20-27.2 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-27.2
§ 27-20-27.2. Conditions of coverage. [Repealed on effective date of § 27-20-64.]
Status: in_force

As provided in § 27-20-27, coverage shall be extended to new cancer therapies still under investigation when the following circumstances are present:

(1) Treatment is being provided pursuant to a phase II, III or IV clinical trial which has been approved by the National Institutes of Health (NIH) in cooperation with the National Cancer Institute (NCI), community clinical oncology programs; the Food and Drug Administration in the form of an investigational new drug (IND) exemption; the Department of Veterans Affairs; or a qualified nongovernmental research entity as identified in the guidelines for NCI cancer center support grants;

(2) The proposed therapy has been reviewed and approved by a qualified institutional review board (IRB);

(3) The facility and personnel providing the treatment are capable of doing so by virtue of their experience, training, and volume of patients treated to maintain expertise;

(4) The patients receiving the investigational treatment meet all protocol requirements;

(5) There is no clearly superior, noninvestigational alternative to the protocol treatment;

(6) The available clinical or preclinical data provide a reasonable expectation that the protocol treatment will be at least as efficacious as the noninvestigational alternative; and

(7) The coverage of new cancer therapy treatment provided pursuant to a phase II clinical trial is not required for only that portion of that treatment that is provided as part of the phase II clinical trial and is funded by a national agency, such as the National Cancer Institute, the Veterans Administration, the Department of Defense, or funded by commercial organizations such as the biotechnical and/or pharmaceutical industry or manufacturers of medical devices. Any portions of a phase II trial which are customarily funded by government, biotechnical and/or pharmaceutical and/or medical device industry sources in Rhode Island or in other states shall continue to be funded in Rhode Island and coverage pursuant to this section supplements, does not supplant customary funding.
R.I. Gen. Laws § 27-51-7 — RI Code / Title 27 / Chapter 27-51 / Section 27-51-7
§ 27-51-7. Penalties and liabilities.
Status: in_force

(a) If the commissioner finds after a hearing conducted in accordance with the Administrative Procedures Act, chapter 35 of title 42, that any person has violated any provision(s) of this chapter, the commissioner may order:

(1) For each separate violation, a penalty in an amount not exceeding one thousand dollars ($1,000);

(2) Revocation or suspension of the producers license. If it was found that because of material noncompliance the insurer has suffered any loss or damage, the commissioner may maintain a civil action brought by or on behalf of the insurer and its policyholders and creditors for recovery of compensatory damages for the benefit of the insurer and its policyholders and creditors or other appropriate relief.

(b) If an order of rehabilitation or liquidation of the insurer has been entered pursuant to applicable Rhode Island law and the receiver appointed under that order determines that the MGA or any other person has not materially complied with this chapter, or any regulation or order promulgated pursuant to this chapter, and the insurer suffered any loss or damage from the noncompliance, the receiver may maintain a civil action for recovery of damages or other appropriate sanctions for the benefit of the insurer.

(c) Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided for in the insurance law.

(d) Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, and auditors.
R.I. Gen. Laws § 27-9-7.2 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-7.2
§ 27-9-7.2. Premium reduction for antitheft devices.
Status: in_force

Every schedule of rates, rating plan, or rating system for automobile liability and physical damage insurance filed with the commissioner shall provide for an appropriate reduction in premium charges for vehicles equipped with an antitheft mechanism or device approved by the commissioner. The commissioner is authorized to promulgate rules and regulations to carry out the purpose of this section.
R.I. Gen. Laws § 27-18-64 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-64
§ 27-18-64. 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. Such coverage 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 executive office of health and human services as eligible for services under part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1471 et seq.).

(b) Insurers shall reimburse certified, early intervention providers, who are designated as such by the executive office of health and 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 executive office of health and 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 § 27-20-72 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-72
§ 27-20-72. Health insurance contracts  Full year coverage for contraception.
Status: in_force

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 § 27-4-25 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-25
§ 27-4-25. Physical exam by insurance company.
Status: in_force

Any applicant for life insurance with any company organized or doing business within this state shall be provided, upon request, any and all medical reports by a physician or other medical personnel that were performed at the request or the direction of that company. These reports shall only be provided to a physician of the applicants choice whether the applicant receives a rating or rejection from a company and the provisions of this section shall also apply to medical examinations performed pursuant to applications for an increase in insurance coverage.
R.I. Gen. Laws § 27-52-4 — RI Code / Title 27 / Chapter 27-52 / Section 27-52-4
§ 27-52-4. Required contract provisions  Reinsurance intermediary brokers.
Status: in_force

Transactions between a RB and the insurer it represents in that capacity shall only be entered into pursuant to a written authorization, specifying the responsibilities of each party. The authorization shall, at a minimum, provide that:

(1) The insurer may terminate the RBs authority at any time;

(2) The RB will render accounts to the insurer accurately detailing all material transactions, including information necessary to support all commissions, charges, and other fees received by, or owing, to the RB, and remit all funds due to the insurer within thirty (30) days of receipt;

(3) All funds collected for the insurers account will be held by the RB in a fiduciary capacity in a bank that is a qualified U.S. financial institution as defined in this chapter;

(4) The RB will comply with § 27-52-5;

(5) The RB will comply with the written standards established by the insurer for the cession or retrocession of all risks; and

(6) The RB will disclose to the insurer any relationship with any reinsurer to which business will be ceded or retroceded.
R.I. Gen. Laws § 27-32-9 — RI Code / Title 27 / Chapter 27-32 / Section 27-32-9
§ 27-32-9. Severability.
Status: in_force

If any provision of this chapter or application of it to any person or circumstance is held invalid, this invalidity shall not affect other provisions or applications of the chapter, which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared severable.
R.I. Gen. Laws § 27-6-42 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-42
§ 27-6-42. Interchange of rating plan data.
Status: in_force

Reasonable rules and plans may be promulgated by the commissioner for the interchange of data necessary for the application of rating plans.
R.I. Gen. Laws § 27-59-2 — RI Code / Title 27 / Chapter 27-59 / Section 27-59-2
§ 27-59-2. Licensing authority.
Status: in_force

Any alien insurance company, with the approval of the commissioner, may be treated, in whole or in part, as a domestic insurer of this state; provided, that:

(1) The alien insurance company appoints a resident registered agent to accept service of process and to act on its behalf in this state. Whenever the registered agent cannot with reasonable diligence be found at the registered office of the alien insurance company, the commissioner shall be an agent of the alien insurance company on which any process, notice, or demand may be served; and

(2) The alien insurance company obtains from the commissioner a license authorizing it to do insurance business in the state.
R.I. Gen. Laws § 27-44-15 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-15
§ 27-44-15. Exemptions.
Status: in_force

The director may, by his or her own initiative or upon request of any person, by rule, exempt any market from any or all of the provisions of this chapter, if and to the extent that the director finds an exemption necessary to achieve the purpose of this chapter.
R.I. Gen. Laws § 27-1-2.1 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-2.1
§ 27-1-2.1. Corporate governance standards.
Status: in_force

(a) The importance of good corporate governance is crucial in promoting integrity in an insurance companys business practices and in maintaining public confidence and policyholder trust. The size and ownership structure of a company often determines the corporate governance standards employed by the company. All Rhode Island domestic insurers, regardless of their size or ownership structure, shall establish the following minimum corporate governance standards:

(1) The board of directors must be comprised of a minimum of five (5) and a maximum of twenty-one (21) members.

(2) The board must meet at least two (2) times per year, however, four (4) times per year is encouraged.

(3) The board must establish a written attendance policy.

(4) The board shall have authority to meet in executive session.

(5) There must be an audit committee established by and amongst the board of directors for the purpose of overseeing the accounting and financial reporting processes of the insurer and audits of the financial statement of the insurer. If no such committee exists, the entire board of directors shall act as the audit committee.

(6) The board must review the minutes of the audit committee.

(7) The audit committee must meet at least two (2) times per year.

(8) There must be a written audit committee charter.

(9) At least one member of the audit committee must have knowledge of statutory accounting principles or generally accepted accounting principles.

(10) The internal audit function should have a direct reporting relationship to the audit committee for critical matters such as the audit plan, resources, and budgets.

(11) The audit committee must approve the selection of the independent auditor that performs any audit required by the Rhode Island regulation governing annual audited financial reports.

(12) The audit committee shall require the independent accountant that performs any audit required by Rhode Island regulation governing annual audited financial reports, to timely report to the audit committee in accordance with the requirements of Statement of Auditing Standards No. 61, communications with audit committee, or its replacement, including:

(i) All significant accounting policies and material permitted practices;

(ii) All material alternative treatments of financial information within statutory accounting principles that have been discussed with management officials of the insurer, ramifications of the use of the alternative disclosures and treatments, and the treatment preferred by the accountant; and

(iii) Other material written communications between the accountant and the management of the insurer, such as any management letter or schedule of unadjusted differences.

(13) There must be a written code of ethics covering directors and officers that includes the insurers conflict of interest policy.

(14) There should be a written policy encouraging employees to come forward with observations of improprieties or other malfeasance.

(15) On or after July 1, 2008, no domestic insurer or any affiliate member of its holding company system (as defined in § 27-35-1 et seq.) may extend or maintain credit, arrange for the extension of credit, or renew an extension of credit in the form of a personal loan to or for any director or officer of a domestic insurer. The terms and purpose of any such existing extensions of credit made to any director or officer of a domestic insurer must be disclosed to the director. For purposes of this subsection, benefits that are offered to directors or officers as policyholders of a domestic insurer, or benefits that are offered to the general public in the insurers normal course of business, shall not be considered a violation of this subsection.

(b) In addition to the standards enumerated in subsection (a) of this section, the following corporate governance standards must be employed by all Rhode Island domestic mutual insurance companies and all domestic insurance companies writing more than one hundred million dollars ($100,000,000) in premium, in any jurisdiction, on a direct and/or assumed basis, as determined at the end of the previous calendar year:

(1) The board must have an independent majority of members.

(2) The audit committee must have an independent majority of members.

(3) The audit committee must approve all related party transactions, which include transactions between the company and its affiliates and those between the company and its officers and directors. The company may establish materiality thresholds, however, they must be clearly stated in its audit committee charter as required by subsection (a)(8), but in no event shall the materiality thresholds exceed those established in chapter 35 of this title.

(c) For purposes of this section, an independent board or audit committee member is defined as an individual: (1) who is not being compensated by the domestic insurer or any company within its holding company system (organization), other than any reasonable compensation and benefits for services as a director, and has not been compensated within the past twelve (12) months including full-time and part-time compensation as an employee or an independent contractor, except for reasonable compensation as a director; (2) whose own compensation is not determined by individuals who are compensated by the organization, except for reasonable compensation paid to the director; (3) who does not receive material financial benefits (i.e., service contracts, grants, or other payments) from the organization; or (4) who is not related to (as a spouse, sibling, parent, or child) or the domestic partner of an individual compensated by or who receives material financial benefits from the organization. Policyholders of a domestic insurer may be considered independent providing they meet the requirements as defined in this subsection.

(d) Any Rhode Island domestic insurer that does not currently employ one or more of the standards enumerated in subsections (a) and (b) of this section, must submit a plan of corrective action to the director for the directors approval. The director, at the directors discretion, may waive any of the requirements in this section for a period not exceeding thirty-six (36) months. The directors refusal to approve a plan of corrective action after reviewing such plan of corrective action for a period of sixty (60) days shall constitute a final order for purposes of the Rhode Island administrative procedures act allowing the party to appeal to the superior court.

(e) Nothing contained in the companys bylaws shall conflict with the corporate governance standards set forth in this act. Any amendments to a domestic insurance companys bylaws shall be submitted in writing to the department.

(f) A domestic insurer that is a member of an insurance holding company system as defined in chapter 35 of this title, is exempt from this section if it can demonstrate that it is, or is controlled by an entity that either is required to be compliant with, or voluntarily is compliant with, all of the following provisions of the Sarbanes-Oxley Act of 2002: (i) the preapproval requirements of section 201 (section 10A(i) of the Securities Exchange Act of 1934); (ii) the audit committee independence requirements of section 301 (section 10A(m)(3) of the Securities Exchange Act of 1934); and (iii) the internal control over financial reporting requirements of section 404 (Item 308 of SEC regulation S-K)  (SOX Compliant Entity). If the department makes a determination, as a result of its statutory examination or financial analysis, that the domestic insurer is not controlled by a SOX Compliant entity or that the insurers interests and affairs are not adequately considered and evaluated by the SOX Compliant Entity, the domestic insurer must take steps to comply with this act.

(g) A Rhode Island domestic insurer that is a wholly-owned subsidiary of another Rhode Island domestic insurer that is compliant with the provisions of subsection (a), and if applicable the requirements of subsection (b), shall be exempt from compliance with any other requirements of this act.

(h) The requirements of this section, 27-1-2.1, shall not apply to entities regulated pursuant to chapters 19, 20, 20.1, 20.2, 20.3, and 41 of this title and shall not supersede or replace any specific statutory corporate governance standards otherwise applicable to domestic insurance companies.
R.I. Gen. Laws § 27-41-91 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-91
§ 27-41-91. Health insurance contracts  Copayments exemption for COVID-19 vaccinations.
Status: in_force

(a) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for COVID-19 related services, including, but not limited to: emergency services, inpatient services, provider office visits, and inpatient hospital stays, as long as the COVID-19 state of emergency remains in effect.

(b) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for the administration of the COVID-19 vaccine or a COVID-19 test.

(c) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary for the efficient administration and enforcement of this section.
R.I. Gen. Laws § 27-44-18 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-18
§ 27-44-18. Penalties.
Status: in_force

(a) The director may, if he or she finds that any person or organization has violated any provision of this chapter, impose a penalty of not more than one thousand dollars ($1,000) for each violation, but if the director finds the violation to be willful, he or she may impose a penalty of not more than fifty thousand dollars ($50,000) for each violation. The penalties may be in addition to any other penalty provided by law.

(b) For the purposes of this section, any insurer using a rate for which the insurer has failed to file the rate, supplementary rate information, or supporting information, as required by this chapter or by any rules and regulations that the director may promulgate, has committed a separate violation for each day that failure continues.

(c) The director may suspend or revoke the license of any rating organization or insurer that fails to comply with an order of the director within the time limited by the order, or any extension of the order that the director may grant.

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

(e) No penalty shall be imposed and no license shall be suspended or revoked except upon a written order of the director, stating his or her findings, made after a hearing.
R.I. Gen. Laws § 27-44-19 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-19
§ 27-44-19. Regulations.
Status: in_force

The director may promulgate any reasonable regulations that are necessary and proper to enforce this chapter and to require any information that the director finds necessary.
R.I. Gen. Laws § 27-19-59 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-59
§ 27-19-59. Mandatory coverage for scalp hair prosthesis.
Status: in_force

(a) 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 on or after January 1, 2007, that provides coverage for any other prosthesis, shall provide coverage for expenses for scalp hair prosthesis worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that the coverage shall be subject to the same limitations and guidelines as other prosthesis, and that coverage shall not exceed an amount of three hundred fifty dollars ($350) per covered member per year, exclusive of any deductible.

(b) 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 § 27-59-1 — RI Code / Title 27 / Chapter 27-59 / Section 27-59-1
§ 27-59-1. Definitions.
Status: in_force

As used in this chapter, unless the context requires otherwise:

(1) Alien insurance company means any insurance company incorporated or organized under the laws of any country other than the United States.

(2) Commissioner means the director of the department of business regulation.
R.I. Gen. Laws § 27-9-18 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-18
§ 27-9-18. Disapproval of filing after review period  Removal of discrimination  Hearings to determine effect of legislation.
Status: in_force

(a) If at any time, subsequent to the applicable review period provided for in § 27-9-16 or § 27-9-17, 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 that hearing to every insurer and rating organization that used that rate or made that filing, issue an order specifying on 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. That 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 similar notice to the insurer affected and to any rating organization that made the filing, issue an order that the discrimination be removed.

(b)(1) Whenever legislation is enacted that restricts or removes common law rights of action in tort and/or statutory rights as to causes of action or damages, within one year after the passage of that restrictive legislation, those insurance companies underwriting affected lines shall request hearings to be held to determine the effect of that legislation on insurance policies, their cost and benefits;

(2) The findings of the hearings with reference to the decrease of frequency in claims shall constitute the basis for an immediate reduction of rates and if excess profits have been obtained, the commissioner shall order a refund of all excess profits, and the commissioner shall annually review the continued effect of the legislation until it is reasonably ascertained that a proper rate level has been established. Copies of any order issued pursuant to this section shall be sent to every affected insurer and rating organization.
R.I. Gen. Laws § 27-29-17 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-17
§ 27-29-17. Application.
Status: in_force

Sections 27-29-17  27-29-17.4 shall apply to commercial property insurance policies, commercial liability insurance policies, commercial package policies, commercial excess or umbrella policies, and commercial auto policies. These sections shall not apply to reinsurance, aviation insurance, workers compensation and employers liability insurance, multistate location risks, or policies subject to retrospective rating plans.
R.I. Gen. Laws § 27-29-12 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-12
§ 27-29-12. Regulations.
Status: in_force

The commissioner of insurance may adopt reasonable rules and regulations for the implementation and administration of this chapter.
R.I. Gen. Laws § 27-25-33 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-33
§ 27-25-33. Licensing of insurance producers.
Status: in_force

(a) Insurance producers of societies shall be licensed in accordance with the provisions of the laws regulating the licensing, revocation, suspension, or termination of license of resident and nonresident insurance producers.

(b) No examination or license shall be required of any regular salaried officer, employee, or member of a licensed society who devotes substantially all of his or her services to activities other than the solicitation of fraternal insurance contracts from the public, and who receives for the solicitation of the contracts no commission or other compensation directly dependent upon the amount of business obtained.

(c) Any insurance producer, representative, or member of a society who devotes, or intends to devote, less than fifty percent (50%) of his or her time to the solicitation and procurement of insurance contracts for the society or who was in the service of a society on January 1, 1985, shall be exempt from the requirements of subsection (a) of this section. Any person who in the preceding calendar year has solicited and procured life insurance contracts on behalf of any society in an amount of insurance in excess of fifty thousand dollars ($50,000) or, in the case of any other kind or kinds of insurance which the society might write, on the persons of more than twenty-five (25) individuals and who has received or will receive a commission or other compensation for those contracts, shall be presumed to be devoting, or intending to devote, fifty percent (50%) of his or her time to the solicitation or procurement of insurance contracts for the society.
R.I. Gen. Laws § 27-46-10 — RI Code / Title 27 / Chapter 27-46 / Section 27-46-10
§ 27-46-10. Purchasing group taxation.
Status: in_force

Premium taxes and taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any members of the purchasing groups shall be:

(1) Imposed at the same rate and subject to the same interest, fines, and penalties as that applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insureds; and

(2) Paid first by the insurance source, and if not by the source by the agent or broker or producer for the purchasing group, and if not by the agent or broker or producer then by the purchasing group, and if not by the purchasing group then by each of its members.
R.I. Gen. Laws § 27-19-5.3 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-5.3
§ 27-19-5.3. Additional powers.
Status: in_force

Notwithstanding any other law or section of this chapter that may be inconsistent with this section, each nonprofit hospital service corporation may, through a subsidiary, develop, underwrite, and/or offer for sale life insurance, disability insurance, long-term care insurance, employee assistance programs, and/or other health-related programs; provided, however, prior to underwriting risk under policies of insurance listed above, the nonprofit hospital service corporation must first demonstrate that underwriting such risk is consistent with the statutory mission of the nonprofit hospital service corporation and obtain prior written approval from the health insurance commissioner. Each nonprofit hospital service corporation may also directly, or by contracting with another entity, develop and/or offer for sale the policies or programs described in this section. However, the nonprofit hospital service corporation shall not directly underwrite any risk under a policy of insurance described in this section.
R.I. Gen. Laws § 27-9-23 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-23
§ 27-9-23. Admission of and services to subscribers.
Status: in_force

Subject to rules and regulations that have been approved by the commissioner as reasonable, each rating organization shall permit any insurer not a member to be a subscriber to its rating services for any kind of insurance or subdivision of insurance for which it is authorized to act as a rating organization. Notice of proposed changes in those rules and regulations shall be given to subscribers. Each rating organization shall furnish its rating services without discrimination to its members and subscribers. The reasonableness of any rule or regulation in its application to subscribers, or the refusal of any rating organization to admit an insurer as a subscriber, shall, at the request of any subscriber or any affected insurer, be reviewed by the commissioner at a hearing held upon at least ten (10) days written notice to the rating organization and to the subscriber or insurer. If the commissioner finds that the rule or regulation is unreasonable in its application to subscribers, the commissioner shall order that the rule or regulation shall not be applicable to subscribers. If the rating organization fails to grant or reject an insurers application for subscribership within thirty (30) days after it was made, the insurer may request a review by the commissioner as if the application had been rejected. If the commissioner finds that the insurer has been refused admittance to the rating organization as a subscriber without justification, the commissioner shall order the rating organization to admit the insurer as a subscriber. If the commissioner finds that the action of the rating organization was justified, the commissioner shall make an order affirming its action.
R.I. Gen. Laws § 27-6-22 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-22
§ 27-6-22. Filed schedules and plans not to be disapproved if rates meet requirements.
Status: in_force

No manual, minimum, or class rate, rating schedule, rating plan, rating rule, or any modification of any of these which has been filed pursuant to the requirements of §§ 27-6-8  27-6-16 shall be disapproved if the rates produced meet the requirements of this chapter.
R.I. Gen. Laws § 27-57-4 — RI Code / Title 27 / Chapter 27-57 / Section 27-57-4
§ 27-57-4. Information to be provided by the department of human services, office of child support services, child support enforcement.
Status: in_force

(a) The department shall periodically within each year furnish the insurance companies and insurers subject to this section with a list or compilation of names of individuals, with last known addresses, who as of the date of the list or compilation owe past-due support in excess of five hundred dollars ($500) as shown on the Rhode Island family court/department of human services, office of child support services, child support enforcement computer system (CSE system). For the purposes of this section, the terms used in this section have the meaning and definitions specified in §15-16-2.

(b) In order to facilitate the efficient and prompt reporting of those arrearages in one centralized location, it is the duty and responsibility of the insurance companies doing business in the state to utilize one centralized database to which the department shall report and administer.

[See §12-1-15 of the General Laws.]
R.I. Gen. Laws § 27-5-12 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-12
§ 27-5-12. Declination of premium notes by mutual companies  Provision as to liability.
Status: in_force

Every mutual fire insurance company organized under the laws of this state may decline to take premium notes in partial payment for insurance; provided, there is inserted in the body of the policy issued a provision making the assured, his or her or their executors, administrators, or assigns, liable for any assessments provided in the policy, and as shall become necessary in order to pay all losses and expenses not exceeding twenty (20) times the amount of the cash premium paid.
R.I. Gen. Laws § 27-6-48 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-48
§ 27-6-48. Suspension or revocation of licenses.
Status: in_force

(a) The commissioner may suspend the license of any rating organization or insurer that fails to comply with an order of the commissioner within the time limited by the order, or any extension that the commissioner may grant. The commissioner shall not suspend the license of any rating 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 a license shall become effective, and it shall remain in effect for the period fixed by the commissioner, unless the commissioner modifies or rescinds that suspension, or until the order upon which that 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 upon not less than ten (10) days written notice to the person or organization specifying the alleged violation.
R.I. Gen. Laws § 27-41-27.2 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-27.2
§ 27-41-27.2. Health insurance rates.
Status: in_force

No insurance company organized as a stock or mutual corporation that merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or acquires control of a nonprofit hospital service corporation organized under chapter 19 of this title, a nonprofit medical service corporation organized under chapter 20 of this title, or a health maintenance organization organized under chapter 41 of this title: (1) May file with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) May charge to any party in the state any rate or premium, that takes into account or reflects in any manner the value of any contribution, distribution, or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a nonprofit hospital service corporation, nonprofit medical service corporation, or health maintenance organization. For any rate that is to be charged to policyholders, regardless of whether this rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the companys compliance with this section.
R.I. Gen. Laws § 27-18-66 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-66
§ 27-18-66. Tobacco cessation programs.
Status: in_force

(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2010, that provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if such medical coverage does not include prescription drug coverage, such contract, plan, or policy shall not be required to include coverage for FDA approved smoking cessation medications.

(b) As used in this section, smoking cessation treatment includes the use of an over-the-counter (OTC) or prescription U.S. Food and Drug Administration (FDA) approved smoking cessation medication when used in accordance with FDA approval, for not more than two (2) courses of medication of up to fourteen (14) weeks each, annually, when recommended and prescribed by a prescriber who holds prescriptive privileges in the state in which they are licensed, and used in combination with an annual outpatient benefit of sixteen (16) one-half (Â½) hour evidence-based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner, in accordance with the most current clinical practice guidelines sponsored by the United States Department of Health and Human Services or its component agencies.

(c) Health insurance contracts, plans, or policies to which this section applies, may impose copayments and/or deductibles for the benefits mandated by this section consistent with the contracts, plans, or policies copayments and/or deductibles for physician services and medications. Nothing contained in this section shall impact the reimbursement, medical necessity or utilization review, managed care, or case management practices of these health insurance contracts, plans, or policies.

(d) 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 § 27-34-16 — RI Code / Title 27 / Chapter 27-34 / Section 27-34-16
§ 27-34-16. Immunity.
Status: in_force

There shall be no liability on the part of, and no cause of action of any nature shall arise against, any member insurer, the association, or its agents or employees, the board of directors, or any persons serving as an alternate or substitute representative of any director, or the commissioner or his or her representatives for any action taken or any failure to act by them in the performance of their powers and duties under this chapter.
R.I. Gen. Laws § 27-49-3 — RI Code / Title 27 / Chapter 27-49 / Section 27-49-3
§ 27-49-3. Disclosure of information.
Status: in_force

(a) Upon written request to an insurer by an authorized governmental agency, an insurer or agent authorized by an insurer to act on its behalf shall release to the requesting authorized governmental agency any or all relevant information that is deemed important to the authorized governmental agency and that the insurer may possess relating to any specific motor vehicle theft or motor vehicle insurance fraud. Relevant information may include, but is not limited to:

(1) Insurance policy information relevant to the motor vehicle theft or motor vehicle insurance fraud under investigation, including any application for the policy;

(2) Policy premium payment records that are available;

(3) History of previous claims made by the insured; and

(4) Information relating to the investigation of the motor vehicle theft or motor vehicle insurance fraud, including statements of any person, proofs of loss, and notice of loss.

(b) When an insurer knows the identity of a person, or possesses information tending to establish the identity of a person, whom it has reason to believe committed a criminal or fraudulent act relating to a motor vehicle theft or motor vehicle insurance claim, or has knowledge of a criminal or fraudulent act that is reasonably believed not to have been reported to an authorized governmental agency, then for the purpose of notification and investigation, the insurer or an agent authorized by an insurer to act on its behalf shall notify an authorized governmental agency of the knowledge or information and provide any additional information in accordance with subsection (a). For the purpose of this chapter, when an insurer provides any of the authorized governmental agencies with notice pursuant to this section it shall be deemed sufficient notice to all authorized governmental agencies. Nothing in this subsection shall abrogate or impair the rights or powers created under subsection (a).

(c) The authorized governmental agency provided with information pursuant to subsection (a) or (b) may release or provide the information to any other authorized governmental agencies.

(d) Any insurer providing information to an authorized governmental agency pursuant to this section shall have the right to request and receive relevant information from the authorized governmental agency, and receive within a reasonable time, not to exceed thirty (30) days, the requested information.
R.I. Gen. Laws § 27-46-12 — RI Code / Title 27 / Chapter 27-46 / Section 27-46-12
§ 27-46-12. Duty of agents or brokers or insurance producers to obtain license.
Status: in_force

(a) Risk retention groups. No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance in this state from a risk retention group unless that person, firm, association, or corporation is licensed as an insurance agent or broker or producer in accordance with applicable provisions of law.

(b) Purchasing groups. (1) No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance in this state for a purchasing group from an authorized insurer or a risk retention group chartered in a state unless that person, firm, association, or corporation is licensed as an insurance agent or broker or producer in accordance with applicable provisions of law; (2) No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance coverage in this state for any member of a purchasing group under a purchasing groups policy unless that person, firm, association, or corporation is licensed as an insurance agent or broker or producer in accordance with applicable provisions of law; (3) No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance from an insurer not authorized to do business in this state on behalf of a purchasing group located in this state unless that person, firm, association, or corporation is licensed as a surplus lines agent or excess line broker in accordance with applicable provisions of law.

(c) Residency. For the purposes of acting as an agent or broker or insurance producer for a risk retention group or purchasing group pursuant to subsections (a) and (b) of this section, the requirement of residence in this state shall not apply.

(d) Notice requirements. Every person, firm, association, or corporation licensed pursuant to the provisions of law relating to agents or brokers or insurance producers shall inform each prospective insured on business placed with risk retention groups or written through a purchasing group of the provisions of the notice required by § 27-46-4(7) in the case of a risk retention group and § 27-46-9(c) in the case of a purchasing group.
R.I. Gen. Laws § 27-2-14 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-14
§ 27-2-14. Forwarding of process by commissioner.
Status: in_force

(a) Whenever lawful process against a foreign insurance company shall be served upon the insurance commissioner, the commissioner shall forward a copy of the process served on the commissioner, to the person appointed by the insurance company to accept service of process on behalf of the company. The manner of forwarding shall be at the discretion of the insurance commissioner.

(b) Service upon the insurance commissioner shall be accomplished by regular mail or by whatever alternative method is designated by the commissioner.

(c) For each copy of process the insurance commissioner shall collect, for the use of the state, the sum of twenty-five dollars ($25.00), which shall be paid by the plaintiff at the time of the service; the fee is to be recovered by the plaintiff as part of the taxable costs, if the plaintiff prevails in the suit.
R.I. Gen. Laws § 27-71-8 — RI Code / Title 27 / Chapter 27-71 / Section 27-71-8
§ 27-71-8. Confidentiality requirements.
Status: in_force

(a) Except as otherwise provided by law, market conduct surveillance personnel shall have free and full access to all books and records, employees, officers, and directors, as practicable, of the insurer during regular business hours. An insurer utilizing a third-party model or product for any of the activities under examination shall cause, upon the request of market conduct surveillance personnel, the details of such models or products to be made available to such personnel. All documents, whether from a third party or an insurer, including, but not limited to, working papers, third-party models or products, complaint logs, and copies thereof, created, produced, or obtained by or disclosed to the commissioner or any other person in the course of any market conduct actions made pursuant to this chapter, or in the course of market analysis by the commissioner of the market conditions of an insurer, or obtained by the NAIC as a result of any of the provisions of this chapter, shall be confidential by law and privileged, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. The commissioner will work with an insurer to assure that the insurers privacy and information security procedures are not compromised as a result of or in connection with an examination.

(b) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the commissioner under this section.

(c) Market conduct surveillance personnel shall be vested with the power to issue subpoenas and examine insurance company personnel under oath when such action is ordered by the commissioner.

(d) Notwithstanding the provisions of subsection (a) of this section, in order to assist in the performance of the commissioners duties, the commissioner may:

(1) Share documents, materials, or other information, including the confidential and privileged documents, materials, or information subject to subsection (a), with other state, federal, and international regulatory agencies and law enforcement authorities and the NAIC and its affiliates and subsidiaries, provided that the recipient agrees to and has the legal authority to maintain the confidentiality and privileged status of the document, material, communication, or other information;

(2) Receive documents, materials, communications, or information, including otherwise confidential and privileged documents, materials, or information, from the NAIC and its affiliates or subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any documents, materials, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information;

(3) Enter into agreements governing the sharing and use of information consistent with this subsection (d); and

(4) Notwithstanding the provisions of this section, no insurer shall be compelled to waive any statutory or common law privilege, but may voluntarily disclose such document to the commissioner in response to any market analysis, market conduct action or examination as provided in this chapter.
R.I. Gen. Laws § 27-18-3.4 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-3.4
§ 27-18-3.4. Judicial review.
Status: in_force

Any person, firm, or corporation aggrieved by a decision or order per § 27-18-3.3 shall have a right of appeal pursuant to the provisions of § 42-35-15.
R.I. Gen. Laws § 27-5-26 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-26
§ 27-5-26. Physical assets for protection of policyholders.
Status: in_force

The policy registers, insurance maps, books of record, and other books in use by a fire insurance company in its business, and its policy and other blanks, office furniture, fixtures, and supplies, are not to be considered as assets, but shall be held by the company for its use in the protection of its policyholders.
R.I. Gen. Laws § 27-18-90 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-90
§ 27-18-90. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.
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, 2023, shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobulin therapy.

(b) [Deleted by P.L. 2025, ch. 286, § 1 and P.L. 2025, ch. 287, § 1.]

(c) The healthcare benefits outlined in this section apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this section outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carriers network.

(d), (e) [Deleted by P.L. 2025, ch. 286, § 1 and P.L. 2025, ch. 287, § 1.]
R.I. Gen. Laws § 27-19-63 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-63
§ 27-19-63. Prohibition on 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 Internal Revenue Code, a medical savings account, as defined in section 220 of the Internal Revenue Code, and a health savings account, as defined in section 223 of the Internal Revenue Code, are not subject to the requirements of subsections (a)(1) and (a)(2) of this section. (ii) The provisions of this subsection (a) shall not prevent a health insurance carrier and health benefit plan 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 and health benefit plan 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), 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 in accordance with federal laws and regulations.

(c)(1) The provisions of this section relating to lifetime limits apply to any health insurance carrier providing coverage under an individual or group health plan, including grandfathered health plans.

(2) The provisions of this section relating to annual limits apply to any health insurance carrier providing coverage under a group health plan, including grandfathered health plans, 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, § 2 and P.L. 2024, ch. 202, § 2.]
R.I. Gen. Laws § 27-33-7 — RI Code / Title 27 / Chapter 27-33 / Section 27-33-7
§ 27-33-7. Authorization of payment.
Status: in_force

The fund shall reimburse the secretary, up to amounts actually collected by it, upon drafts or vouchers duly authorized by the general treasurer with the approval of the director of business regulation.
R.I. Gen. Laws § 27-77-6 — RI Code / Title 27 / Chapter 27-77 / Section 27-77-6
§ 27-77-6. Exemption.
Status: in_force

(a) An insurer shall be exempt from the requirements of this chapter, if:

(1) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than five hundred million dollars ($500,000,000); and

(2) The insurance group of which the insurer is a member has annual direct written and unaffiliated assumed premium, including international direct and assumed premium, but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than one billion dollars ($1,000,000,000).

(b) If an insurer qualifies for exemption pursuant to subsection (a)(1) of this section, but the insurance group of which the insurer is a member does not qualify for exemption pursuant to subsection (a)(2), then the ORSA summary report that may be required pursuant to § 27-77-5 shall include every insurer within the insurance group. This requirement may be satisfied by the submission of more than one ORSA summary report for any combination of insurers provided any combination of reports includes every insurer within the insurance group.

(c) If an insurer does not qualify for exemption pursuant to subsection (a)(1) of this section, but the insurance group of which it is a member qualifies for exemption pursuant to subsection (a)(2), then the only ORSA summary report that may be required pursuant to § 27-77-5 shall be the report applicable to that insurer.

(d) An insurer that does not qualify for exemption pursuant to subsection (a) may apply to the commissioner for a waiver from the requirements of this chapter based upon unique circumstances. In deciding whether to grant the insurers request for waiver, the commissioner may consider the type and volume of business written, ownership and organizational structure, and any other factor the commissioner considers relevant to the insurer or insurance group of which the insurer is a member. If the insurer is part of an insurance group with insurers domiciled in more than one state, the commissioner shall coordinate with the lead state commissioner and with the other domiciliary commissioners in considering whether to grant the insurers request for a waiver.

(e) Notwithstanding the exemptions stated in this section:

(1) The commissioner may require that an insurer maintain a risk management framework, conduct an ORSA, and file an ORSA summary report based on unique circumstances including, but not limited to, the type and volume of business written, ownership and organizational structure, federal agency requests, and international supervisor requests; and

(2) The commissioner may require that an insurer maintain a risk management framework, conduct an ORSA, and file an ORSA summary report if the insurer has risk-based capital for company action level event as defined and governed by chapter 4.6 of this title, meets one or more of the standards of an insurer deemed to be in hazardous financial condition as defined in chapter 14.2 of this title, or otherwise exhibits qualities of a troubled insurer as determined by the commissioner.

(f) If an insurer that qualifies for an exemption pursuant to subsection (a) subsequently no longer qualifies for that exemption due to changes in premium as reflected in the insurers most recent annual statement or in the most recent annual statements of the insurers within the insurance group of which the insurer is a member, the insurer shall have one year following the year the threshold is exceeded to comply with the requirements of this chapter.
R.I. Gen. Laws § 27-35-12 — RI Code / Title 27 / Chapter 27-35 / Section 27-35-12
§ 27-35-12. Judicial review  Mandamus.
Status: in_force

(a) Any person aggrieved by any act, determination, rule, regulation, or order or any other action of the commissioner pursuant to this chapter may appeal the action to the superior court. The court shall conduct its review without a jury and by trial de novo, except that if all parties, including the commissioner, so stipulate, the review shall be confined to the record. Portions of the record may be introduced by stipulation into evidence in a trial de novo as to those parties so stipulating.

(b) The filing of an appeal pursuant to this section shall stay the application of any rule, regulation, order, or other action of the commissioner to the appealing party unless the court, after giving the party notice and an opportunity to be heard, determines that a stay would be detrimental to the interest of policyholders, shareholders, creditors, or the public.

(c) Any person aggrieved by any failure of the commissioner to act or make a determination required by this chapter may petition the superior court of Providence County for a writ in the nature of a mandamus or a peremptory mandamus directing the commissioner to act or make the determination.
R.I. Gen. Laws § 27-29-13.2 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-13.2
§ 27-29-13.2. Cancellation provisions for return of unearned premium.
Status: in_force

Every insurance policy issued and approved for use in Rhode Island shall provide clear language on the method of calculation of the unearned premium portion, if any, to be returned to the insured if the policy is canceled. Insurance policies shall not state refer to manuals to determine the amount of unearned premium to be returned. For all cancellations, the actual percentage retained by the insurer shall be discernible in the policy cancellation provisions. If a policy is canceled using a short-rate table, the insurer shall provide the short-rate table within the cancellation provisions of the insurance policy so that an insured can make an informed decision when cancelling a policy midterm. If a policy premium is fully earned or minimum earned on issuance of the policy, the quote and policy provisions shall clearly state that fact. Insurers shall not impose cancellation fees when insurance policies are canceled using short-rate tables.
R.I. Gen. Laws § 27-25-35 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-35
§ 27-25-35. Service of process.
Status: in_force

(a) Every society authorized to do business in this state shall appoint in writing the commissioner of insurance and each successor in office to be its true and lawful attorney upon whom all lawful process in any action or proceeding against it shall be served, and shall agree in the writing that any lawful process against it which is served on the attorney shall be of the same legal force and validity as if served upon the society, and that the authority shall continue in force so long as any liability remains outstanding in this state. Copies of the appointment, certified by the commissioner of insurance, shall be deemed sufficient evidence and shall be admitted in evidence with the same force and effect as the original might be admitted.

(b) Service shall only be made upon the commissioner of insurance, or if absent, upon the person in charge of the commissioners office. It shall be made in duplicate and shall constitute sufficient service upon the society. When legal process against a society is served upon the commissioner of insurance, the commissioner shall forward one of the duplicate copies by registered mail, prepaid, directed to the secretary or corresponding officer. No service shall require a society to file its answer, pleading, or defense in less than thirty (30) days from the date of mailing the copy of the service to a society. Legal process shall not be served upon a society except in the manner provided in this section. At the time of serving any process upon the commissioner of insurance, the plaintiff or complainant in the action shall pay to the commissioner of insurance a fee of five dollars ($5.00).
R.I. Gen. Laws § 27-18-2.1 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-2.1
§ 27-18-2.1. Uniform explanation of benefits and coverage.
Status: repealed

(a) A health insurance carrier 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 [42 U.S.C. § 300gg-15] of the Public Health Service Act, as amended by the federal Affordable Care Act. 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 § 27-6-50 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-50
§ 27-6-50. Pleadings and evidence at hearings.
Status: in_force

At any hearing before the commissioner, observance of formal rules of pleading or evidence shall not be required.
R.I. Gen. Laws § 27-29-17.5 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-17.5
§ 27-29-17.5. Insureds right to loss information.
Status: in_force

(a) Upon request by the first-named insured or that insureds authorized agent or broker, the insurer shall provide the following loss information, for the period of time coverage has been provided by the insurer or for five (5) years, whichever is less, within fourteen (14) days of such request:

(1) Information on closed claims, including date and descriptions of occurrence, and payments; and

(2) Information on open claims, including date and description of occurrence, and amounts of any payments and loss reserves.

(b) Nothing in this section shall affect the confidentiality requirements pursuant to chapter 37.3 of title 5 and to insurance regulations 99 (privacy of consumer financial information) and 100 (privacy of consumer health information) as promulgated by the department of business regulation.

(c) This section shall not apply to life, accident, health, personal automobile, homeowners, dwelling and boat, personal recreational vehicles, personal excess liability, personal umbrella, or reinsurance policies.

(d) Notwithstanding any other provision of this section, loss reserve information for claims subject to a documented coverage dispute between the insurer and the insured need not be provided to the first named insured or such insureds authorized agent or broker.
R.I. Gen. Laws § 27-49-6 — RI Code / Title 27 / Chapter 27-49 / Section 27-49-6
§ 27-49-6. Severability.
Status: in_force

If any clause, sentence, paragraph, section, or part of this chapter or its application to any person or circumstances, shall, for any reason, be adjudged by any court of competent jurisdiction to be invalid, that judgment shall not affect, impair, or invalidate the remainder of this chapter, and the application of this chapter to other persons or circumstances, but shall be confined in its operation to the clause, sentence, paragraph, section, or part of it directly involved in the controversy in which the judgment shall have been rendered and to the person or circumstances involved.
R.I. Gen. Laws § 27-17-13 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-13
§ 27-17-13. Certificate of deposit by foreign exchange or interinsurer.
Status: in_force

A foreign reciprocal exchange or interinsurer shall, before being authorized to do business in this state, furnish to the commissioner a certificate issued by a state treasurer or other state financial officer of the state where its principal place of business is located, that there has been deposited with him or her either in cash or securities the sum of one hundred thousand dollars ($100,000) for the benefit of all policyholders.
R.I. Gen. Laws § 27-74-9 — RI Code / Title 27 / Chapter 27-74 / Section 27-74-9
§ 27-74-9. Provider agreements  Provider listing requirements.
Status: in_force

(a) A discount medical plan organization shall have a written provider agreement with all providers offering medical or ancillary services to its members. The written provider agreement may be entered into directly with the provider or indirectly with a provider network to which the provider belongs.

(b) A provider agreement between a discount medical plan organization and a provider shall provide the following:

(1) A list of the medical or ancillary services and products to be provided at a discount;

(2) The amount or amounts of the discounts or, alternatively, a fee schedule that reflects the providers discounted rates; and

(3) That the provider will not charge members more than the discounted rates.

(c) A provider agreement between a discount medical plan organization and a provider network shall require that the provider network have written agreements with its providers that:

(1) Contain the provisions described in subsection (b) of this section;

(2) Authorize the provider network to contract with the discount medical plan organization on behalf of the provider; and

(3) Require the provider network to maintain an up-to-date list of its contracted providers and to provide the list on a monthly basis to the discount medical plan organization.

(d) A provider agreement between a discount medical plan organization and an entity that contracts with a provider network shall require that the entity, in its contract with the provider network, require the provider network to have written agreements with its providers that comply with subsection (c) of this section.

(e) The discount medical plan organization shall maintain a copy of each active provider agreement into which it has entered.

(f) Each discount medical plan organization shall maintain on an internet website page an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network. The internet website address shall be prominently displayed on all of its advertisements, marketing materials, brochures, and discount medical plan cards.

(g) This subsection applies to those providers with which the discount medical plan organization has contracted with directly as well as those providers that are members of a provider network with which the discount medical plan organization has contracted.
R.I. Gen. Laws § 27-10-4 — RI Code / Title 27 / Chapter 27-10 / Section 27-10-4
§ 27-10-4. Veterans license.
Status: in_force

The commissioner shall issue a license as an insurance claim adjuster, other than for life and accident and health insurance, without the payment of a fee, to any honorably discharged soldier, sailor, or marine who has at any time served the United States in time of war, and who shall present proof that he or she is the person who served and provides the certificate of his or her honorable discharge.
R.I. Gen. Laws § 27-2-6.1 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-6.1
§ 27-2-6.1. Special deposit for benefit of policyholders.
Status: in_force

(a) The insurance commissioner may require any insurance company, association, or society incorporated by or organized under the laws of any other state or government that seeks to make within this state any contract of insurance to make a special deposit as a condition to licensing. The special deposit shall be held in trust and on deposit for the benefit of all Rhode Island policyholders of the company, association, or society. The special deposit may be in any amount and form acceptable to the insurance commissioner. The special deposit shall be deposited with the insurance commissioner or with the general treasurer of this state.

(b) The special deposit shall be held exclusively for the benefit of the Rhode Island policyholders and claimants of the company, notwithstanding the source of the special deposit, and in any agreement entered pursuant to this section the insurer shall grant to the director an interest in the deposit to secure all present and future obligations of the insurer to the policyholders and claimants of the insurer in the state of Rhode Island. The directors interest shall continue until the insurers obligations are fully satisfied or until the deposit is released by the director.
R.I. Gen. Laws § 27-20-35.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-35.1
§ 27-20-35.1. Third-party reimbursement for services of registered nurse first assistants.
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 registered nurse first assistant; provided, that the following conditions are met:

(1) The registered nurse first assistant provides certain healthcare services under the supervision of a licensed physician; is currently licensed as a registered nurse in Rhode Island; has successfully completed a course in preparing the registered nurse as a first assistant in accordance with the Association of Operating Room Nurses core curriculum guide for the registered nurse first assistant and includes a minimum of one academic year in a college or university with didactic instruction and clinical internship programs; and is certified in perioperative nursing by the Certification Board of Perioperative Nursing (minimum of two years perioperative experience);

(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 registered nurse first assistant is not a salaried employee of the licensed hospital or facility for which the nonprofit medical service corporation has an alternative contractual relationship to fund the services of a registered nurse first assistant.

(b) It remains within the sole discretion of the nonprofit medical service corporation as to which registered nurse first assistant in surgery it contracts with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit medical service corporation: provided, that no nonprofit medical service corporation is required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant and any other healthcare provider. Nothing contained in this section precludes the nonprofit medical service corporations from conducting managed care, medical necessity, or utilization review.
R.I. Gen. Laws § 27-76-4 — RI Code / Title 27 / Chapter 27-76 / Section 27-76-4
§ 27-76-4. Notice of property loss.
Status: in_force

No insurance policy or contract covering damages to personal lines residential property may be canceled or nonrenewed, nor may the premium for such a policy be increased solely as a result of inquiries or claims made under the policy that resulted in no loss payout or resulted in a loss payout of less than five hundred dollars ($500). The provisions of this section shall not apply where more than one non-catastrophic claim is made under the policy in a three-year (3) period that resulted in any loss payout.
R.I. Gen. Laws § 27-19-72 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-72
§ 27-19-72. Consumer notification.
Status: in_force

Every nonprofit hospital service corporation providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a nonduplication of benefits clause: NO DUPLICATION OF BENEFITS.
R.I. Gen. Laws § 27-8-2 — RI Code / Title 27 / Chapter 27-8 / Section 27-8-2
§ 27-8-2. Reinsurance by domestic companies.
Status: in_force

Domestic fire and marine insurance companies may affect reinsurance of any risks taken by them.
R.I. Gen. Laws § 27-41-28 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-28
§ 27-41-28. Applicability.
Status: in_force

Notwithstanding any of the provisions of this chapter, except for §§ 27-41-5, 27-41-26, 27-41-35, and 27-41-37 which shall apply to all licensed health maintenance organizations including health maintenance organizations licensed pursuant to chapter 17 of title 23, nothing contained in this chapter shall apply to those health maintenance organizations licensed pursuant to chapter 17 of title 23 that were actively engaged in the provision of or making available to enrolled participants healthcare services prior to January 1, 1982; provided, that this exemption shall not under any circumstances have effect beyond July 1, 1994, and that on and after July 1, 1991, § 27-41-18 shall also apply to all licensed health maintenance organizations licensed pursuant to chapter 17 of title 23. Any health maintenance organization that was actively engaged in the provision of or making available to enrolled participants healthcare services prior to January 1, 1982, including a health maintenance organization that experiences a change in owner or change in operator as defined in § 23-17-2, may, at its discretion, continue to be licensed under the requirements and provisions of chapter 17 of title 23 until July 1, 1994, or under the requirements and provisions of this chapter. That health maintenance organization shall be deemed to be licensed under the requirements and the provisions of this chapter upon submission of materials required under § 27-41-3(b)(1), (2), (3), (4), and (11) sufficient and satisfactory to the director. Until July 1, 1998, the director shall waive, reduce, or alter the requirements of §§ 27-41-4 and 27-41-13 for licensure for this defined class of health maintenance organizations unless after notice and hearing the director finds that reasonable progress is not being made toward meeting the requirements of those sections. After July 1, 1998, the director may waive, reduce, or alter the requirements of §§ 27-41-4 and 27-41-13 for licensure for this defined class of health maintenance organizations if the licensee demonstrates to the satisfaction of the director that it is making satisfactory progress toward compliance with the requirements of those sections.
R.I. Gen. Laws § 27-19-13 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-13
§ 27-19-13. Services rendered in certain institutions.
Status: in_force

No nonprofit hospital service corporation may deny payments for services rendered to its subscribers by hospitals operated by the state or any municipality of the state if the nonprofit hospital service corporation permits payment for similar services rendered by contracting hospitals as provided in this chapter.
R.I. Gen. Laws § 27-35-2.5 — RI Code / Title 27 / Chapter 27-35 / Section 27-35-2.5
§ 27-35-2.5. Acquisitions involving insurers not otherwise covered.
Status: in_force

(a) Definitions. The following definitions shall apply for the purposes of this section only:

(1) Acquisition means any agreement, arrangement or activity the consummation of which results in a person acquiring directly or indirectly the control of another person, and includes but is not limited to, the acquisition of voting securities, the acquisition of assets, bulk reinsurance and mergers.

(2) An involved insurer includes an insurer which either acquires or is acquired, is affiliated with an acquirer or acquired, or is the result of a merger.

(b) Scope.(1) Except as exempted in subsection (b)(2) of this section, this section applies to any acquisition in which there is a change in control of an insurer authorized to do business in this state.

(2) This section shall not apply to the following:

(i) A purchase of securities solely for investment purposes so long as the securities are not used by voting or otherwise to cause or attempt to cause the substantial lessening of competition in any insurance market in this state. If a purchase of securities results in a presumption of control under § 27-35-1(3), it is not solely for investment purposes unless the commissioner of the insurers state of domicile accepts a disclaimer of control or affirmatively finds that control does not exist and the disclaimer action or affirmative finding is communicated by the domiciliary commissioner to the commissioner of this state;

(ii) The acquisition of a person by another person when both persons are neither directly nor through affiliates primarily engaged in the business of insurance, if pre-acquisition notification is filed with the commissioner in accordance with subsection (c)(1) of this section thirty (30) days prior to the proposed effective date of the acquisition. However, such pre-acquisition notification is not required for exclusion from this section if the acquisition would otherwise be excluded from this section by any other subparagraph of subsection (b)(2) of this section;

(iii) The acquisition of already affiliated persons;

(iv) An acquisition if, as an immediate result of the acquisition,

(A) In no market would the combined market share of the involved insurers exceed five percent (5%) of the total market,

(B) There would be no increase in any market share, or

(C) In no market would

(I) The combined market share of the involved insurers exceed twelve percent (12%) of the total market, and

(II) The market share increase by more than two percent (2%) of the total market.

For the purpose of this subsection (b)(2)(iv), a market means direct written insurance premium in this state for a line of business as contained in the annual statement required to be filed by insurers licensed to do business in this state;

(v) An acquisition for which a pre-acquisition notification would be required pursuant to this section due solely to the resulting effect on the ocean marine insurance line of business;

(vi) An acquisition of an insurer whose domiciliary commissioner affirmatively finds that the insurer is in failing condition; there is a lack of feasible alternative to improving such condition; the public benefits of improving the insurers condition through the acquisition exceed the public benefits that would arise from not lessening competition; and the findings are communicated by the domiciliary commissioner to the commissioner of this state.

(c) Pre-acquisition notification; Waiting period. An acquisition covered by subsection (b) of this section may be subject to an order pursuant to subsection (e) of this section unless the acquiring person files a pre-acquisition notification and the waiting period has expired. The acquired person may file a pre-acquisition notification. The commissioner shall give confidential treatment to information submitted under this subsection in the same manner as provided in §27-35-6.

(1) The pre-acquisition notification shall be in such form and contain such information as prescribed by the NAIC relating to those markets which, under subsection (b)(2)(iv) of this section, cause the acquisition not to be exempted from the provisions of this section. The commissioner may require such additional material and information as deemed necessary to determine whether the proposed acquisition, if consummated, would violate the competitive standard of subsection (d) of this section. The required information may include an opinion of an economist as to the competitive impact of the acquisition in this state accompanied by a summary of the education and experience of such person indicating his or her ability to render an informed opinion.

(2) The waiting period required shall begin on the date of receipt of the commissioner of a pre-acquisition notification and shall end on the earlier of the thirtieth day after the date of receipt, or termination of the waiting period by the commissioner. Prior to the end of the waiting period, the commissioner on a one-time basis may require the submission of additional needed information relevant to the proposed acquisition, in which event the waiting period shall end on the earlier of the thirtieth day after receipt of the additional information by the commissioner or termination of the waiting period by the commissioner.

(d) Competitive standard.(1) The commissioner may enter an order under subsection (e)(1) of this section with respect to an acquisition if there is substantial evidence that the effect of the acquisition may be substantially to lessen competition in any line of insurance in this state or tend to create a monopoly or if the insurer fails to file adequate information in compliance with subsection (c) of this section.

(2) In determining whether a proposed acquisition would violate the competitive standard of subsection (d)(1) of this section, the commissioner shall consider the following:

(i) Any acquisition covered under subsection (b) of this section involving two (2) or more insurers competing in the same market is prima facie evidence of violation of the competitive standards.

(A) If the market is highly concentrated and the involved insurers possess the following shares of the market:

(B) Or, if the market is not highly concentrated and the involved insurers possess the following shares of the market:

A highly concentrated market is one in which the share of the four (4) largest insurers is seventy-five percent (75%) or more of the market. Percentages not shown in the tables are interpolated proportionately to the percentages that are shown. If more than two (2) insurers are involved, exceeding the total of the two columns in the table is prima facie evidence of violation of the competitive standard in subsection (d)(1) of this section. For the purpose of this item, the insurer with the largest share of the market shall be deemed to be Insurer A.

(ii) There is a significant trend toward increased concentration when the aggregate market share of any grouping of the largest insurers in the market, from the two (2) largest to the eight (8) largest, has increased by seven percent (7%) or more of the market over a period of time extending from any base year five (5) to ten (10) years prior to the acquisition up to the time of the acquisition. Any acquisition or merger covered under subsection (b) of this section involving two (2) or more insurers competing in the same market is prima facie evidence of violation of the competitive standard in subsection (d)(1) of this section if:

(A) There is a significant trend toward increased concentration in the market;

(B) One of the insurers involved is one of the insurers in a grouping of large insurers showing the requisite increase in the market share; and

(C) Another involved insurers market is two percent (2%) or more.

(iii) For the purposes of subsection (d)(2) of this section:

(A) The term insurer includes any company or group of companies under common management, ownership or control;

(B) The term market means the relevant product and geographical markets. In determining the relevant product and geographical markets, the commissioner shall give due consideration to, among other things, the definitions or guidelines, if any, promulgated by the NAIC and to information, if any, submitted by parties to the acquisition. In the absence of sufficient information to the contrary, the relevant product market is assumed to be the direct written insurance premium for a line of business, such line being that used in the annual statement required to be filed by insurers doing business in this state, and the relevant geographical market is assumed to be this state;

(C) The burden of showing prima facie evidence of violation of the competitive standard rests upon the commissioner.

(iv) Even though an acquisition is not prima facie violative of the competitive standard under subsections (d)(2)(i) and (d)(2)(ii) of this section, the commissioner may establish the requisite anticompetitive effect based upon other substantial evidence. Even though an acquisition is prima facie violative of the competitive standard under subsections (d)(2)(i) and (d)(2)(ii) of this section, a party may establish the absence of the requisite anticompetitive effect based upon other substantial evidence. Relevant factors in making a determination under this subsection (d)(2)(iv) include, but are not limited to, the following: market shares, volatility of ranking of market leaders, number of competitors, concentration, trend of concentration in the industry, and ease of entry and exit into the market.

(3) An order may not be entered under subsection (e)(1) of this section if:

(i) The acquisition will yield substantial economies of scale or economies in resource utilization that cannot be feasibly achieved in any other way, and the public benefits which would arise from such economies exceed the public benefits which would arise from not lessening competition; or

(ii) The acquisition will substantially increase the availability of insurance, and the public benefits of the increase exceed the public benefits which would arise from not lessening competition.

(e) Orders and penalties.(1)(i) If an acquisition violates the standards of this section, the commissioner may enter an order:

(A) Requiring an involved insurer to cease and desist from doing business in this state with respect to the line or lines of insurance involved in the violation; or

(B) Denying the application of an acquired or acquiring insurer for a license to do business in this state.

(ii) Such an order shall not be entered unless:

(A) There is a hearing;

(B) Notice of the hearing is issued prior to the end of the waiting period and not less than fifteen (15) days prior to the hearing; and

(C) The hearing is concluded and the order is issued no later than sixty (60) days after the date of the filing of the pre-acquisition notification with the commissioner.

Every order shall be accompanied by a written decision of the commissioner setting forth findings of fact and conclusions of law.

(iii) An order pursuant to this subsection (e)(1) shall not apply if the acquisition is not consummated.

(2) Any person who violates a cease and desist order of the commissioner under subsection (e)(1) of this section and while the order is in effect may, after notice and hearing and upon order of the commissioner, be subject to one or more of the penalties set forth in §42-14-16.

(3) Any insurer or other person who fails to make any filing required by this section, and who also fails to demonstrate a good faith effort to comply with any filing requirement, shall be subject to one or more penalties set forth in §42-14-16.

(f) Inapplicable provisions. Sections 27-35-8(b), 27-35-8(c), and 27-35-10 do not apply to acquisitions covered under subsection (b) of this section.
R.I. Gen. Laws § 27-74-13 — RI Code / Title 27 / Chapter 27-74 / Section 27-74-13
§ 27-74-13. Annual reports.
Status: in_force

(a) If the information required in subsection (b) of this section is not provided at the time of renewal of a certificate of registration under § 27-74-5, a discount medical plan organization shall file an annual report with the commissioner in the form prescribed by the commissioner, within three (3) months after the end of each fiscal year.

(b) The report shall include:

(1) If different from the initial application for a certificate of registration or at the time of renewal of a certificate of registration or the last annual report, as appropriate, a list of the names and residence addresses of all persons responsible for the conduct of the organizations affairs, together with a disclosure of the extent and nature of any contracts or arrangements with these persons and the discount medical plan organization, including any possible conflicts of interest;

(2) The number of discount medical plan members in the state; and

(3) Any other information relating to the performance of the discount medical plan organization that may be required by the commissioner.

(c) Any discount medical plan organization that fails to file an annual report in the form and within the time required by this section shall:

(1) Forfeit:

(i) Up to five hundred dollars ($500) each day for the first ten (10) days during which the violation continues; and

(ii) Up to one thousand dollars ($1,000) each day after the first ten (10) days during which the violation continues; and

(2) Upon notice by the commissioner, lose its authority to enroll new members or to do business in this state while the violation continues.
R.I. Gen. Laws § 27-18-88 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-88
§ 27-18-88. Gender rating.
Status: in_force

(a) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state, that provides medical coverage that includes coverage for physician services in a physicians office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall vary the premium rate for a health coverage plan based on the gender of the individual policy holders, enrollees, subscribers, or members.

(b) This section shall not apply to insurance coverage providing benefits for any of the following:

(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 of bodily injury or death by accident or both; and

(9) Other limited benefit policies.
R.I. Gen. Laws § 27-20-49 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-49
§ 27-20-49. Dental insurance assignment of benefits.
Status: in_force

Every entity providing a contract of insurance as defined in this chapter shall allow, as a provision in a group or individual policy, contract, or health benefit plan for coverage of dental services, any person insured by the entity to direct, in writing, that benefits from a health benefit plan, policy, or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by the entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to the entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving the payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.
R.I. Gen. Laws § 27-41-13.1 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-13.1
§ 27-41-13.1. Initial net worth and capital requirements.
Status: in_force

Before the director issues a certificate of authority in accordance with § 27-41-4 of this act, an applicant seeking to establish or operate a health maintenance organization shall have the greater of:

(1) The amount of capital required for a health organization under chapter 4.7 of this title;

(2) An initial net worth of three million dollars ($3,000,000); or

(3) At the commissioners discretion, an amount greater than required under subsection (1) or (2), as indicated by a business plan and a projected risk-based capital calculation after the first full year of operation based on the most current National Association of Insurance Commissioners Health Annual Statements Blank.
R.I. Gen. Laws § 27-12-1 — RI Code / Title 27 / Chapter 27-12 / Section 27-12-1
§ 27-12-1. Time of filing  Contents of report.
Status: in_force

(a) Every insurance company of any name or kind doing business in this state shall annually on the first day of January, or within two (2) months after that date, file with the insurance commissioner an annual National Association of Insurance Commissioners statement convention blank, prepared in accordance with the National Association of Insurance Commissioners annual statement instructions and accounting practices and procedures manuals, examiners handbook, securities valuation manual, and any other manuals published by the National Association of Insurance Commissioners that may be amended, signed and sworn to by its president and secretary, of its exact condition specifying that the company is a fire, marine, 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 in mortgages, in what companies, 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; the amount of liabilities, specifying the amount of outstanding claims, adjusted or unadjusted, due or not due; and 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; and, except in the case of a company writing less than one million dollars ($1,000,000) of total direct plus assumed written premiums during a calendar year or which has fewer than one thousand (1,000) policyholders or certificate holders at the end of a calendar year, a statement of actuarial opinion relating to loss and loss adjustment expense reserves; and, except in the case of a company having direct premiums written of less than one million dollars ($1,000,000) in any calendar year and fewer than one thousand (1,000) policyholders or certificate holders at the end of a calendar year, an audited financial report prepared by an independent certified public accountant; and 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 commissioner to obtain more definite information of the company; and shall pay a filing fee of one hundred dollars ($100).

(b) Companies may be required to file quarterly statements upon request by the insurance commissioner, in accordance with the National Association of Insurance Commissioners guidelines and procedures, due on or before forty-five (45) days after the quarter ending. Annual and quarterly statements shall be available for inspection by the public.

(c) The commissioner may assess a late fee of one hundred dollars ($100) per day for each day the insurer is late in filing its annual or quarterly statement, except that the insurer may request and receive a reasonable extension of the filing date without penalty.

(d) Provisions of this chapter shall apply to corporations organized under chapters 19, 20, 20.1, 20.2, 20.3, and 41 of this title.

(e) With respect to individual and group health benefit contracts, including managed care contracts, written by an insurance company or health organization subject to the requirements of this chapter, when the expected claim payments or incurred costs, claims adjustment expenses, and administration costs exceed the premiums to be collected for the remainder of a contract period, the insurer or health organization shall recognize a premium deficiency reserve by recording an additional liability for the deficiency, with a corresponding charge to operations. The reserve shall be calculated in accordance with regulations promulgated pursuant to this chapter.

(f) In addition to the powers that the commissioner has under other sections of this title relating to the financial statements of health organizations, the commissioner also has the power to require any health organizations subject to this title to file the annual audited financial statements of its controlling affiliate or person whether or not the controlling affiliate or person is licensed or authorized pursuant to this title. Additionally, if the controlling affiliate or person is an insurer or health organization that prepares statutory financial statements for submission to its state of domicile, the annual and/or quarterly statutory financial statements shall be filed with the commissioner. In the event the health organization fails to comply with a request of the commissioner pursuant to this section, the commissioner shall have the power to suspend or revoke the license of the health organization and/or to examine the controlling affiliate or person.

(g) As used in this section, control including controlling and affiliate and person have the meanings ascribed to them in § 27-35-1. The term health organization has the meaning ascribed to it in § 27-4.7-2.
R.I. Gen. Laws § 27-16-2.5 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-2.5
§ 27-16-2.5. Exemption for automobile club service.
Status: in_force

Nothing in §§ 27-16-1.2 and 27-16-2.2 shall be construed to limit or prevent any automobile club or association from paying or agreeing to pay for the services of an attorney as provided in § 11-27-16(a)(8), nor from providing or agreeing to provide or pay for its members bail, towing, or mechanical road service.
R.I. Gen. Laws § 27-41-65 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-65
§ 27-41-65. Mandatory coverage for certain lyme disease treatments.
Status: in_force

Subscribers to any health maintenance organization plan shall be afforded coverage under that plan on or after January 1, 2004, for diagnostic testing and long-term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled Lyme Disease Diagnosis and Treatment after making a thorough evaluation of the patients symptoms, diagnostic test results, and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because the treatment may be characterized as unproven, experimental, or investigational in nature.
R.I. Gen. Laws § 27-71-12 — RI Code / Title 27 / Chapter 27-71 / Section 27-71-12
§ 27-71-12. Data collection and participation in national market conduct databases.
Status: in_force

(a) The commissioner shall collect and report market data to the NAICs market information systems, including the complaint database system, the examination tracking system, and the regulatory information retrieval system, or other comparable successor NAIC products as determined by the commissioner. In addition to complaint data, the accuracy of insurer-specific information reported to the NAIC to be used for market analysis purposes or as the basis for market conduct actions shall be reviewed by appropriate personnel in the department of business regulation and by the insurer.

(b) Information collected and maintained by the department of business regulation shall be compiled in a manner that meets the requirements of the NAIC.

(c) After completion of any level of market analysis, prior to further market conduct action, the state shall contact the insurer to review the analysis.

(d)(1) A company responding to a commissioners request to produce information shall produce it as it is kept in the usual course of business or shall organize and label it to correspond with the categories in the demand.

(2) If a commissioners request does not specify the form or forms for producing electronically stored information, a company responding to the request must produce the information in a form or forms in which the company ordinarily maintains it or in a form or forms that are reasonably usable.

(3) A company responding to an information request need not produce the same electronically stored information in more than one form.

(e) Whether through market analysis, market conduct action, or in response to another regulatory request, any information provided in response to a data call from the commissioner shall be treated as confidential and privileged. It shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action. No waiver of privilege or confidentiality shall occur as a result of responding to such data call.