R.I. Gen. Laws § 27-19-7.2 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-7.2
§ 27-19-7.2. Filing of policy forms.
Status: in_force

(a) A nonprofit hospital service corporation 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form shall be used if disapproved by the commissioner under this section, or if the commissioners approval has been withdrawn after notice and an opportunity to be heard, or until the expiration of sixty (60) days following the filing of the form.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 § 27-19-82 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-82
§ 27-19-82. 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, § 2 and P.L. 2025, ch. 287, § 2.]

(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, § 2 and P.L. 2025, ch. 287, § 2.]
R.I. Gen. Laws § 27-48-6 — RI Code / Title 27 / Chapter 27-48 / Section 27-48-6
§ 27-48-6. Penalties.
Status: in_force

(a)(1) If the director believes that the controlling producer or any other person has not materially complied with this chapter, or any regulation or order promulgated pursuant to this chapter, after notice and opportunity to be heard, the director may order the controlling producer to cease placing business with the controlled insurer; and

(2) If it was found that because of the material noncompliance that the controlled insurer or any policyholder of the insurer has suffered any loss or damage, the director may maintain a civil action or intervene in an action brought by or on behalf of the insurer or policyholder for recovery of compensatory damages for the benefit of the insurer or policyholder or other appropriate relief.

(b) If an order for liquidation or rehabilitation of the controlled insurer has been entered pursuant to chapter 14.3 of this title, and the receiver appointed under that order believes that the controlling producer 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 director to impose any other penalties provided for in the insurance law.

(d) Nothing contained in this section is intended to or shall in any manner alter or affect the rights of policyholders, claimants, creditors, or other third parties.
R.I. Gen. Laws § 27-1-26 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-26
§ 27-1-26. Principles for classification of creditors and stockholders.
Status: in_force

For the purposes of §§ 27-1-23  27-1-25, the following principles shall be applied in determining classes of creditors and stockholders; provided, that as to any situation not covered by the principles, the court may make any further determination of classes, not inconsistent with the principles, that may be fair and equitable:

(1) Creditors. No creditor whose claim is wholly secured shall be included in any class provided for under this chapter, nor have any right to vote at any meeting of creditors as long as the plan does not impair that security. Any creditor whose claim is partially secured shall, unless the creditor releases the creditors right to the security, be included in the class of general creditors, but shall be entitled to vote only as to the portion of the creditors claim in excess of the value of the security; and

(2) Stockholders. Common or capital stock and preferred stock shall be classified as separate classes of stock. Common or capital stock of the same par value, regardless of series or number of issues, and preferred stock of the same par value, regardless of series or number of issues, shall constitute only one class of common or capital or preferred stock, unless the charter of the company specifically otherwise provides, in which event the provisions of the charter shall be controlling.
R.I. Gen. Laws § 27-18-52 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-52
§ 27-18-52. Genetic testing.
Status: in_force

(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.

(b) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides health insurance medical coverage that includes coverage for physician services in a physicians office, and every policy that provides major medical or similar comprehensive-type coverage excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall:

(1) Use a genetic test or request for genetic tests or the results of a genetic test to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or an individual health insurance policy, contract, or plan;

(2) Request or require a genetic test for the purpose of determining whether or not to issue or renew an individuals health benefits coverage, to set reimbursement/copay levels, or determine covered benefits and services;

(3) Release the results of a genetic test without the prior written authorization of the individual from whom the test was obtained, except in a format whereby individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose this information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure; an exception shall exist for participating in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as The Common Rule);

(4) Request or require information as to whether an individual has ever had a genetic test, or participated in genetic testing of any kind, whether for clinical or research purposes.

(c) For the purposes of this section, genetic testing is the analysis of an individuals DNA, RNA, chromosomes, proteins, and certain metabolites in order to detect heritable disease-related genotypes, mutations, phenotypes, or karyotypes for clinical purposes. Those purposes include predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or prognosis. Prenatal, newborn, and carrier screening, as well as testing in high-risk families, may be included provided there is an approved release by a parent or guardian. Tests for metabolites are covered only when they are undertaken with high probability that an excess of deficiency of the metabolite indicates the presence of heritable mutations in single genes. Genetic testing does not mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs or for HIV infections.
R.I. Gen. Laws § 27-51-1 — RI Code / Title 27 / Chapter 27-51 / Section 27-51-1
§ 27-51-1. Short title.
Status: in_force

This chapter may be known as the Managing General Agents Act.
R.I. Gen. Laws § 27-9-38 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-38
§ 27-9-38. Collection and compilation of experience data.
Status: in_force

The commissioner shall promulgate reasonable rules and statistical plans reasonably adapted to each of the rating systems on file with the commissioner, which may be modified and which shall be used after this by each insurer in the recording and reporting of its loss and country-wide expense experience, in order that the experience of all insurers may be made available at least annually in a form and detail as may be necessary to aid the commissioner in determining whether rating systems comply with the standards set forth in §§ 27-9-4  27-9-6. Those rules and plans may also provide for the recording and reporting of expense experience items that are specially applicable to the state and are not susceptible of determination by a prorating of country-wide expense experience. In promulgating those rules and plans, the commissioner shall give due consideration to the rating systems on file with the commissioner and, in order that those rules and plans may be as uniform as is practicable among the several states, to the rules and to the form of the plans used for the rating systems in other states. No insurer shall be required to record or report its loss experience on a classification basis that is inconsistent with the rating system filed by it. The commissioner may designate one or more rating organizations or other agencies to assist the commissioner in gathering that experience and making compilations of it, and those compilations shall be made available, subject to reasonable rules promulgated by the commissioner, to insurers and rating organizations.
R.I. Gen. Laws § 27-5-11 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-11
§ 27-5-11. Enforcement of standard policy requirements.
Status: in_force

The director of business regulation shall enforce the provisions of §§ 27-5-1  27-5-10.
R.I. Gen. Laws § 27-19-80 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-80
§ 27-19-80. 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 policyholders, 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 § 27-29-4 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-4
§ 27-29-4. Unfair methods of competition and unfair or deceptive acts or practices defined.
Status: in_force

The following are defined as unfair methods of competition and unfair and deceptive acts or practices in the business of insurance:

(1) Misrepresentations and false advertising of policies or contracts. Making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, or statement, sales presentation, omission, or comparison misrepresenting the terms of any policy issued or to be issued or the benefits, conditions, or advantages promised by any policy or the dividends or share of the surplus to be received on any policy, or making any false or misleading statement as to the dividends or share of surplus previously paid on any policy, or making any misleading representation or any misrepresentation as to the financial condition of any insurer, or as to the legal reserve system upon which any life insurer operates, or using any name or title of any policy or class of policies misrepresenting the true nature of that policy or class of policies, or making any misrepresentation to any policyholder insured in any company including any intentional misquote of a premium rate, for the purpose of inducing or tending to induce the policyholder to lapse, forfeit, or surrender his or her insurance, or misrepresenting for the purpose of effecting a pledge or assignment of or effecting a loan against any policy, or misrepresenting any policy as being share or stock;

(2) False information and advertising generally. Making, publishing, disseminating, circulating, or placing before the public or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public in a newspaper, magazine, or other publication, or in the form of a notice, circular, pamphlet, letter, or poster, or over any radio or television station, or in any other way, an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance or with respect to any person in the conduct of his or her insurance business that is untrue, deceptive, or misleading;

(3) Defamation. Making, publishing, disseminating, or circulating, directly or indirectly, or aiding, abetting, or encouraging the making, publishing, disseminating, or circulating of any oral or written statement or any pamphlet, circular, article of literature that is false or maliciously critical of or derogatory to the financial condition of an insurer, and that is calculated to injure any person engaged in the business of insurance;

(4) Boycott, coercion, and intimidation. Entering into any agreement to commit, or by any concerted action committing, any act of boycott, coercion, or intimidation resulting in or tending to result in unreasonable restraint of, or monopoly in, the business of insurance;

(5) False financial statements. (i) Knowingly filing with any supervisory or other public official, or knowingly making, publishing, disseminating, circulating, or delivering to any person, or placing before the public or causing directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public any false material statement of financial condition of an insurer; or (ii) Knowingly making any false entry of a material fact in any book, report, or statement of any insurer or knowingly omitting to make a true entry of any material fact pertaining to the business of the insurer in any book, report, or statement of the insurer;

(6) Stock operations and advisory board contracts. Issuing or delivering or permitting agents, officers, or employees to issue or deliver agency company stock or other capital stock, or benefit certificates or shares in any common law corporation, or securities of any special or advisory board contracts or other contracts of any kind promising returns and profits as an inducement to insurance;

(7) Unfair discrimination. (i) Making or permitting any unfair discrimination between individuals of the same class and equal expectation of life in the rates charged for any policy of life insurance or of life annuity or in the dividends or other benefits payable on any such policy or life annuity, or in any other of the terms and conditions of the policy; (ii) Making or permitting any unfair discrimination between individuals of the same class and of essentially the same hazard in the amount of premium, policy fees, or rates charged for any policy or contract of accident or health insurance or in the benefits payable under any policy or contract, or in any of the terms or conditions of that policy, or in any other manner; (iii) Making or permitting any unfair discrimination between individuals or risks of the same class and of essentially the same hazards by refusing to issue, refusing to renew, canceling, or limiting the amount of insurance coverage on a property or casualty risk because of the geographic location of the risk, unless: (A) The refusal, cancellation, or limitation is for a business purpose that is not a pretext for unfair discrimination; or (B) The refusal, cancellation, or limitation is required by law or regulation; (iv) Making or permitting any unfair discrimination between individuals or risks of the same class and of essentially the same hazards by refusing to issue, refusing to renew, canceling, or limiting the amount of insurance coverage on a residential property risk, or the personal property contained in the residential property risk, because of the age of the residential property, unless: (A) The refusal, cancellation, or limitation is for a business purpose that is not a pretext for unfair discrimination; or (B) The refusal, cancellation, or limitation is required by law or regulation; (v) Refusing to insure, refusing to continue to insure, or limiting the amount of coverage available to an individual because of the sex or marital status of the individual; nothing in this subsection shall prohibit an insurer from taking marital status into account for the purpose of defining persons eligible for dependent benefits; (vi) To terminate, or to modify coverage, or to refuse to issue or refuse to renew any property or casualty policy solely because the applicant or insured or any employee of either is mentally or physically impaired; provided, that this subsection shall not apply to accident and health insurance sold by a casualty insurer and, provided that this subsection shall not be interpreted to modify any other provision of law relating to the termination, modification, issuance, or renewal of any insurance policy or contract; or (vii) Making or permitting any unfair discrimination by treating persons in a domestic partnership as defined in § 27-29-2, differently than persons in a marriage for the purposes of premiums, policy fees, or rates charged for policies of casualty, fire, homeowners, accident and sickness, marine, or automobile insurance;

(8) Rebates. (i) Except as otherwise expressly provided by law, knowingly permitting or offering to make or making any policy or agreement as to the policy other than as plainly expressed in the policy issued on it, or paying or allowing or giving or offering to pay, allow, or give, directly or indirectly, as inducement to the policy, any rebate of premiums payable on the policy, or any special favor or advantage in the dividends or other benefits on the policy, or any valuable consideration or inducement not specified in the policy, or giving, selling, or purchasing or offering to give, sell, or purchase as inducement to the policy, or in connection with the policy, any stocks, bonds, or other securities of any insurance company or other corporation, association, or partnership, or any dividends or profits accrued on the security, or anything of value not specified in the policy; (ii) Nothing in subsection (7) of this section or subsection (8)(i) of this section shall be construed as including within the definition of discrimination or rebates any of the following practices: (A) In the case of any contract of life insurance policies or life annuity, annuities paying bonuses to policyholders or abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance; provided, that any bonuses or abatement of premiums shall be fair and equitable to policyholders and for the best interests of the company and its policyholders; (B) In the case of life insurance policies issued on the industrial debit plan, making allowance to policyholders who have continuously for a specified period made premium payments directly to an office of the insurer in an amount that fairly represents the saving in collection expenses; (C) Readjustment of the rate of premium for a group insurance policy based on the loss or expense experience under it, at the end of the first or any subsequent policy year of insurance under the policy, which may be made retroactive only for the policy year; (D) Engaging in an arrangement that would not violate section 106 of the Bank Holding Company Act Amendments of 1972 (12 U.S.C. § 1972), as interpreted by the Board of Governors of the Federal Reserve System, or section 5(q) of the Home Owners Loan Act, 12 U.S.C. § 1464(q); (E) The offer or provision by insurers or producers, by or through employees, affiliates, or third-party representatives, of value-added products or services at no or reduced cost when such products or services are not specified in the policy of insurance if the product or service: (I) Relates to the insurance coverage; and (II) Is primarily designed to satisfy one or more of the following: (aa) Provide loss mitigation or loss control; (bb) Reduce claim costs or claim settlement costs; (cc) Provide education about liability risks or risk of loss to persons or property; (dd) Monitor or assess risk, identify sources of risk, or develop strategies for eliminating or reducing risk; (ee) Enhance health; (ff) Enhance financial wellness through items such as education or financial planning services; (gg) Provide post-loss services; (hh) Incent behavioral changes to improve the health or reduce the risk of death or disability of a customer (defined for purposes of this subsection as policyholder, potential policyholder, certificate holder, potential certificate holder, insured, potential insured, or applicant); or ( ii ) Assist in the administration of the employee or retiree benefit insurance coverage. (III) The cost to the insurer or producer offering the product or service to any given customer must be reasonable in comparison to that customers premiums or insurance coverage for the policy class. (IV) If the insurer or producer is providing the product or service offered, the insurer or producer must ensure that the customer is provided with contact information to assist the customer with questions regarding the product or service. (V) The commissioner may adopt regulations when implementing the permitted practices set forth in this statute to ensure consumer protection. Such regulations, consistent with applicable law, may address, among other issues, consumer data protections and privacy, consumer disclosure, and unfair discrimination. (VI) The availability of the value-added product or service must be based on documented objective criteria and offered in a manner that is not unfairly discriminatory. The documented criteria must be maintained by the insurer or producer and produced upon request by the department. (VII) If an insurer or producer does not have sufficient evidence, but has a good-faith belief that the product or service meets the criteria in subsection (8)(ii)(E)(II) of this section, the insurer or producer may provide the product or service in a manner that is not unfairly discriminatory as part of a pilot or testing program for no more than one year. An insurer or producer must notify the department of such a pilot or testing program offered to consumers in this state prior to launching and may proceed with the program unless the department objects within twenty-one (21) days of notice; (F)(I) Offering or giving non-cash gifts, items, or services, including meals to or charitable donations on behalf of a customer, in connection with the marketing, sale, purchase, or retention of contracts of insurance, as long as the cost does not exceed an amount determined to be reasonable by the commissioner per policy year per term. The offer must be made in a manner that is not unfairly discriminatory. The customer may not be required to purchase, continue to purchase, or renew a policy in exchange for the gift, item, or service. (II) Offering or giving non-cash gifts, items, or services including meals to or charitable donations on behalf of a customer, to commercial or institutional customers in connection with the marketing, sale, purchase, or retention of contracts of insurance, as long as the cost is reasonable in comparison to the premium or proposed premium and the cost of the gift or service is not included in any amounts charged to another person or entity. The offer must be made in a manner that is not unfairly discriminatory. The customer may not be required to purchase, continue to purchase, or renew a policy in exchange for the gift, item, or service. (III) Conducting raffles or drawings to the extent permitted by state law, as long as there is no financial cost to entrants to participate, the drawing or raffle does not obligate participants to purchase insurance, the prizes are not valued in excess of a reasonable amount determined by the commissioner, and the drawing or raffle is open to the public. The raffle or drawing must be offered in a manner that is not unfairly discriminatory. The customer may not be required to purchase, continue to purchase, or renew a policy in exchange for the gift, item, or service; (iii) An insurer, producer or representative of either may not offer or provide insurance as an inducement to the purchase of another policy or otherwise use the words free, no cost, or words of similar import, in an advertisement.

(9) Free choice of insurance producer or insurer. (i) When any person, firm, or corporation engaged in the business of lending money on the security of real or personal property, or in the business of negotiating, purchasing, selling, or holding loans on the security of real property, or in the business of building, selling, or financing the sale or purchase of real property, or any trustee, director, officer, agent, or other employee of that person, firm, or corporation, requires that property insurance be procured for the property, the borrower, debtor, or purchaser shall have free choice of insurance producer and insurer through or by which the insurance is to be placed or written, subject only to the right of the builder, creditor, lender, or seller: (A) To require evidence, to be produced at a reasonable time prior to commencement or renewal of risk, that the insurance providing reasonable coverage has been obtained in an amount equal to the amount required by the builder, creditor, lender, or seller; (B) To require insurance in an insurer authorized to do business and having a licensed resident insurance producer agent in this state; and (C) To refuse to accept insurance in a particular insurer on reasonable grounds related to solvency; (ii) When any contractor or subcontractor is required to procure a surety bond or policy of insurance with respect to any building or construction contract that is about to be, or that has been bid or entered into, the contractor or subcontractor shall have free choice of insurance producer and insurer through or by which the surety bond or insurance is to be written; provided, that the owner or contractor shall have the right: (A) To require evidence, to be produced at a reasonable time prior to commencement or renewal of risk, that the insurance providing reasonable coverage has been obtained in an amount equal to the amount required by the builder, creditor, lender, or seller; (B) To require insurance in an insurer authorized to do business and having a licensed resident insurance producer in this state; and (C) To refuse to accept insurance in a particular insurer on reasonable grounds related to solvency; provided, that the owner or contractor shall have the right to approve the form, sufficiency, or manner of execution of the surety bond or policy of insurance furnished by the insurance company or insurance producer selected by the contractor or subcontractor; (iii) No person who lends money or extends credit may: (A) Solicit insurance for the protection of real property after a person indicates interest in securing a first mortgage credit extension until that person has received a commitment in writing from the lender as to a loan or credit extension; (B) Unreasonably reject a policy furnished by the borrower for the protection of the property securing the creditor lien. A rejection shall not be deemed unreasonable if it is based on reasonable standards, uniformly applied, relating to the extent of coverage required and the financial soundness and the services of an insurer. The standards shall not discriminate against any particular type of insurer, nor shall the standards call for rejection of a policy because it contains coverage in addition to that required in the credit transaction; (C) Require that any borrower, mortgagor, purchaser, insurer, or insurance producer pay a separate charge, in connection with the handling of any policy required as security for a loan on real estate, or pay a separate charge to substitute the policy of one insurer for that of another. This subsection does not include the interest that may be charged on premium loans or premium advancements in accordance with the terms of the loan or credit document; (D) Use or disclose, without the prior written consent of the borrower, mortgagor, or purchaser taken at a time other than the making of the loan or extension of credit, information relative to a policy that is required by the credit transaction, for the purpose of replacing the insurance; or (E) Require any procedures or conditions of duly licensed insurance producers or insurers not customarily required of those insurance producers or insurers affiliated or in any way connected with the person who lends money or extends credit; (iv) Every person who lends money or extends credit and who solicits insurance on real and personal property subject to subsection (9)(iii) of this section shall explain to the borrower in writing that the insurance related to the credit extension may be purchased from an insurer or insurance producer of the borrowers choice, subject only to the lenders right to reject a given insurer or insurance producer as provided in subsection (9)(iii)(B) of this section. Compliance with disclosures as to insurance required by truth-in-lending laws or comparable state laws shall be compliance with this subsection; (v) This requirement for a commitment shall not apply in cases where the premium for the required insurance is to be financed as part of the loan or extension of credit involving personal property transactions; (vi) The commissioner shall have the power to examine and investigate those insurance-related activities of any person or insurer that the commissioner believes may be in violation of this section. Any affected person may submit to the commissioner a complaint or material pertinent to the enforcement of this section; (vii) Nothing in this section shall prevent a person who lends money or extends credit from placing insurance on real or personal property in the event the mortgagor, borrower, or purchaser has failed to provide required insurance in accordance with the terms of the loan or credit document; (viii) Nothing contained in this section shall apply to credit life or credit accident and health insurance;

(10) Notice of free choice of insurance producer or insurer. Every debtor, borrower, or purchaser of property with respect to which insurance of any kind on the property is required in connection with a debt or loan secured by the property or in connection with the sale of the property, shall be informed in writing by the builder, creditor, lender, or seller, of his or her right of free choice in the selection of the insurance producer and insurer through or by which the insurance is to be placed. There shall be no interference, either directly or indirectly, with the borrowers, debtors, or purchasers free choice of an insurance producer and of an insurer that complies with the requirements of this section, and the builder, creditor, lender, seller, owner, or contractor shall not refuse the policy tendered by the borrower, debtor, purchaser, contractor, or subcontractor. Upon notice of any refusal of the tendered policy, the insurance commissioner shall order the builder, creditor, lender, seller, owner, or contractor to accept the tendered policy, if the commissioner determines that the refusal is not in accordance with the requirements of this section. Failure to comply with an order of the insurance commissioner shall be deemed a violation of this section;

(11) Using insurance information to detriment of another. Whenever the instrument requires that the purchaser, mortgagor, or borrower furnish insurance of any kind on real property being conveyed or is collateral security to a loan, the mortgagee, vendor, or lender shall refrain from disclosing or using any and all insurance information to his or her or its own advantage and to the detriment of either the borrower, purchaser, mortgagor, insurance company, or agency complying with the requirements relating to insurance;

(12) Prohibited group enrollments. No insurer shall offer more than one group policy of insurance through any person unless that person is licensed, at a minimum, as an insurance producer. This prohibition shall not apply to employer-employee relationships, or to any of these enrollments;

(13) Failure to maintain complaint handling procedures. No insurer shall fail to maintain a complete record of all the complaints it received since the date of its last examination pursuant to the general laws providing for examination of insurers. This record shall indicate the total number of complaints, their classification by line of insurance, the nature of each complaint, the disposition of each complaint, and the time it took to process each complaint. For the purposes of this subsection, complaint means any written communication primarily expressing a grievance;

(14) Misrepresentation in insurance applications. Making false or fraudulent statements or representations on or relative to an application for a policy, for the purpose of obtaining a fee, commission, money, or other benefit from any insurers, insurance producer, or individual person;

(15) Requiring that repairs be made to an automobile at a specified auto body repair shop or interfering with the insureds or claimants free choice of repair facility. The insured or claimant shall be promptly informed by the insurer of his or her free choice in the selection of an auto body repair shop. Once the insured or claimant has advised the insurer that an auto body repair shop has been selected, the insurer may not recommend that a different auto body repair shop be selected to repair the automobile. An auto body repair shop may file a complaint with the department of business regulation alleging a violation of this subsection (15). Whenever the department of business regulation has reason to believe that an insurer has violated this subsection (15), the department shall conduct an investigation and may convene a hearing. A complaint filed by an auto body repair shop must be accompanied by a statement written and signed by the insured or claimant setting forth the factual basis of the complaint, and the insured or claimant must voluntarily appear and testify at any administrative proceedings on the complaint; and

(16) Requiring that motor vehicle glass repair be made at a specified motor vehicle glass repair shop or interfering with the insureds or claimants free choice of a licensed repair facility. The insured or claimant shall be promptly informed by the insurer of his or her free choice in the selection of a licensed motor vehicle glass repair shop. The insurer shall not require a person to use or employ unfair or deceptive acts or practices, threaten, coerce, or intimidate to induce a person to use or select a particular licensed motor vehicle glass repair shop to provide motor vehicle glass repair services. An insurer shall not knowingly contract with, refer motor vehicle glass repair services to, or otherwise negotiate with an unlicensed motor vehicle glass repair shop, as defined in chapter 38.5 of title 5. Once the insured or claimant has advised the insurer that a motor vehicle glass repair shop has been selected, the insurer may not recommend that a different motor vehicle glass repair shop be selected to repair the motor vehicle glass, and an insurer shall not assign or dispatch the repair work or forward a related policy or policyholders contact or repair scheduling information to a different licensed motor vehicle glass repair shop without the knowledge and consent of the insured. An insured may at any point in time elect to change the insureds choice of licensed motor vehicle glass repair shop. However, an insurer authorized to conduct business in the state may provide directly, or through other means, including electronic transmissions, specific, truthful, and nondeceptive information regarding the features and benefits available to the insured under the policy to assist the insured in selecting a licensed motor vehicle glass repair shop or scheduling a licensed motor vehicle glass repair shop to perform motor vehicle glass repair, or enter into any preferred provider agreements and/or participate in direct repair programs or direct repair networks with licensed motor vehicle glass repair shops. A motor vehicle glass repair shop may file a complaint with the department of business regulation alleging a violation of this subsection (16). Whenever the department of business regulation has reason to believe that an insurer has violated this subsection (16), the department shall conduct an investigation and may convene a hearing. A complaint filed by a motor vehicle glass repair shop must be accompanied by a statement written and signed by the insured or claimant setting forth the factual basis of the complaint, and the insured or claimant must voluntarily appear and testify at any administrative proceedings on the complaint.
R.I. Gen. Laws § 27-19-2 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-2
§ 27-19-2. Organization as charitable corporation  Insurance laws inapplicable.
Status: in_force

Each nonprofit hospital service corporation shall be incorporated as a charitable corporation under the provisions of chapter 6 of title 7, and shall be subject to that chapter and to this chapter. The laws of this state relative to insurance companies or to the business of insurance shall not apply to any nonprofit hospital service corporation unless expressly provided in those laws. Each nonprofit hospital service corporation shall be deemed to be an insurer, for the purposes of compliance with chapter 17 of title 44.
R.I. Gen. Laws § 27-46-6 — RI Code / Title 27 / Chapter 27-46 / Section 27-46-6
§ 27-46-6. Countersignatures not required.
Status: in_force

A policy of insurance issued to a risk retention group or any member of that group shall not be required to be countersigned as otherwise provided in this title.
R.I. Gen. Laws § 27-41-75 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-75
§ 27-41-75. Prohibition on rescission of coverage.
Status: in_force

(a)(1) Coverage under a health plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the individual is covered under the plan, unless:

(i) The individual or a person seeking coverage on behalf of the individual, performs an act, practice, or omission that constitutes fraud; or

(ii) The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.

(2) For purposes of subsection (a)(1)(i), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health maintenance organization.

(b) At least thirty (30) days advance written notice shall be provided to each plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.

(c) For purposes of this section, to rescind means to cancel or to discontinue coverage with retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.

(d) This section applies to grandfathered health plans.
R.I. Gen. Laws § 27-81-3 — RI Code / Title 27 / Chapter 27-81 / Section 27-81-3
§ 27-81-3. Definitions.
Status: in_force

As used in this chapter:

(1) Clinically appropriate means care that is delivered in the appropriate medical setting.

(2) Distant site means a site at which a healthcare provider is located while providing healthcare services by means of telemedicine.

(3) Healthcare facility means an institution providing healthcare services or a healthcare setting, including, but not limited to: hospitals and other licensed inpatient centers; ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers; diagnostic, laboratory and imaging centers; and rehabilitation and other therapeutic health settings.

(4) Healthcare professional means a physician or other healthcare practitioner licensed, accredited, or certified to perform specified healthcare services consistent with state law.

(5) Healthcare provider means a healthcare professional or a healthcare facility.

(6) Healthcare services means any services included in the furnishing to any individual of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of that care or hospitalization, and the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability.

(7) Health insurer means any person, firm, or corporation offering and/or insuring healthcare services on a prepaid basis, including, but not limited to, a nonprofit service corporation, a health maintenance organization, the Rhode Island Medicaid program, including its contracted managed care entities, or an entity offering a policy of accident and sickness insurance.

(8) Health maintenance organization means a health maintenance organization as defined in chapter 41 of this title.

(9) Medically necessary means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health-related condition, including services necessary to prevent a decremental change in either medical or mental health status.

(10) Nonprofit service corporation means a nonprofit hospital service corporation as defined in chapter 19 of this title, or a nonprofit medical service corporation as defined in chapter 20 of this title.

(11) Originating site means a site at which a patient is located at the time healthcare services are provided to them by means of telemedicine, which can include a patients home where medically necessary and clinically appropriate.

(12) Policy of accident and sickness insurance means a policy of accident and sickness insurance as defined in chapter 18 of this title.

(13) Rhode Island Medicaid program means a state-administered, medical assistance program that is funded by the state and federal governments under Title XIX and Title XXI of the U.S. Social Security Act and any general or public laws and administered by the executive office of health and human services.

(14) Store-and-forward technology means the technology used to enable the transmission of a patients medical information from an originating site to the healthcare provider at the distant site without the patient being present.

(15) Telemedicine means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate assessment, diagnosis, counseling and prescribing treatment, and care management of a patients health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. Telemedicine does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
R.I. Gen. Laws § 27-6-47 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-47
§ 27-6-47. Penalty for violations.
Status: in_force

Any person or organization willfully violating any provision of this chapter shall, upon conviction, be fined not less than one hundred dollars ($100) and not more than five hundred dollars ($500) for each violation. That penalty may be in addition to any other penalty provided by law.
R.I. Gen. Laws § 27-12-5 — RI Code / Title 27 / Chapter 27-12 / Section 27-12-5
§ 27-12-5. Abstracts printed for general assembly.
Status: in_force

The insurance commissioner shall make available, by electronic means, the annual reports filed by all insurance companies licensed in the state and provide these reports to members of the general assembly upon request.
R.I. Gen. Laws § 27-71-6 — RI Code / Title 27 / Chapter 27-71 / Section 27-71-6
§ 27-71-6. Protocols for market conduct actions.
Status: in_force

(a) Market conduct actions taken as a result of a market analysis shall focus on the general business practices and compliance activities of insurers, rather than identifying infrequent or unintentional random errors that do not cause consumer harm.

(b)(1) The commissioner is authorized to determine the frequency and timing of such market conduct actions. The timing shall depend upon the specific market conduct action to be initiated, unless extraordinary circumstances indicating a risk to consumers require immediate action.

(2) If the commissioner has information that more than one insurer is engaged in common practices that may violate statute or regulations, he or she may schedule and coordinate multiple examinations simultaneously.

(c) The insurer shall be given an opportunity to resolve such matters that arise as a result of market analysis to the satisfaction of the commissioner before any additional market conduct actions are taken against the insurer. If the insurer has modified such practice or procedure as a result of a market conduct action taken by the commissioner of another state, the commissioner shall accept appropriate documentation that the insurer has satisfactorily modified the practice or procedure and made similar modification to such practice or procedure in this state. The commissioner may require other or additional practice or procedure modifications as are necessary to achieve compliance with specific state laws or regulations, which differ substantially from those of the state conducted examination.
R.I. Gen. Laws § 27-19-71 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-71
§ 27-19-71. Orally administered anticancer medication  Cost-sharing requirement.
Status: in_force

(a) Every individual or group hospital or medical expense insurance policy, or individual or group hospital or medical services plan contract, plan, or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and prescription drug coverage, and provides coverage for intravenously administered anticancer medication, shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section. Notwithstanding the above, the requirements shall not be construed to impose any form of cap on cost sharing.

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

Every life insurance company, health insurance company, livestock, or other insurance company, cooperative, or assessment, shall before making any contract of insurance, deposit with the insurance commissioner a statement signed and sworn to by the president and secretary of the company, specifying the amount of its capital and all of its assets and the manner of its investment, designating the amount invested in mortgages, public securities, and in stock of incorporated companies, stating what companies, and also the amount invested in other securities, particularizing each item of investment, the amount insured by existing policies, the amount of liabilities, specifying the amount of outstanding claims, adjusted or unadjusted, due or not due, and the largest sum insured in any one risk; provided, that no more than one statement needs to be filed on behalf of the company.
R.I. Gen. Laws § 27-9-8.1 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-8.1
§ 27-9-8.1. Advisory organization  Permitted activity.
Status: in_force

Any advisory organization, in addition to other activities not prohibited, is authorized, on behalf of its members and subscribers, to:

(1) Develop statistical plans including territorial and class definitions;

(2) Collect statistical data from members, subscribers, or any other source;

(3) Prepare and distribute prospective loss costs which may include provisions for special assessments;

(4) Prepare and distribute factors, calculations, or formulas pertaining to classification, territory, increased limits, and other variables;

(5) Prepare and distribute manuals of rating rules and rating schedules that do not include final rates, expense provisions, profit provisions, or minimum premiums;

(6) Distribute information that is required or directed to be filed with the director;

(7) Conduct research and collect statistics in order to discover, identify, and classify information relating to causes or prevention of losses;

(8) Conduct research and collect information to determine the impact of statutory changes upon prospective loss costs and special assessments;

(9) Prepare policy forms and endorsements and consult with members, subscribers, and others relative to their use and application;

(10) Conduct research and on-site inspections for the purpose of providing risk information relating to individual structures;

(11) Conduct on-site inspections to determine rating classifications for individual insureds;

(12) Establish a committee that may include insurance company representatives to review the determination of the rating classification for individual insureds and suggest modifications to the classification system;

(13) Collect, compile, and distribute past and current prices of individual insurers and publish that information;

(14) Collect and compile exposure and loss experience for the purpose of individual risk experience ratings; and

(15) Furnish any other services, as approved by the director, related to those services enumerated in this section.
R.I. Gen. Laws § 27-17-21 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-21
§ 27-17-21. Applicability of rating laws.
Status: in_force

The provisions of the laws of this state regulating the making and applying of insurance rates and providing for the licensing of rating organizations as set forth in chapters 6 and 9 of this title and §§ 27-2-13, 27-5-1  27-5-11 and 27-8-4  27-8-6 shall apply to reciprocal or interinsurance contracts, but nothing contained in those sections shall be construed to prohibit the return of savings or dividends to subscribers or policyholders.
R.I. Gen. Laws § 27-32-4 — RI Code / Title 27 / Chapter 27-32 / Section 27-32-4
§ 27-32-4. Valuation of accounts.
Status: in_force

Assets allocated to a separate account shall be valued at their market value on the date of valuation, or if there is no readily available market, then in accordance with the terms of the applicable written agreement; provided, that the portion of the assets of a separate account at least equal to the companys reserve liability with regard to guaranteed benefits and funds, if any, shall be valued in accordance with the rules applicable to the companys assets.
R.I. Gen. Laws § 27-25-20 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-20
§ 27-25-20. Nonforfeiture benefits, cash surrender values, certificate loans, and other options.
Status: in_force

(a) For certificates issued prior to January 1, 1986, the value of every paid up nonforfeiture benefit and the amount of any cash surrender value, loan, or other option granted shall comply with the provisions of law applicable immediately prior to January 1, 1985.

(b) For certificates issued on or after January 1, 1986, for which reserves are computed on the commissioners 1941 standard ordinary mortality table, the commissioners 1941 standard industrial table, or the commissioners 1958 standard ordinary mortality table, or the commissioners 1980 standard mortality table, or any more recent table made applicable to life insurers, every paid up nonforfeiture benefit and the amount of any cash surrender value, loan, or other option granted shall not be less than the corresponding amount ascertained in accordance with the laws of this state applicable to life insurers issuing policies containing life benefits based upon those tables.
R.I. Gen. Laws § 27-18-22 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-22
§ 27-18-22. Effect on other law.
Status: in_force

Nothing in this chapter shall be construed to repeal the provisions of chapter 13.1 of this title.
R.I. Gen. Laws § 27-18-6 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-6
§ 27-18-6. Sequence of provisions.
Status: in_force

The provisions that are the subject of §§ 27-18-3 and 27-18-4, or any corresponding provisions used in lieu of them in accordance with those sections, shall be printed in the consecutive order of the provisions in the section or, at the option of the insurer, the provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered, or issued.
R.I. Gen. Laws § 27-18-1 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-1
§ 27-18-1. Policy of accident and sickness insurance construed.
Status: in_force

Policy of accident and sickness insurance, as used in this chapter, includes any policy or contract covering against loss resulting from sickness or from bodily injury or death by accident, or both.
R.I. Gen. Laws § 27-8-9 — RI Code / Title 27 / Chapter 27-8 / Section 27-8-9
§ 27-8-9. Penalty for violations.
Status: in_force

Any person or corporation violating any provision of §§ 27-8-7 and 27-8-8 shall, upon conviction, be punished by a fine not exceeding five hundred dollars ($500) or by imprisonment not exceeding one year, or both.
R.I. Gen. Laws § 27-72-17 — RI Code / Title 27 / Chapter 27-72 / Section 27-72-17
§ 27-72-17. Unfair trade practices.
Status: in_force

A violation of this chapter shall be considered an unfair trade practice pursuant to state law and subject to the penalties provided by state law.
R.I. Gen. Laws § 27-5-6.1 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-6.1
§ 27-5-6.1. Notice concerning single interest hazard insurance.
Status: in_force

No bank or lending institution doing business in this state, whether acting under state or federal authority, which includes, but is not limited to: (1) A bank, savings bank, or trust company, as defined in title 19, its affiliates or subsidiaries; (2) A bank holding company, as defined in 12 U.S.C. § 1841, its affiliates or subsidiaries; (3) mortgage companies and mortgage services; and (4) Any other individual, corporation, partnership, or association authorized to take deposits and/or to make loans of money under the provisions of title 19, shall, in connection with a loan secured by residential property situated in the state of Rhode Island of four (4) or fewer units and occupied or to be occupied in whole or in part by the mortgagor, obtain a single interest hazard insurance policy for the property and impose the cost on the mortgagor unless the bank or lending institution shall give the mortgagor written notice of its intent to obtain that coverage and ten (10) days shall have elapsed after the date on which notice is given; provided, that nothing in this section shall require the giving of notice or preclude the bank or lending institution from obtaining that coverage and imposing the cost on the mortgagor where the bank or lending institution has received notice of the nonrenewal or cancellation of the hazard insurance on the property.
R.I. Gen. Laws § 27-52-7 — RI Code / Title 27 / Chapter 27-52 / Section 27-52-7
§ 27-52-7. Required contract provisions  Reinsurance intermediary managers.
Status: in_force

Transactions between a RM and the reinsurer it represents in that capacity shall only be entered into pursuant to a written contract, specifying the responsibilities of each party, which shall be approved by the reinsurers board of directors. At least thirty (30) days before the reinsurer assumes or cedes business through the producer, a true copy of the approved contract shall be filed with the commissioner for approval. The contract shall, at a minimum, provide that:

(1) The reinsurer may terminate the contract for cause upon written notice to the RM. The reinsurer may immediately suspend the authority of the RM to assume or cede business during the pendency of any dispute regarding the cause for termination;

(2) The RM will render accounts to the reinsurer accurately detailing all material transactions, including information necessary to support all commissions, charges, and other fees received by, or owing to the RM, and remit all funds due under the contract to the reinsurer on not less than a monthly basis;

(3) All funds collected for the reinsurers account will be held by the RM in a fiduciary capacity in a bank that is a qualified U.S. financial institution as defined in this chapter. The RM may retain no more than three (3) months estimated claims payments and allocated loss adjustment expenses. The RM shall maintain a separate bank account for each reinsurer that it represents;

(4) For at least ten (10) years after the expiration of each contract of reinsurance transacted by the RM, the RM will keep a complete record for each transaction showing:

(i) The type of contract, limits, underwriting restrictions, classes, or risks and territory;

(ii) Period of coverage, including effective and expiration dates, cancellation provisions, and notice required of cancellation, and disposition of outstanding reserves on covered risks;

(iii) Reporting and settlement requirements of balances;

(iv) Rate used to compute the reinsurance premium;

(v) Names and addresses of reinsurers;

(vi) Rates of all reinsurance commissions, including the commissions on any retrocessions handled by the RM;

(vii) Related correspondence and memoranda;

(viii) Proof of placement;

(ix) Details regarding retrocessions handled by the RM, as the provision of this chapter, including the identity of retrocessionaries and percentage of each contract assumed or ceded;

(x) Financial records including, but not limited to, premium and loss accounts; and

(xi) When the RM places a reinsurance contract on behalf of a ceding insurer:

(A) Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or

(B) If placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative;

(5) The reinsurer will have access and the right to copy all accounts and records maintained by the RM related to its business in a form usable by the reinsurer;

(6) The contract cannot be assigned in whole or in part by the RM;

(7) The RM will comply with the written underwriting and rating standards established by the insurer for the acceptance, rejection, or cession of all risks;

(8) Sets forth the rates, terms, and purposes of commissions, charges, and other fees that the RM may levy against the reinsurer;

(9) If the contract permits the RM to settle claims on behalf of the reinsurer:

(i) All claims will be reported to the reinsurer in a timely manner;

(ii) A copy of the claim file will be sent to the reinsurer at its request or as soon as it becomes known that the claim:

(A) Has the potential to exceed the lesser of an amount determined by the commissioner or the limit set by the reinsurer;

(B) Involves a coverage dispute;

(C) May exceed the RMs claims settlement authority;

(D) Is open for more than six (6) months; or

(E) Is closed by payment of the lesser of an amount set by the commissioner or an amount set by the reinsurer;

(iii) All claim files will be the joint property of the reinsurer and RM. Upon an order of liquidation of the reinsurer the files shall become the sole property of the reinsurer or its estate; the RM shall have reasonable access to and the right to copy the files on a timely basis;

(iv) Any settlement authority granted to the RM may be terminated for cause upon the reinsurers written notice to the RM or upon the termination of the contract. The reinsurer may suspend the settlement authority during the pendency of the dispute regarding the cause of termination;

(10) If the contract provides for a sharing of interim profits by the RM, the interim profits will not be paid until one year after the end of each underwriting period for property business and five (5) years after the end of each underwriting period for casualty business, or a later period set by the commissioner for specified lines of insurance, and not until the adequacy of reserves on remaining claims has been verified pursuant to the provisions of this chapter;

(11) The RM will annually provide the reinsurer with a statement of its financial condition prepared by an independent certified accountant;

(12) The reinsurer shall periodically, at least semiannually, conduct an onsite review of the underwriting and claims processing operations of the RM;

(13) The RM will disclose to the reinsurer any relationship it has with any insurer prior to ceding or assuming any business with the insurer pursuant to this contract; and

(14) Within the scope of its actual or apparent authority, the acts of the RM are deemed to be the acts of the reinsurer on whose behalf it is acting.
R.I. Gen. Laws § 27-41-83 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-83
§ 27-41-83. Discretionary clauses.
Status: in_force

(a) No new or existing policy or certificate may contain any provision:

(1) Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or

(2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.

(b) Any such clause or language included in a contract, policy, or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.

(c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.
R.I. Gen. Laws § 27-18-3 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-3
§ 27-18-3. Required provisions.
Status: repealed

(a) Except as provided in §27-18-5, each policy delivered or issued for delivery to any person in this state shall contain the provisions specified in this section in the words in which the provisions appear in this section; provided, that the insurer may, at its option, substitute, for one or more of the provisions, corresponding provisions of different wording approved by the commissioner which are in each instance not less favorable in any respect to the insured or the beneficiary. The provisions shall be preceded individually by the caption appearing in this subsection or, at the option of the insurer, by the appropriate individual or group captions or subcaptions as the commissioner may approve:

(1) A provision as follows:

ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless the approval is endorsed on it or attached to it. No agent has authority to change this policy or to waive any of its provisions.

(2) A provision as follows:

TIME LIMIT ON CERTAIN DEFENSES: (a) After three (3) years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for this policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of that three-year period.

(This policy provision shall not be construed as to affect any legal requirement for avoidance of a policy or denial of a claim during the initial three (3) year period, nor to limit the application of §27-18-4(1), (2), (3), (4), and (5) in the event of a misstatement with respect to age or occupation or other insurance.)

(A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium: (i) until at least age fifty (50); or (ii) in the case of a policy issued after age forty-four (44), for at least five (5) years from its date of issue, may contain in lieu of this provision the following provision (from which the clause in parentheses may be omitted at the insurer's option) under the caption INCONTESTABLE:

After this policy has been in force for a period of three (3) years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.)

(b) No claim for loss incurred or disability (as defined in the policy) commencing after three (3) years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.

(3) A provision as follows:

GRACE PERIOD: A grace period of ____  (insert a number not less than seven (7) for weekly premium policies, ten (10) for monthly premium policies, and thirty-one (31) for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.

(A policy which contains a cancellation provision may add, at the end of the above provision:

subject to the right of the insurer to cancel in accordance with the cancellation provision of this policy.)

(A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision:

Unless not less than ten (10) days prior to the premium due date the insurer has delivered to the insured or has mailed to his or her last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted,)

(4) A provision as follows:

REINSTATEMENT: If any renewal premium is not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept this premium, without requiring in connection with it an application for reinstatement, shall reinstate the policy; provided, that if the insurer or the agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of the application by the insurer or, lacking approval, upon the forty-fifth day following the date of the conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of the application. The reinstated policy shall cover only loss resulting from an accidental injury as may be sustained after the date of reinstatement and loss due to a sickness as may begin more than ten (10) days after this date. In all other respects the insured and insurer shall have the same rights under the reinstated policy as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed on it or attached to it in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which the premium has not been previously paid, but not to any period more than sixty (60) days prior to the date of reinstatement.

(The last sentence of this provision may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums: (i) until at least age fifty (50); or (ii) in the case of a policy issued after age forty-four (44), for at least five (5) years from its date of issue.)

(5) A provision as follows:

NOTICE OF CLAIM: Written notice of claim must be given to the insurer within twenty (20) days after the occurrence or commencement of any loss covered by the policy, or as soon after this as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at ____________  (insert the location of any office as the insurer may designate for the purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer.

(In a policy providing a loss of time benefit which may be payable for at least two (2) years, an insurer may at its option insert the following between the first and second sentences of this provision:

Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two (2) years, the insured shall, at least once in every six (6) months after having given notice of claim, give to the insurer notice of continuance of the disability, except in the event of legal incapacity. The period of six (6) months following any filing of proof by the insured or any payment by the insurer on account of the claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of notice shall not impair the insured's right to any indemnity which would have accrued during the period of six (6) months preceding the date on which the notice is actually given.)

(6) A provision as follows:

CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant any forms as are usually furnished by it for filing proofs of loss. If the forms are not furnished within fifteen (15) days after the giving of notice, the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character, and the extent of the loss for which claim is made.

(7) A provision as follows:

PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its office in the case of a claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety (90) days after the termination of the period for which the insurer is liable and in the case of a claim for any other loss within ninety (90) days after the date of the loss. Failure to furnish proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within this time, provided the proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is required.

(8) A provision as follows:

TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of this loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid ____________  (insert period for payments which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.

(9) A provision as follows:

PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting the payment which may be prescribed in this policy and effective at the time of payment. If no designation or provision is effective, indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid either to the beneficiary or to the estate. All other indemnities will be payable to the insured.

(The following provisions, or either of them, may be included with this provision at the option of the insurer:

If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or not competent to give a valid release, the insurer may pay the indemnity, up to an amount not exceeding $______  (insert an amount which shall not exceed one thousand dollars ($1,000)), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled to the payment. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of the payment. Subject to any written direction of the insured in the application or otherwise, all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical, or surgical services may, at the insurers option and unless the insured requests otherwise in writing not later than the time of filing proofs of the loss, be paid directly to the hospital or person rendering the services; but it is not required that the service be rendered by a particular hospital or person.)

(10) A provision as follows:

PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim under this policy and to make an autopsy in case of death where it is not forbidden by law.

(11) A provision as follows:

LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of this policy. No action shall be brought after the expiration of three (3) years after the time written proof of loss is required to be furnished.

(12) A provision as follows:

CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.

(The first clause of this provision, relating to the irrevocable designation of beneficiary, may be omitted at the insurer's option.)

(13) A provision as follows:

Medical services means those professional services and supplies rendered by or under the direction of persons duly licensed under the laws of this state to practice medicine, surgery, or podiatry as may be specified by any medical service plan. Medical service shall not be construed to include hospital services.

(c)(1) Each policy issued and/or renewed shall contain a minimum home healthcare benefit as follows:

(i) Home health care is defined as a medically necessary program to reduce the length of a hospital stay or to delay or eliminate an otherwise medically necessary hospital admission;

(ii) The home healthcare program shall be formulated and supervised by the subscriber's physician;

(iii) Minimum home healthcare coverage shall not exceed six (6) home or office physician's visits per month, and shall not exceed three (3) nursing visits per week, home health aide visits up to twenty (20) hours per week, and the following services as needed: physical or occupational therapy as a rehabilitative service, respiratory service, speech therapy, medical social work, nutrition counseling, prescription drugs and medication, medical and surgical supplies, such as dressings, bandages, and casts, minor equipment such as commodes and walkers, laboratory testing, x-rays, and E.E.G. and E.K.G. evaluations; and

(iv) Communicable diseases and/or nervous, emotional, and mental illness are excluded from home healthcare coverage.

(2) The commissioner shall approve the wording in each policy that in each instance shall not be less favorable in any respect to the insured or the beneficiary, as the benefits are outlined in subdivision (1) of this subsection. Any accident and sickness insurance policy whose benefits are limited to income protection or the furnishing of disability income or a limited benefit health coverage are excluded from this subsection. Notwithstanding the provisions of § 27-18-19(3) [repealed], the minimum home healthcare benefit shall be included in blanket and/or group policies of accident and sickness insurance.

(3) A limited benefit policy, for the purposes of this section, is any accident and sickness policy that covers one or more specified risks including, but not limited to, accidental death or injury or specified disease. A policy that broadly covers accident and sickness, but which contains exclusions and limitations with respect to certain risks or services, is not a limited benefit policy.

(4) With respect to blanket and/or group policies, the provisions of this subsection shall apply only to services provided to residents of Rhode Island or employees of Rhode Island employers.
R.I. Gen. Laws § 27-7-2.5 — RI Code / Title 27 / Chapter 27-7 / Section 27-7-2.5
§ 27-7-2.5. Minimum coverage  Medical payments.
Status: in_force

(a) No policy insuring against loss resulting from liability imposed by law, or for injuries caused by a motor vehicle collision or for injuries arising out of the ownership, maintenance, or use of a motor vehicle, shall be delivered or issued in this state unless coverage is provided in the policy for medical payments in an amount of not less than twenty-five hundred dollars ($2,500) for each individual and five thousand dollars ($5,000) aggregate for the protection of persons injured regardless of the fault of the injured person; provided, that the named insured shall have the right to reject that coverage in writing.

(b) The insurer or any affiliated insurer shall be required to notify the policyholder in any renewal policy as to the availability of medical payments coverage. Unless the insured named in the policy requests medical payments coverage in writing, that coverage need not be provided in any subsequent policy issued by the same insurer or any affiliate for motor vehicles owned by the named insured, including, but not limited to, renewal, reinstatement, substitute, amended, modified, transfer, or replacement policies where the named insured has rejected the coverage in connection with the policy previously issued to the insured by the same insurer or an affiliate.
R.I. Gen. Laws § 27-19-5.1 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-5.1
§ 27-19-5.1. Cancellation of coverage by employers.
Status: in_force

No employer shall cancel any contract of insurance provided for the benefit of his or her employee as provided for in this chapter without first allowing the employee the opportunity to continue the contract of insurance, with the employee paying an amount not to exceed the total contribution required of the employer and employee for the continuation of the protection while the employee is disabled and receiving benefits pursuant to the provision of the Workers Compensation Act, chapters 29  38 of title 28.
R.I. Gen. Laws § 27-6-36 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-36
§ 27-6-36. Use of information from noncomplying advisory organization.
Status: in_force

No insurer that makes its own filings or any rating organization shall support its filings by statistics, or adopt ratemaking recommendations, furnished to it by an advisory organization that has not complied with §§ 27-6-33  27-6-35, or with an order of the commissioner involving those statistics or recommendations issued under § 27-6-35. If the commissioner finds any insurer or rating organization to be in violation of this section the commissioner may issue an order requiring the discontinuance of that violation.
R.I. Gen. Laws § 27-6-8 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-8
§ 27-6-8. Filing of rate schedules and plans.
Status: in_force

(a) Every insurer shall file with the commissioner, except as to inland marine risks that by general custom of the business are not written according to manual rates or rating plans, every manual, minimum, or class rate, rating schedule or rating plan, and every other rating rule, and every modification of any of these which it proposes to use; provided, that rates other than class rates determined by the application of any rating schedule or rating plan may be modified without additional filing to produce rates for individual risks which are lower than those filed and which evaluate variations in physical or moral hazards, individual risk experience, or expense provisions and which are not inadequate or unfairly discriminatory. Every filing shall state the proposed effective date, and shall indicate the character and extent of the coverage contemplated.

(b) When a filing is not accompanied by the information upon which the insurer supports that filing, and the commissioner does not have sufficient information to determine whether that filing meets the requirements of the chapter, the commissioner shall require the insurer to furnish the information upon which it supports that filing. The information furnished in support of a filing may include: (1) The experience or judgment of the insurer or rating organization making the filing; (2) Its interpretation of any statistical data it relies upon; (3) The experience of other insurers or rating organizations; or (4) Any other relevant factors. A filing and any supporting information shall be open to public inspection. Specific inland marine rates on risks specially rated, made by a rating organization, shall be filed with the commissioner.
R.I. Gen. Laws § 27-44-4 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-4
§ 27-44-4. Competitive market.
Status: in_force

(a) A competitive market is presumed to exist unless the director, after a hearing, determines that a reasonable degree of competition does not exist in the market and issues a ruling to that effect. The ruling shall remain in effect until the time the director deems that a competitive market exists, and issues a ruling to that effect. The director may, without a hearing, make a ruling that a competitive market exists based upon a departmental analysis of the market. Notwithstanding the foregoing, any insurer may request a hearing before the director to present evidence that competition exists in the affected market after a ruling of noncompetition has been in effect for at least one year.

(b) In determining whether a reasonable degree of competition exists, the director shall consider relevant tests of workable competition pertaining to market structure, market performance, and market conduct, and the practical opportunities available to consumers in the market to acquire pricing and other consumer information and to compare and obtain insurance from competing insurers. The tests may include, but are not limited to, the following: size and number of firms actively engaged in the market; market shares and changes in the market shares of firms; ease of entry and latent competition of insurers capable of easy entry and exit from a given market; underwriting restrictions; whether profitability for companies generally in the market is unreasonably high; availability of consumer information concerning the product and sales outlets or other sales mechanisms; existence of a degree of rate differential within a class of business; and efforts of insurers to provide consumer information. The determination of competition involves the interaction of the various tests, and the weight given to specific tests depends upon the particular situation and pattern of tests results.
R.I. Gen. Laws § 27-20-24 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-24
§ 27-20-24. Rehabilitation, liquidation, or conservation.
Status: in_force

(a) Any rehabilitation, liquidation, administrative supervision, or conservation of a nonprofit medical service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit medical service corporation upon any one or more of the following grounds:

(1) That the nonprofit medical service corporation is insolvent; for the purposes of this section, the term insolvent means the inability of the nonprofit medical service corporation to meet its debts and financial obligations as they become due;

(2) That the nonprofit medical service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subsection (a)(1) of this section; or

(3) That the nonprofit medical service corporations financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.

(b) A claim by a healthcare provider shall not be asserted against any subscriber or member of the nonprofit medical service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit medical service corporation.
R.I. Gen. Laws § 27-6-34 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-34
§ 27-6-34. Documents filed by advisory organizations.
Status: in_force

Every advisory organization shall file with the commissioner:

(1) A copy of its constitution, its articles of agreement or association or its certificate of incorporation, and its bylaws, rules, and regulations governing its activities;

(2) A list of its members;

(3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process issued at the commissioners direction may be served; and

(4) An agreement that the commissioner may examine that advisory organization in accordance with the provisions of §§ 27-6-39 and 27-6-40.
R.I. Gen. Laws § 27-64-1 — RI Code / Title 27 / Chapter 27-64 / Section 27-64-1
§ 27-64-1. Short title.
Status: in_force

This chapter may be cited as the Protected Cell Companies Act.
R.I. Gen. Laws § 27-5-22 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-22
§ 27-5-22. Application of special reserve fund to protection of policyholders.
Status: in_force

Whenever the claims upon a fire insurance company shall exceed the amount of its capital stock and of the guaranty surplus fund provided for by this chapter, the company shall notify the insurance commissioner of the fact, who shall then make or cause to be made an examination of the company, and shall issue the commissioners certificate of the result, showing the amounts of capital, of guaranty surplus fund, of special reserve fund, of reinsurance liability, and of other assets. Upon the issuing of that certificate in duplicate, one copy to be given to the company and one to be recorded in the office of the insurance commissioner, the special reserve fund shall be immediately held to protect all policyholders of the company other than those that are claimants upon it at the date of the certificate, and the special reserve fund together with other assets, certified by the insurance commissioner as equal in value to the amount of the unearned premiums of the company, to be ascertained as provided in this chapter, shall constitute the capital and assets of the company for the protection of policyholders other than the claimants and for the further conduct of its business, and any official certificate of the insurance commissioner shall be binding and conclusive upon all parties interested in the company, whether as stockholders, creditors, or policyholders. Upon the payment to the claimants, who are claimants at the date of the certificate, of the full sum of the capital of the company and of its guaranty surplus fund and of its assets at that date, excepting only the special reserve fund and an amount of its assets equal to the liability of the company for unearned premiums, as certified in this manner by the insurance commissioner, the company shall be forever discharged from any and all further liability to the claimants and to each of them, and the insurance commissioner shall, after issuing the commissioners certificate, upon the demand of the company, transfer to it all securities that have been deposited with the commissioner by the company as the special reserve fund, and if the amount of the special reserve fund is less than fifty percent (50%) of the full amount of the capital of the company, a requisition shall be issued by the insurance commissioner upon the stockholders to make up the capital to that proportion of its full amount; provided, that any capital impaired in this manner shall be made up at least to the sum of two hundred thousand dollars ($200,000), and in case the company, after the requisition, shall fail to make up its capital at least to the sum of two hundred thousand dollars ($200,000), the special reserve fund shall still be held as security and liable for any and all losses occurring upon policies of the company.
R.I. Gen. Laws § 27-49-4 — RI Code / Title 27 / Chapter 27-49 / Section 27-49-4
§ 27-49-4. Evidence and confidentiality.
Status: in_force

Any information furnished pursuant to this chapter shall be privileged and not a part of any public record. Except as otherwise provided by law, any authorized governmental agency, insurer, or an agent authorized by an insurer to act on its behalf that receives any information furnished pursuant to this chapter, shall not release the information to public inspection. The evidence or information shall not be subject to subpoena duces tecum in a civil or criminal proceeding, unless, after reasonable notice to any insurer, agent authorized by an insurer to act on its behalf, and authorized governmental agency that has an interest in the information and a subsequent hearing, the court determines that the public interest and any ongoing investigation by the authorized governmental agency, insurer, or an agent authorized by an insurer to act on its behalf will not be jeopardized by compliance with the subpoena or subpoena duces tecum.
R.I. Gen. Laws § 27-32-7 — RI Code / Title 27 / Chapter 27-32 / Section 27-32-7
§ 27-32-7. Regulation of issuance and sale of agreements  Rules and regulations.
Status: in_force

Notwithstanding any other provisions of law, the insurance commissioner shall have sole authority to regulate the issuance and sale of the agreements and to issue reasonable rules and regulations necessary to carry out the purposes and provisions of this chapter. Provided, the insurance commissioner shall license any person selling annuities.
R.I. Gen. Laws § 27-3-41 — RI Code / Title 27 / Chapter 27-3 / Section 27-3-41
§ 27-3-41. Service of process.
Status: in_force

No person licensed to act as a surplus line broker in the state shall place any risk with any unauthorized insurer unless that insurer has previously, in writing, appointed that broker as an agent for the acceptance of service of process, or unless the unauthorized insurer shall have designated a Rhode Island representative as an agent for the service of process, copies of which shall be filed with the insurance commissioner. The designation of a licensed broker or other representative for the purpose stated shall be cumulative to any other methods that may be provided by law for service of process upon an unauthorized insurer.
R.I. Gen. Laws § 27-2-29 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-29
§ 27-2-29. Information security program.
Status: in_force

(a) Commensurate with the size and complexity of an insurer, the nature and scope of an insurers activities, including its use of third-party service providers, and the sensitivity of the nonpublic information used by the insurer or in the insurers possession, custody, or control, each foreign insurance company shall develop, implement, and maintain a comprehensive written information security program, based on the insurers risk assessment and that contains administrative, technical, and physical safeguards for the protection of nonpublic information and the insurers information system. For purposes of this section, information security program means the administrative, technical, and physical safeguards that an insurer uses to access, collect, distribute, process, protect, store, use, transmit, dispose of, or otherwise handle nonpublic information. Publicly available information means any information that a licensee has a reasonable basis to believe is lawfully made available to the general public from: federal, state, or local government records; widely distributed media; or disclosures to the general public that are required to be made by federal, state, or local law. Nonpublic information means information that is not publicly available information and is:

(1) Business-related information of a licensee, the tampering with which, or unauthorized disclosure, access, or use of which, would cause a material adverse impact to the business, operations, or security of the licensee;

(2) Any information concerning a consumer which, because of name, number, personal mark, or other identifier can be used to identify such consumer, in combination with any one or more of the following data elements:

(i) Social security number;

(ii) Drivers license number or non-driver identification card number;

(iii) Account number, credit or debit card number;

(iv) Any security code, access code, or password that would permit access to a consumers financial account; or

(v) Biometric records;

(3) Any information or data, except age or gender, in any form or medium created by or derived from a healthcare provider or a consumer and that relates to:

(i) The past, present, or future physical, mental, behavioral health, or medical condition of any consumer or a member of the consumers family;

(ii) The provision of health care to any consumer; or

(iii) Payment for the provision of health care to any consumer.

(b) Objectives of information security program. An insurers information security program shall be designed to:

(1) Protect the security and confidentiality of nonpublic information and the security of the information system;

(2) Protect against any threats or hazards to the security or integrity of nonpublic information and the information system;

(3) Protect against unauthorized access to or use of nonpublic information, and minimize the likelihood of harm to any consumer. For the purposes of this section, consumer means an individual, including, but not limited to, applicants, policyholders, insureds, beneficiaries, claimants, and certificate holders, who is a resident of this state and whose nonpublic information is in an insurers possession, custody, or control; and

(4) Define and periodically reevaluate a schedule for retention of nonpublic information and a mechanism for its destruction when no longer needed.

(c) Risk assessment. The insurer shall:

(1) Designate one or more employees, an affiliate, or an outside vendor designated to act on behalf of the insurer who is responsible for the information security program;

(2) Identify reasonably foreseeable internal or external threats that could result in unauthorized access, transmission, disclosure, misuse, alteration, or destruction of nonpublic information, including the security of information systems and nonpublic information that are accessible to, or held by, third-party service providers. For purposes of this section, third-party service providers means a person, not otherwise defined as a licensee, that contracts with a licensee to maintain, process, store or otherwise is permitted access to nonpublic information through its provision of services to the licensee;

(3) Assess the likelihood and potential damage of these threats, taking into consideration the sensitivity of the nonpublic information;

(4) Assess the sufficiency of policies, procedures, information systems, and other safeguards in place to manage these threats, including consideration of threats in each relevant area of the insurers operations, including:

(i) Employee training and management;

(ii) Information systems, including network and software design, as well as information classification, governance, processing, storage, transmission, and disposal; and

(iii) Detecting, preventing, and responding to attacks, intrusions, or other systems failures; and

(5) Implement information safeguards to manage the threats identified in its ongoing assessment, and no less than annually, assess the effectiveness of the safeguards key controls, systems, and procedures.

(d) Risk management. Based on its risk assessment, the insurer shall:

(1) Design its information security program to mitigate the identified risks, commensurate with the size and complexity of the insurers activities, including its use of third-party service providers, and the sensitivity of the nonpublic information used by the insurer or in the insurers possession, custody, or control;

(2) Determine which security measures listed below are appropriate and implement such security measures:

(i) Place access controls on information systems, including controls to authenticate and permit access only to authorized individuals to protect against the unauthorized acquisition of nonpublic information. Authorized individual means an individual known to and screened by the insurer and determined to be necessary and appropriate to have access to the nonpublic information held by the insurer and its information systems;

(ii) Identify and manage the data, personnel, devices, systems, and facilities that enable the organization to achieve business purposes in accordance with their relative importance to business objectives and the organizations risk strategy;

(iii) Restrict access at physical locations containing nonpublic information only to authorized individuals;

(iv) Protect, by encryption or other appropriate means, all nonpublic information while being transmitted over an external network and all nonpublic information stored on a laptop computer or other portable computing or storage device or media;

(v) Adopt secure development practices for in-house developed applications utilized by the insurer and procedures for evaluating, assessing, or testing the security of externally developed applications utilized by the insurer;

(vi) Modify the information system in accordance with the insurers information security program;

(vii) Utilize effective controls, which may include multi-factor authentication procedures for any individual accessing nonpublic information;

(viii) Regularly test and monitor systems and procedures to detect actual and attempted attacks on, or intrusions into, information systems;

(ix) Include audit trails within the information security program designed to detect and respond to cybersecurity events and designed to reconstruct material financial transactions sufficient to support normal operations and obligations of the insurer;

(x) Implement measures to protect against destruction, loss, or damage of nonpublic information due to environmental hazards, such as fire and water damage or other catastrophes or technological failures; and

(xi) Develop, implement, and maintain procedures for the secure disposal of nonpublic information in any format;

(3) Include cybersecurity risks in the insurers enterprise risk management process;

(4) Stay informed regarding emerging threats or vulnerabilities and utilize reasonable security measures when sharing information relative to the character of the sharing and the type of information shared; and

(5) Provide its personnel with cybersecurity awareness training that is updated as necessary to reflect risks identified by the insurer in the risk assessment.

(e) Oversight by board of directors. If the insurer has a board of directors, the board or an appropriate committee of the board shall, at a minimum:

(1) Require the insurers executive management or its designees to develop, implement, and maintain the insurers information security program;

(2) Require the insurers executive management or its designees to report in writing at least annually, the following information:

(i) The overall status of the information security program and the insurers compliance with this chapter; and

(ii) Material matters related to the information security program, addressing issues such as risk assessment, risk management and control decisions, third-party service provider arrangements, results of testing, cybersecurity events or violations and managements responses thereto, or recommendations for changes in the information security program; and

(3) If executive management delegates any of its responsibilities pursuant to this section, it shall oversee the development, implementation, and maintenance of the insurers information security program prepared by the designee(s) and shall receive a report from the designee(s) complying with the requirements of the report to the board of directors.

(f) Oversight of third-party service provider arrangements.

(1) An insurer shall exercise due diligence in selecting its third-party service provider; and

(2) An insurer shall take reasonable steps to request a third-party service provider to implement appropriate administrative, technical, and physical measures to protect and secure the information systems and nonpublic information that are accessible to, or held by, the third-party service provider.

(g) Program adjustments. The insurer shall monitor, evaluate, and adjust, as appropriate, the information security program consistent with any relevant changes in technology, the sensitivity of its nonpublic information, internal or external threats to information, and the insurers own changing business arrangements, such as mergers and acquisitions, alliances and joint ventures, outsourcing arrangements, and changes to information systems.

(h) Incident response plan.

(1) As part of its information security program, each insurer shall establish a written incident response plan designed to promptly respond to, and recover from, any cybersecurity event that compromises the confidentiality, integrity, or availability of nonpublic information in its possession, the insurers information systems, or the continuing functionality of any aspect of the insurers business or operations.

(2) Such incident response plan shall address the following areas:

(i) The internal process for responding to a cybersecurity event;

(ii) The goals of the incident response plan;

(iii) The definition of clear roles, responsibilities, and levels of decision-making authority;

(iv) External and internal communications and information sharing;

(v) Identification of requirements for the remediation of any identified weaknesses in information systems and associated controls;

(vi) Documentation and reporting regarding cybersecurity events and related incident response activities; and

(vii) The evaluation and revision as necessary of the incident response plan following a cybersecurity event.

(3) If the insurer learns that a cybersecurity event has or may have occurred, the insurer, or an outside vendor and/or service provider designated to act on behalf of the insurer, shall conduct a prompt investigation. For the purposes of this section, cybersecurity event means an event resulting in unauthorized access to, disruption, or misuse of an information system or nonpublic information stored on such information system. This does not include the unauthorized acquisition of encrypted nonpublic information if the encryption, process, or key is not also acquired, released, or used without authorization. This also does not include an event with regard to which the insurer has determined that the nonpublic information accessed by an unauthorized person has not been used or released and has been returned or destroyed.

(i) During the investigation, the insurer, or an outside vendor and/or service provider designated to act on behalf of the insurer, shall, at a minimum, determine as much of the following information as possible:

(A) Whether a cybersecurity event has occurred;

(B) Assess the nature and scope of the cybersecurity event;

(C) Identify any nonpublic information that may have been involved in the cybersecurity event; and

(D) Perform or oversee reasonable measures to restore the security of the information systems compromised in the cybersecurity event in order to prevent further unauthorized acquisition, release, or use of nonpublic information in the insurers possession, custody, or control.

(ii) If the insurer learns that a cybersecurity event has or may have occurred in a system maintained by a third-party service provider, and it has or may have impacted the insurers nonpublic information, the insurer shall make reasonable efforts to complete the steps set forth in subsection (h)(3)(i) of this section or make reasonable efforts to confirm and document that the third-party service provider has completed those steps.

(iii) The insurer shall maintain records concerning all cybersecurity events for a period of at least five (5) years from the date of the cybersecurity event. The insurer shall produce those records upon demand of the commissioner pursuant to chapter 13.1 of this title or other statutory authority.
R.I. Gen. Laws § 27-19-64 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-64
§ 27-19-64. Coverage for individuals participating in approved clinical trials.
Status: in_force

(a) As used in this section:

(1) Approved clinical trial means a phase I, phase II, phase III, or phase IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or a life-threatening disease or condition and is described in any of the following:

(i) The study or investigation is approved or funded, which may include funding through in-kind contributions, by one or more of the following:

(A) The federal National Institutes of Health;

(B) The federal Centers for Disease Control and Prevention;

(C) The federal Agency for Health Care Research and Quality;

(D) The federal Centers for Medicare & Medicaid Services;

(E) A cooperative group or center of any of the entities described in subsections (a)(1)(i)(A)-(D) or the U.S. Department of Defense or the U.S. Department of Veterans Affairs;

(F) A qualified nongovernmental research entity identified in the guidelines issued by the federal National Institutes of Health for center support grants; or

(G) A study or investigation conducted by the U.S. Department of Veterans Affairs, the U.S. Department of Defense, or the U.S. Department of Energy, if the study or investigation has been reviewed and approved through a system of peer review that the Secretary of the U.S. Department of Health and Human Services determines:

(I) Is comparable to the system of peer review of studies and investigations used by the federal National Institutes of Health; and

(II) Ensures unbiased review of the highest scientific standards by qualified individuals who have no interest in the outcome of the review;

(ii) The study or investigation is conducted under an investigational new drug application reviewed by the U.S. Food and Drug Administration; or

(iii) The study or investigation is a drug trial that is exempt from having such an investigational new drug application.

(2) Life-threatening condition means any disease or condition from which the likelihood of death is probable unless the course of the disease or condition is interrupted.

(3) Participant has the meaning stated in section 3(7) of federal ERISA [29 U.S.C. §1002].

(4) Participating provider means a healthcare provider that, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide healthcare services to covered persons with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly or indirectly from the health carrier.

(5) Qualified individual means a participant or beneficiary who meets the following conditions:

(i) The individual is eligible to participate in an approved clinical trial according to the trial protocol with respect to the treatment of cancer or other life-threatening disease or condition; and

(ii)(A) The referring healthcare professional is a participating provider and has concluded that the individuals participation in such trial would be appropriate based on the individuals meeting the conditions described in subsection (a)(5)(i); or

(B) The participant or beneficiary provides medical and scientific information establishing the individuals participation in such trial would be appropriate based on the individuals meeting the conditions described in subsection (a)(5)(i).

(b)(1) If a health insurance carrier offering group or individual health insurance coverage provides coverage to a qualified individual, the health carrier:

(i) Shall not deny the individual participation in an approved clinical trial;

(ii) Subject to subsection (b)(3), shall not deny or limit or impose additional conditions on the coverage of routine patient costs for items and services furnished in connection with participation in the approved clinical trial; and

(iii) Shall not discriminate against the individual on the basis of the individuals participation in the approved clinical trial.

(2)(i) Subject to subsection (b)(2)(ii), routine patient costs include all items and services consistent with the coverage typically covered for a qualified individual who is not enrolled in an approved clinical trial.

(ii) For purposes of this subsection (b)(2), routine patient costs do not include:

(A) The investigational item, device, or service itself;

(B) Items and services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient; or

(C) A service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis.

(3) If one or more participating providers are participating in a clinical trial, nothing in subsection (b)(1) shall be construed as preventing a health carrier from requiring that a qualified individual participate in the trial through such a participating provider if the provider will accept the individual as a participant in the trial.

(4) Notwithstanding subsection (b)(3) of this section, subsection (b)(1) shall apply to a qualified individual participating in an approved clinical trial that is conducted outside this state.

(5) This section shall not be construed to require a health carrier offering group or individual health insurance coverage to provide benefits for routine patient care services provided outside of the coverages healthcare provider network unless out-of-network benefits are otherwise provided under the coverage.

(6) Nothing in this section shall be construed to limit a health carriers coverage with respect to clinical trials.

(c) The requirements of this section shall be in addition to the requirements of §§27-18-32  27-19-32.2.

(d) 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.

(e) This section shall be effective for plan years beginning on or after January 1, 2014.
R.I. Gen. Laws § 27-41-14 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-14
§ 27-41-14. Prohibited practices.
Status: in_force

(a) No health maintenance organization, or representative of a health maintenance organization, may cause or knowingly permit the use of advertising that is untrue or misleading, solicitation that is untrue or misleading, or any form of evidence of coverage that is deceptive. For the purposes of this chapter:

(1) A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect that is or may be significant to an enrollee of, or a person considering enrollment with, a health maintenance organization;

(2) A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which the statement is made or the item of information is communicated, the statement or item of information may be reasonably understood by a reasonable person, not possessing special knowledge regarding healthcare coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation, or disadvantage of possible significance to an enrollee of, or a person considering enrollment in, a health maintenance organization, if the benefit or advantage or absence of limitation, exclusion, or disadvantage does not in fact exist; and

(3) An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography, format, and language, shall be such as to cause a reasonable person, not possessing special knowledge regarding health maintenance organizations and evidences of coverage for them, to expect benefits, services, charges, or other advantages that the evidence of coverage does not provide or that the health maintenance organization issuing the evidence of coverage does not regularly make available for enrollees covered under the evidence of coverage.

(b) Section 42-62-12 and regulations pursuant to that section and chapter 29 of this title, relating to unfair competition and practices, shall be construed to apply to health maintenance organizations and evidences of coverage except to the extent that the director of business regulation determines that the nature of health maintenance organizations, and evidences of coverage, render those sections clearly inappropriate.

(c) An enrollee may not be canceled or nonrenewed except for reasons stated in the rules of the health maintenance organization applicable to all enrollees, for the failure to pay the charge for coverage, or for the other reasons as may be approved by the director of business regulation.

(d) No health maintenance organization, unless licensed as an insurer, may use in its name, contracts, or literature any of the words insurance, casualty, surety, or mutual, or any words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this state.

(e) No person, unless in possession of a valid license as a health maintenance organization pursuant to the laws of this state, shall hold itself out as a health maintenance organization or HMO or shall do business as a health maintenance organization or HMO in the state of Rhode Island, and no person shall do business in this state under a name deceptively similar to the name of any health maintenance organization possessing a valid license pursuant to this chapter.

(f) No health maintenance organization shall fail to contract with any provider who is licensed by this state to provide the services delineated in § 27-41-2(20)(i) solely because that provider is a podiatrist as defined in chapter 29 of title 5.

(g) Except as provided in § 27-41-13(i), no contract between a health maintenance organization and a physician for the provision of services to patients may require that the physician indemnify or hold harmless the health maintenance organization for any expenses and liabilities, including without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the plan based on the health maintenance organizations management decisions or utilization review provisions for any patient.
R.I. Gen. Laws § 27-16-7 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-7
§ 27-16-7. Service of process on agent or insurance producer.
Status: in_force

Service of process in an action, suit, or proceeding shall, in addition to the manner provided in § 27-16-6, be valid if served upon any person within this state who, in this state on behalf of the insurer, is: (1) Soliciting insurance or reinsurance; (2) Making, issuing, or delivering any contract of insurance or reinsurance; or (3) Collecting or receiving any premium, membership fee, assessment, or other consideration for insurance or reinsurance; and a copy of the process is sent within ten (10) days after this by registered mail by the plaintiff or plaintiffs attorney to the defendant at the last known principal place of business of the defendant, and the defendants receipt, or the receipt issued by the post office with which the letter is registered, showing the name of the sender of the letter and the name and address of the person to whom the letter is addressed, and the affidavit of the plaintiff or plaintiffs attorney showing compliance with this section, are filed with the clerk of the court in which the action is pending on or before the date the defendant is required to appear, or within any further time as the court may allow.
R.I. Gen. Laws § 27-4-29 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-29
§ 27-4-29. Life insurance database.
Status: in_force

(a) The department of business regulation shall maintain a central database of electronic contact information for each life insurer having policies in force in this state.

(b) On and after January 1, 2013, any member of the immediate family of a decedent searching for life insurance policies covering the decedent may file a request with the department for a search pursuant to this section, provided the decedent was a resident or former resident of this state. Any such request shall include a copy of the subject decedents death certificate. The right to file a request for a search pursuant to this section may not be assigned.

(c) The department shall transmit any such request to all life insurers having policies in force in this state, along with information necessary for responding directly to the person filing the request. Each such insurer shall examine its books and records to make a determination as to the existence of coverage of the subject decedent, and upon a finding that such coverage does exist, shall directly notify the person filing the request.

(d) The department may adopt such rules and regulations as may be necessary to implement the provisions of this section.

(e) Insurers of credit life insurance are exempt from inclusion in the central database and shall not be subject to the requirements of § 27-4-28.
R.I. Gen. Laws § 27-20-63 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-63
§ 27-20-63. Internal and external appeal of adverse benefit determinations.
Status: repealed

(a) The commissioner shall adopt regulations to implement standards and procedures with respect to internal claims and appeals of adverse benefit determinations, and with respect to external appeals of adverse benefit determinations.

(b) The regulations adopted by the commissioner shall apply only to those adverse benefit determinations that are not subject to the jurisdiction of the department of health pursuant to § 23-17.12 et seq. (Utilization Review Act) [repealed].

(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. This section also shall not apply to grandfathered health plans.
R.I. Gen. Laws § 27-19-7.1 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-7.1
§ 27-19-7.1. Uniform explanation of benefits and coverage.
Status: repealed

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

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

(c) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.
R.I. Gen. Laws § 27-20-66 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-66
§ 27-20-66. Discretionary clauses.
Status: in_force

(a) No new or existing policy or certificate may contain any provision:

(1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate; or

(2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.

(b) Any such clause or language included in a contract, policy, or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.

(c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility; receipt of benefits and claims; or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.
R.I. Gen. Laws § 27-25-18 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-18
§ 27-25-18. Benefits not attachable.
Status: in_force

No money or other benefit, charity, relief, or aid to be paid, provided, or rendered by any society shall be liable to attachment, garnishment, or other process, or be seized, taken, appropriated, or applied by any legal or equitable process or operation of law to pay any debt or liability of a member or beneficiary, or any other person who may have a right under a debt or liability of a member or beneficiary, either before or after payment by the society.
R.I. Gen. Laws § 27-73-4 — RI Code / Title 27 / Chapter 27-73 / Section 27-73-4
§ 27-73-4. Powers, duties, and functions of the board.
Status: in_force

The board shall have the following powers, duties, and functions relative to active full-time certified employees pursuant to § 28-9.3-2, and active full-time school district employees pursuant to § 28-9.4-3:

(1) To design and recommend, with input and recommendations from the technical advisory committee, medical benefits plan designs and prescription drug coverage plan designs in accordance with the following:

(i) To design at least six (6) uniform benefit plan designs for all Rhode Island public school employees.

(ii) Benefit plan designs shall include at least one managed care option, at least four (4) preferred provider organization (PPO) options, and at least one health savings account (HSA) compatible high deductible health plan (HDHP) option.

(iii) The actuarial value of any of the approved benefit plan designs may not be greater than the actuarial value of the state employee health plan in effect as of the date the plan designs are approved.

(iv) The PPO options shall reflect four (4) different levels of plan design, with a minimum actuarial difference between each of the plan designs of seven and one-half percent (7.5%).

(v) The actuarial value of the lowest board-recommended benefit plan design shall not be greater than the actuarial value of the public school employee benefit plan design with the lowest actuarial value in effect in the state on January 1, 2011.

(2) To monitor the implementation of the uniform benefit plan designs and to recommend modifications to such benefit plan designs as appropriate.

(3) To report to the governor and general assembly on or before January 1, 2012, with recommendations on the means, feasibility, and benefits of developing a statewide health benefit purchasing arrangement for public school employees.
R.I. Gen. Laws § 27-29-17.3 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-17.3
§ 27-29-17.3. Notice of premium or coverage changes.
Status: in_force

(a) An insurer shall provide to the first-named insured at the mailing address shown on the policy, and to the insurance producer of record, written notice of any premium increase in excess of ten percent (10%) and shall also provide the exact renewal premium, at least sixty (60) days prior to the expiration date of the policy unless the premium increase is the result of an audit or the increase is the result of an increase in exposure at the request of the insured. Not less than sixty (60) days written notice, as provided herein, shall be required for any coverage elimination, reduction, diminution, or increased deductible not at the request of the insured and in this case the notice shall itemize and describe the coverage changes and shall be separate from the renewal policy. If the insurer fails to provide such notice, the coverage provided to the named insured shall remain in effect until notice is provided or until the effective date of replacement coverage obtained by the named insured, whichever occurs first. For the purposes of this section, notice is considered given sixty (60) days following the date of giving of the notice. If the named insured elects not to renew, any earned premium for the period of extension of the terminated policy shall be calculated pro-rata at the lower of the current or previous years rate. If the insured accepts the renewal, the premium increase, if any, and other changes shall be effective the day following the prior policys expiration or anniversary date.

(b) This section shall not apply to changes based upon the altered nature or extent of the risk insured.

(c) For the purposes of this section, notice to the insurance producer of record shall not apply to an insurance producer of record who:

(1) Is an employee of the insurer; or

(2) Is a non-employee exclusive agent of the insurer; provided, however, notice, as required by this section, shall in all applicable cases, be provided to the named insured.
R.I. Gen. Laws § 27-43-1 — RI Code / Title 27 / Chapter 27-43 / Section 27-43-1
§ 27-43-1. Definitions.
Status: in_force

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

(1) Affiliated company means any corporation controlled by or an affiliate of a parent, an industrial insured, or a member organization by virtue of common ownership, control, operation, or management.

(2) Association means any association of individuals, corporations, partnerships, or associations that has a separate legal existence, the member organizations of which collectively:

(i) Own, control, or hold with power to vote all of the outstanding voting securities of an association captive insurance company incorporated as a stock insurance company; or

(ii) Have complete voting control over an association captive insurance company incorporated as a mutual insurance company.

(3) Association captive insurance company means any company that insures risks of the member organizations of the association, and their affiliated companies.

(4) Captive insurance company means any subsidiary captive insurance company, association captive insurance company, or industrial insured captive insurance company formed or licensed under the provisions of this chapter, including a captive insurance company that is organized as a protected cell company under the Protected Cell Companies Act, chapter 64 of this title.

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

(6) Industrial insured means an insured:

(i) Who procures the insurance of any risk or risks by use of the services of a full-time employee acting as an insurance manager or buyer;

(ii) Whose aggregate annual premiums for insurance on all risks total at least twenty-five thousand dollars ($25,000); and

(iii) Who has at least twenty-five (25) full-time employees.

(7) Industrial insured captive insurance company means any company that insures risks of the industrial insured that comprise the industrial insured group, and their affiliated companies.

(8) Industrial insured group means any group that meets either of the following criteria:

(i) Any group of industrial insureds that collectively: (A) Own, control, or hold with power to vote all of the outstanding voting securities of an industrial insured captive insurance company incorporated as a stock insurance company, or (B) Have complete voting control over an industrial insured captive insurance company incorporated as a mutual insurance company; or

(ii) Any group created under 15 U.S.C. § 3901 et seq., as a corporation or other limited liability association.

(9) Member organization means any individual, corporation, partnership, or association that belongs to an association.

(10) Parent means a corporation, partnership, or individual that directly or indirectly owns, controls, or holds with power to vote more than fifty percent (50%) of the outstanding voting securities of a subsidiary captive insurance company.

(11) Personal lines of insurance means personal motor vehicle, homeowners insurance coverage, health insurance, life insurance, workers compensation, residential fire insurance, or any component of them.

(12) Subsidiary captive insurance company means any company that insures risks of its parent and affiliated companies.
R.I. Gen. Laws § 27-6-8.1 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-8.1
§ 27-6-8.1. Rating for nonbusiness policies.
Status: in_force

(a) Notwithstanding the requirements of § 27-6-8, a filing made by an insurer under this section that provides for an overall statewide rate increase or decrease of no more than five percent (5%) in the aggregate for all coverages that are subject to the filing may take effect the date it is filed. The five percent (5%) limitation does not apply on an individual insured basis. No more than one rate filing may be made by an insurer pursuant to the expedited process provided in this subsection during any twelve-month (12) period, unless a rate filing, when combined with any other rate filing or filings made by an insurer within the preceding twelve (12) months, does not result in an overall statewide increase or decrease of more than five percent (5%) in the aggregate for all coverages that are subject to the filing.

(b) Rate filings falling outside of the limitation provided for in subsection (a) of this section shall be subject to § 27-6-11, unless those filings are otherwise exempt from those provisions pursuant to another section of the insurance code.

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

(d) No rate increase within the limitation specified in subsection (a) of this section may be implemented with regard to an individual existing policy, unless the increase is applied at the time of a renewal or conditional renewal of an existing policy and the insurer, at least thirty (30) days in advance of the end of the insureds policy period, mails or delivers to the named insured, at the address shown in the policy, a written notice that clearly and conspicuously discloses its intention to change the rate. A notice of renewal or conditional renewal that clearly and conspicuously discloses the renewal premium applicable to the policy shall be deemed to be in compliance with this subsection.
R.I. Gen. Laws § 27-1-22 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-22
§ 27-1-22. Assessments by receiver of mutual company.
Status: in_force

The receiver of any mutual insurance company shall, under decree of the superior court, make and assess, pursuant to the provisions of the charter of the company of which he or she shall be a receiver, any further assessments, in addition to those that may have been made by the company, as may be necessary for the payment of the debts of the corporation, with the incidental expense of assessing and collecting the assessments and the cost and expenses of closing up the business of the corporation, including any reasonable compensation of the receiver that may be allowed by the court, and may demand, receive, sue for, and collect the assessments. For the purpose of the assessment and collection, the receiver shall have all the powers and rights in these respects that the corporation possessed by virtue of its charter or otherwise; provided, these provisions shall not apply to policies issued by mutual insurance companies that do not render the holders of the policies liable to assessment.
R.I. Gen. Laws § 27-72-5 — RI Code / Title 27 / Chapter 27-72 / Section 27-72-5
§ 27-72-5. Contract requirements.
Status: in_force

(a) No person may use any form of life settlement contract in this state unless it has been filed with and approved, if required, by the commissioner in a manner that conforms with the filing procedures and any time restrictions or deeming provisions, if any, for life insurance forms, policies, and contracts. The commissioner is authorized to contract with outside consultants to review life settlement forms and the total cost of that review shall be borne by, billed directly to, and paid by the provider filing the form(s).

(b) No insurer may, as a condition of responding to a request for verification of coverage or in connection with the transfer of a policy pursuant to a life settlement contract, require that the owner, insured, provider, or broker sign any form, disclosure, consent, waiver, or acknowledgment that has not been expressly approved by the commissioner for use in connection with life settlement contracts in this state.

(c) A person shall not use a life settlement contract form or provide to an owner a disclosure statement form in this state unless first filed with and approved by the commissioner. The commissioner shall disapprove a life settlement contract form or disclosure statement form if, in the commissioners opinion, the contract or provisions contained therein fail to meet the requirements of this chapter or are unreasonable, contrary to the interests of the public, or otherwise misleading or unfair to the owner. At the commissioners discretion, the commissioner may require the submission of advertising material. The commissioner is authorized to contract with outside consultants to review life settlement forms and/or advertising and the total cost of that review shall be borne by, billed directly to, and paid by the provider filing the form(s).
R.I. Gen. Laws § 27-41-76 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-76
§ 27-41-76. 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 maintenance organization 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 maintenance organization 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 26 U.S.C. § 106(c)(2), a medical savings account, as defined in 26 U.S.C. § 220, and a health savings account, as defined in 26 U.S.C. § 223, 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 maintenance organization 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 maintenance organization 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 maintenance organization or 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 maintenance organization or 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, § 4 and P.L. 2024, ch. 202, § 4.]
R.I. Gen. Laws § 27-19-26 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-26
§ 27-19-26. Drug coverage.
Status: in_force

No group health insurer subject to the provisions of this chapter that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.
R.I. Gen. Laws § 27-9-28 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-28
§ 27-9-28. Rate information furnished to insured.
Status: in_force

Any rate filings subject to this chapter and filed by an insurer or rating organization on behalf of its members or subscribers with the insurance commissioner shall be deemed public information at the time of the filing; provided, the insurance commissioner shall furnish the rate filings and all pertinent information as to the rate filings, upon written request, to any insured, to any authorized representative of an insured, to any insurance company trade association, or to any trade association of insurance producers.
R.I. Gen. Laws § 27-16-2.6 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-2.6
§ 27-16-2.6. Hospitals affiliated with accredited medical schools  Indemnification of personnel.
Status: in_force

Nothing in §§ 27-16-1.2  27-16-2.2 shall be construed to limit or prevent hospitals affiliated with an accredited medical school from agreeing to indemnify hospital employees, and physicians, including physicians incorporated or unincorporated practices and employees, and medical, nursing, or allied health students affiliated with the hospital, collectively covered persons, for the legal liability of those covered persons for loss, damage, or expense incident to claims of bodily injury or death arising out of medical malpractice or professional error or mistake, malpractice coverage, whether the hospital charges the covered persons for malpractice coverage or not. The hospitals making the agreements shall be required to establish and maintain a reserve fund with which the malpractice coverage will be provided, which may be either part of or separate from a self-insurance fund maintained by or on behalf of the hospital. Any self-insurance fund shall annually provide a certified financial statement with actuarial projections as to the soundness of its reserving to the director of the department of health and the director of the department of business regulation. The malpractice coverage provided by the agreements shall be in amounts that meet the minimum insurance coverage limits required by any regulation promulgated by the director of business regulation pursuant to § 42-14.1-2.
R.I. Gen. Laws § 27-41-32 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-32
§ 27-41-32. Pap smears  Quality assurance standards.
Status: in_force

A pap smear eligible for reimbursement under § 27-41-30 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is a hospital accredited by the Joint Commission on Accreditation of HealthCare Organizations or the American Osteopathic Association at the time the pap smear is processed.
R.I. Gen. Laws § 27-78-3 — RI Code / Title 27 / Chapter 27-78 / Section 27-78-3
§ 27-78-3. Certificate forms.
Status: in_force

(a) The commissioner of insurance shall prohibit the use of a certificate of insurance form if the form:

(1) Is unfair, misleading, or deceptive, or violates public policy; or

(2) Violates any law, including any regulation promulgated by the commissioner of insurance.

(b) A certificate of insurance is not a policy of insurance and does not affirmatively or negatively amend, extend, or alter the coverage afforded by the policy to which the certificate of insurance makes reference. A certificate of insurance shall not confer to any person new or additional rights beyond what the referenced policy of insurance expressly provides.
R.I. Gen. Laws § 27-10-1 — RI Code / Title 27 / Chapter 27-10 / Section 27-10-1
§ 27-10-1. Purpose and scope.
Status: in_force

This chapter governs the qualifications and procedures for the licensing of: (1) Public adjusters; (2) Company adjusters; and (3) Independent adjusters. It specifies the duties of, and restrictions on, public, company, and independent adjusters. The restrictions on public adjusters include limiting their licensure to assisting insureds in first-party claims.
R.I. Gen. Laws § 27-72-11 — RI Code / Title 27 / Chapter 27-72 / Section 27-72-11
§ 27-72-11. General rules.
Status: in_force

(a) A provider entering into a life settlement contract with any owner of a policy, wherein the insured is terminally or chronically ill, shall first obtain:

(1) If the owner is the insured, a written statement from a licensed attending physician that the owner is of sound mind and under no constraint or undue influence to enter into a settlement contract; and

(2) A document in which the insured consents to the release of his or her medical records to a provider, settlement broker, or insurance producer and, if the policy was issued less than two (2) years from the date of application for a settlement contract, to the insurance company that issued the policy.

(b) The insurer shall respond to a request for verification of coverage submitted by a provider, settlement broker, or life insurance producer not later than thirty (30) calendar days from the date the request is received. The request for verification of coverage must be made on a form approved by the commissioner. The insurer shall complete and issue the verification of coverage or indicate in which respects it is unable to respond. In its response, the insurer shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding the validity of the insurance contract.

(c) Before or at the time of execution of the settlement contract, the provider shall obtain a witnessed document in which the owner consents to the settlement contract; represents that the owner has a full and complete understanding of the settlement contract; that the owner has a full and complete understanding of the benefits of the policy; acknowledges that the owner is entering into the settlement contract freely and voluntarily; and, for persons with a terminal or chronic illness or condition, acknowledges that the insured has a terminal or chronic illness and that the terminal or chronic illness or condition was diagnosed after the policy was issued.

(d) The insurer shall not unreasonably delay effecting change of ownership or beneficiary with any life settlement contract lawfully entered into in this state or with a resident of this state.

(e) If a settlement broker or life insurance producer performs any of these activities required of the provider, the provider is deemed to have fulfilled the requirements of this chapter.

(f) If a broker performs those verification of coverage activities required of the provider, the provider is deemed to have fulfilled the requirements of § 27-72-9.

(g) Within twenty (20) days after an owner executes the life settlement contract, the provider shall give written notice to the insurer that issued that insurance policy that the policy has become subject to a life settlement contract. The notice shall be accompanied by the documents required by § 27-72-10(a)(2).

(h) All medical information solicited or obtained by any licensee shall be subject to the applicable provision of state law relating to confidentiality of medical information, if not otherwise provided in this chapter.

(i) All life settlement contracts entered into in this state shall provide that the owner may rescind the contract on or before fifteen (15) days after the date it is executed by all parties thereto. Rescission, if exercised by the owner, is effective only if both notice of the rescission is given, and the owner repays all proceeds and any premiums, loans, and loan interest paid on account of the provider within the rescission period. If the insured dies during the rescission period, the contract shall be deemed to have been rescinded subject to repayment by the owner or the owners estate of all proceeds and any premiums, loans, and loan interest to the provider.

(j) Within three (3) business days after receipt from the owner of documents to effect the transfer of the insurance policy, the provider shall pay the proceeds of the settlement to an escrow or trust account managed by a trustee or escrow agent in a state or federally chartered financial institution pending acknowledgement of the transfer by the issuer of the policy. The trustee or escrow agent shall be required to transfer the proceeds due to the owner within three (3) business days of acknowledgement of the transfer from the insurer.

(k) Failure to tender the life settlement contract proceeds to the owner by the date disclosed to the owner renders the contract voidable by the owner for lack of consideration until the time the proceeds are tendered to and accepted by the owner. A failure to give written notice of the right of rescission hereunder shall toll the right of rescission until thirty (30) days after the written notice of the right of rescission has been given.

(l) Any fee paid by a provider, party, individual, or an owner to a broker in exchange for services provided to the owner pertaining to a life settlement contract shall be computed as a percentage of the offer obtained, not the face value of the policy. Nothing in this section shall be construed as prohibiting a broker from reducing such brokers fee below this percentage if the broker so chooses.

(m) The broker shall disclose to the owner anything of value paid or given to a broker, which relates to a life settlement contract.

(n) No person at any time prior to, or at the time of, the application for, or issuance of, a policy, or during a two-year (2) period commencing with the date of issuance of the policy, shall enter into a life settlement regardless of the date the compensation is to be provided and regardless of the date the assignment, transfer, sale, devise, bequest, or surrender of the policy is to occur. This prohibition shall not apply if the owner certifies to the provider that:

(1) The policy was issued upon the owners exercise of conversion rights arising out of a group or individual policy, provided the total of the time covered under the conversion policy plus the time covered under the prior policy is at least twenty-four (24) months. The time covered under a group policy must be calculated without regard to a change in insurance carriers, provided the coverage has been continuous and under the same group sponsorship; or

(2)(i) The owner submits independent evidence to the provider that one or more of the following conditions have been met within the two-year (2) period:

(A) The owner or insured is terminally or chronically ill;

(B) The owner or insured disposes of his or her ownership interests in a closely held corporation, pursuant to the terms of a buyout or other similar agreement in effect at the time the insurance policy was initially issued;

(C) The owners spouse dies;

(D) The owner divorces his or her spouse;

(E) The owner retires from full-time employment;

(F) The owner becomes physically or mentally disabled and a physician determines that the disability prevents the owner from maintaining full-time employment; or

(G) A final order, judgment, or decree is entered by a court of competent jurisdiction, on the application of a creditor of the owner, adjudicating the owner bankrupt or insolvent, or approving a petition seeking reorganization of the owner or appointing a receiver, trustee, or liquidator to all or a substantial part of the owners assets.

(ii) Copies of the independent evidence required by subsection (n)(2)(i) of this section shall be submitted to the insurer when the provider submits a request to the insurer for verification of coverage. The copies shall be accompanied by a letter of attestation from the provider that the copies are true and correct copies of the documents received by the provider. Nothing in this section shall prohibit an insurer from exercising its right to contest the validity of any policy.

(iii) If the provider submits to the insurer a copy of independent evidence provided for in subsection (n)(2)(i) of this section when the provider submits a request to the insurer to effect the transfer of the policy to the provider, the copy is deemed to establish that the settlement contract satisfies the requirements of this section.
R.I. Gen. Laws § 27-56-3 — RI Code / Title 27 / Chapter 27-56 / Section 27-56-3
§ 27-56-3. Nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
Status: in_force

(a) Materiality and scope. (1) No nonrenewals, cancellations, or revisions of ceded reinsurance agreements need to be reported pursuant to § 27-56-1 if the nonrenewals, cancellations, or revisions are not material. For the purposes of this chapter, a material nonrenewal, cancellation, or revision is one that affects: (i) As respects property and casualty business, including accident and health business written by a property and casualty insurer: (A) More than fifty percent (50%) of the insurers total ceded written premium; or (B) More than fifty percent (50%) of the insurers total ceded indemnity and loss adjustment reserves. (ii) As respects life, annuity, and accident and health business: more than fifty percent (50%) of the total reserve credit taken for business ceded, on an annualized basis, as indicated in the insurers most recent annual statement. (iii) As respects either property and casualty or life, annuity, and accident and health business, either of the following events shall constitute a material revision that must be reported: (A) An authorized reinsurer representing more than ten percent (10%) of a total cession is replaced by one or more unauthorized reinsurers; or (B) Previously established collateral requirements have been reduced or waived as respects one or more unauthorized reinsurers representing collectively more than ten percent (10%) of a total cession. (2) No filing shall be required if: (i) As respects property and casualty business, including accident and health business written by a property and casualty insurer: the insurers total ceded written premium represents, on an annualized basis, less than ten percent (10%) of its total written premium for direct and assumed business; or (ii) As respects life, annuity, and accident and health business: the total reserve credit taken for business ceded represents, on an annualized basis, less than ten percent (10%) of the statutory reserve requirement prior to any cession.

(b) Information to be reported. (1) The following information is required to be disclosed in any report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements: (i) Effective date of the nonrenewal, cancellation, or revision; (ii) The description of the transaction with an identification of the initiator of it; (iii) Purpose of, or reason for, the transaction; and (iv) If applicable, the identity of the replacement reinsurers. (2) Insurers are required to report all material nonrenewals, cancellations, or revisions of ceded reinsurance agreements on a non-consolidated basis unless the insurer is part of a consolidated group of insurers that utilizes a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and integrity of the insurers reserves and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars ($1,000,000) total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five percent (5%) of the insurers capital and surplus.
R.I. Gen. Laws § 27-19-30.1 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-30.1
§ 27-19-30.1. 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 otherwise acquires control of a nonprofit hospital service corporation organized under this chapter, a nonprofit medical service corporation organized under chapter 20 of this title, or a health maintenance organization organized under chapter 41 of this title, may: (1) File with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) 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 otherwise 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 the 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 § 27-18-46 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-46
§ 27-18-46. Penalties and remedies.
Status: in_force

(a) Any person, firm, corporation, association, or other legal entity who or which shall violate the provisions of § 27-18-45 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one year, or by both fine and imprisonment.

(b) In addition to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association, or other legal entity who or which shall willfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each violation, and each violation shall constitute a separate and distinct offense under this section.
R.I. Gen. Laws § 27-6-2 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-2
§ 27-6-2. Applicability.
Status: in_force

(a) This chapter applies to fire, marine, and inland marine insurance on risks located in this state. Inland marine insurance shall include insurance now or defined by statute, or by interpretation of a statute, or if not defined or interpreted by statute, by ruling of the insurance commissioner, referred to throughout this chapter as commissioner, or as established by general custom of the business, as inland marine insurance.

(b) This chapter shall not apply:

(1) To reinsurance, other than joint reinsurance to the extent stated in §§ 27-6-37 and 27-6-38;

(2) To insurance of vessels or craft, their cargoes, marine builders risks, marine protection and indemnity, or other risks commonly insured under marine, as distinguished from inland marine, insurance policies;

(3) To insurance of hulls of aircraft, including their accessories and equipment, or against liability arising out of the ownership, maintenance, or use of aircraft; or

(4) To motor vehicle insurance, or to insurance against liability arising out of the ownership, maintenance, or use of motor vehicles.
R.I. Gen. Laws § 27-6-33 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-33
§ 27-6-33. Advisory organization defined.
Status: in_force

Every group, association, or other organization of insurers, whether located within or outside of this state, which assists insurers that make their own filings or rating organizations in ratemaking, by the collection and furnishing of loss or expense statistics, or by the submission of recommendations, but which does not make filings under this chapter, shall be known as an advisory organization.
R.I. Gen. Laws § 27-66-5 — RI Code / Title 27 / Chapter 27-66 / Section 27-66-5
§ 27-66-5. Prior approval required  Department of business regulation.
Status: in_force

A conversion shall require review and approval from the department of business regulation, after a public hearing, in accordance with the provisions of this chapter.
R.I. Gen. Laws § 27-41-16 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-16
§ 27-41-16. Examination.
Status: in_force

(a) The director of business regulation may make an examination of the affairs of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements pursuant to its healthcare plan as often as is reasonably necessary for the protection of the interests of the people of this state. The examination shall be performed and the associated costs shall be borne by the company in accordance with all the provisions of chapter 13.1 of this title.

(b) The director of health may make an examination concerning the quality of healthcare services of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state.

(c) Each health maintenance organization shall establish and maintain on an ongoing basis a quality assurance program that involves the assessment of all quality assurance activities conducted in the provision of its healthcare services to its subscribers, which shall include no less than:

(1) Assessment of health outcomes;

(2) Ongoing review of health services by physicians and other health professionals; and

(3) Utilization and systematic data collection.

(d) Every health maintenance organization and provider shall submit its books and records to those examinations and in every way facilitate them. For the purpose of examinations, the director of business regulation and the director of health may administer oaths to, and examine, the officers and agents of the health maintenance organization and the principals of their providers concerning their business.

(e) The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the director of the department for whom the examination is being conducted. The total cost of those examinations, whether made by the director of business regulation or by the director of health, shall be borne by the examined health maintenance organizations and shall be in the same amount as provided for in § 27-13-1, and shall be paid to the director of the department conducting the examination for deposit as general revenues. That assessment shall be in addition to any taxes and fees payable to the state. In instances where the examination is performed by outside accountants, the expenses of the examination shall be borne by the examined health maintenance organization.

(f) In lieu of any state examination, the director of business regulation or the director of health may accept the report of an examination made by the director of business regulation or the director of health of another state.
R.I. Gen. Laws § 27-19-68 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-68
§ 27-19-68. Prohibition on preexisting condition exclusions.
Status: in_force

(a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title or chapter:

(1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.

(2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.

(b) As used in this section:

(1) Preexisting condition exclusion means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the effective date of coverage.

(2) Preexisting condition exclusion means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individuals health status before the individuals effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.

(c) This section shall not apply to grandfathered health plans providing individual health insurance coverage.

(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 § 27-9-33 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-33
§ 27-9-33. Use of information from noncomplying advisory organization.
Status: in_force

No insurer that makes its own filings or any rating organization shall support its filings by statistics, or adopt ratemaking recommendations, furnished to it by an advisory organization that has not complied with §§ 27-9-30  27-9-32, or with an order of the commissioner involving statistics or recommendations issued under § 27-9-32. If the commissioner finds any insurer or rating organization to be in violation of this section, the commissioner may issue an order requiring the discontinuance of that violation.
R.I. Gen. Laws § 27-18-8 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-8
§ 27-18-8. Filing of accident and sickness insurance policy forms.
Status: in_force

(a) Any insurance company authorized to do an accident and sickness business within this state in accordance with the provisions of this title shall file all accident and sickness insurance policy forms and rates used by it in the state with the insurance 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 under § 27-18-8.3, or until the expiration of the waiting period established under § 27-18-8.3. 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, the commissioner shall forbid its use, and shall notify the company in writing as provided in § 27-18-8.2.

(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 § 27-19-23 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-23
§ 27-19-23. Coverage for infertility.
Status: in_force

(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a nonprofit hospital service corporation provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent (20%), may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.

(b) For purposes of this section, infertility means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.

(c) For purposes of this section, standard fertility-preservation services means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations.

(d) For purposes of this section, iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.

(e) For purposes of this section, may directly or indirectly cause means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.

(f) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).
R.I. Gen. Laws § 27-18-49 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-49
§ 27-18-49. Human leukocyte antigen testing.
Status: in_force

(a) 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, as it may be from time to time amended. 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.

(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 § 27-32-6 — RI Code / Title 27 / Chapter 27-32 / Section 27-32-6
§ 27-32-6. Prerequisites to delivery of contract  Qualification of company.
Status: in_force

No domestic life insurance company, and no other life insurance company admitted to transact business in this state, shall be authorized to deliver within this state any agreement providing benefits in variable amounts until the company has satisfied the insurance commissioner that its condition or methods of operation in connection with the issuance of those agreements will not render its operation hazardous to the public or its policyholders in this state. In determining the qualification of a company requesting authority to deliver the contracts within this state, the insurance commissioner shall consider, among other things:

(1) The history and financial condition of the company;

(2) The character, responsibility, and general fitness of the officers and directors of the company; and

(3) In the case of a company other than a domestic company, whether the regulation provided by the jurisdiction of its incorporation provides a degree of protection to policyholders and the public that is substantially equal to that provided by this chapter and the rules and regulations issued pursuant to this chapter.
R.I. Gen. Laws § 27-18-33.3 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-33.3
§ 27-18-33.3. Patient choice in dispensing of clinician-administered drugs.
Status: in_force

(a) As used in this section,

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

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

(ii) Is typically administered:

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

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

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

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

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

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

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

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

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

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

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

(4) The office of the health insurance commissioner shall provide the general assembly with their analysis no later than February 28, 2026.
R.I. Gen. Laws § 27-6-4 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-4
§ 27-6-4. Considerations in ratemaking.
Status: in_force

Rates shall be made in accordance with the following provisions:

(1) Manual, minimum, or class rates, rating schedules, or rating plans shall be made and adopted, except in the case of specific inland marine rates, on risks specially rated;

(2) Rates shall not be excessive, inadequate, or unfairly discriminatory; and

(3) Due consideration shall be given to past and prospective loss experience within and outside of this state, to the conflagration and catastrophe hazards, to a reasonable margin for underwriting profit and contingencies, to dividends savings or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members, or subscribers, to past and prospective expenses both country-wide and those specially applicable to this state, and to all other relevant factors within and outside of this state. In the case of fire insurance rates consideration shall be given to the experience of the fire insurance business during a period of not less than the most recent five-year (5) period for which that experience is available.
R.I. Gen. Laws § 27-54-6 — RI Code / Title 27 / Chapter 27-54 / Section 27-54-6
§ 27-54-6. Injunctions.
Status: in_force

If the attorney general or the director, or his or her designee, has reason to believe that a person is engaged in conduct prohibited by this chapter, he or she may petition an appropriate court for an order prohibiting that person from further engaging in that conduct. The filing of a petition under this section does not preclude any other remedy that is available by law.
R.I. Gen. Laws § 27-2-3 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-3
§ 27-2-3. Reciprocal privileges of nonresident insurance producers.
Status: in_force

(a) Any commission received by a Rhode Island licensed resident insurance producer may be shared with another licensed resident insurance producer, or with a licensed nonresident insurance producer; provided, that if the nonresident insurance producer resides in, or is a licensed insurance producer in, a state that requires the retention of a stipulated percentage of the commission on risks placed in the state by nonresident insurance producers, then and in that event the Rhode Island resident insurance producer shall require the same percentage of the commission as would be required if a Rhode Island insurance producer should place similar insurance in the state of the residence of the nonresident insurance producer; provided, that if the nonresident insurance producer resides in a state, county, or municipality that by statute or ordinance prohibits the division of commissions on insurance covering property or risks in the city, county, or state of the nonresident insurance producer, then and in that event, it shall be unlawful for the Rhode Island resident insurance producer to pay the nonresident insurance producer any share or portion of the commission on insurance on property or risks in the state of Rhode Island.

(b) This section shall not apply to bid bonds issued by any admitted surety insurer in connection with any public or private contract.

(c) An insurance producer that has been a licensed nonresident insurance producer prior to June 30, 1989, for twelve (12) years or more but whose company is no longer licensed to do business in a reciprocal state after June 30, 1989, may be licensed in Rhode Island as a special nonresident insurance producer.
R.I. Gen. Laws § 27-18-12 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-12
§ 27-18-12. Less favorable provisions prohibited.
Status: in_force

No policy provision that is not subject to §§ 27-18-3  27-18-10 shall make a policy, or any portion of a policy, less favorable in any respect to the insured or the beneficiary than the provisions of the policy that are subject to this chapter.