R.I. Gen. Laws § 27-9-56 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-56
§ 27-9-56. Use of credit rating.
Status: in_force

(a) An insurer may use insurance scoring for rating and underwriting policies of personal motor vehicle insurance only under the following conditions:

(1) The insurer demonstrates the predictive nature of their insurance score to the insurance division.

(2) An insurer shall, once every two (2) years if requested by an existing customer, obtain an updated insurance score for the customer. If, after obtaining the insurance score, the customer has improved the customers credit rating, the user of the information shall afford the customer any decrease in rates that are available due to the improved rating. The user may not increase the rate of an existing customer based solely on a worsening in the customers insurance score unless: (i) The worsening is due to a bankruptcy, tax lien, garnishment, foreclosure, or judgment; or (ii) If a subsequent insurance score no sooner than six (6) months later confirms the worsening in score. Should an existing customers score change as the result of an updated credit report, the decrease or increase in rates must be done at renewal subject to conditions established herein.

(3) An insurer shall not decline insurance for a new customer based solely on an insurance score, or absence of an insurance score; and an insurer shall not cancel, nonrenew or increase the rate of an existing customer based solely on a worsening in a customers insurance score unless: (i) The worsening is due to a bankruptcy, tax lien, garnishment, foreclosure, or judgment; or (ii) If a subsequent insurance score no sooner than six (6) months later confirms the worsening in score. Should an existing customers score change as the result of an updated credit report, the decrease or increase in rates must be done at renewal subject to conditions established herein.

(4) No insurer is obligated to obtain a current credit report or insurance score for an insured if: the insured is in the most favorably-priced tier of the insurer, within a group of affiliated insurers; or credit was not used for the insured when the policy was initially written. However, the insurer shall have the discretion to use credit for the insured upon renewal, if consistent with its underwriting guidelines. The user may not increase the rate of an existing customer based solely on a worsening in the customers insurance score unless: (i) The worsening is due to a bankruptcy, tax lien, garnishment, foreclosure, or judgment; or (ii) If a subsequent insurance score no sooner than six (6) months later confirms the worsening in score. Should an existing customers score change as the result of an updated credit report, the decrease or increase in rates must be done at renewal subject to conditions established herein.

(5) If a credit bureau determines that disputed information is inaccurate or incorrect and such information was used in determining an insurance score that resulted in a denial, cancellation, or nonrenewal of or higher premiums or less favorable policy terms for a consumer, the insurer shall, within thirty (30) days of receiving notice of correction, reissue or re-rate the policy by refunding the amount of the overpayment of premium based on the corrected insurance score retroactive to the shorter of the last twelve (12) months of coverage or the actual period of coverage. An insurance score as used in this section shall be defined as a number or rating that is derived from an algorithm, computer application, model, or other process that is based in whole or in part on credit history.

(b) Agents shall be held harmless by insurers for all acts, efforts, and disclosures in obtaining an insurance score on the insurers behalf. The commissioner is authorized and empowered to establish rules and regulations to carry out the provisions of this section and to fulfill the goals of this section.

(c) Notwithstanding the above, an insurer authorized to do business in Rhode Island that uses credit information to underwrite or rate risks, shall not use the following as a negative factor in any insurance scoring methodology or in reviewing credit information for the purpose of underwriting or rating a policy of personal insurance:

(1) Credit inquiries not initiated by the consumer or inquiries requested by the consumer for the consumers own credit information;

(2) Inquiries relating to insurance coverage, if so identified on a consumers credit report;

(3) Collection accounts with a medical industry code, if so identified on the consumers credit report;

(4) Multiple lender inquiries, if coded by the consumer reporting agency on the consumers credit report as being from the home mortgage industry and made within thirty (30) days of one another, unless only one inquiry is considered;

(5) Multiple lender inquiries, if coded by the consumer reporting agency on the consumers credit report as being from the automobile lending industry and made within thirty (30) days of one another, unless only one inquiry is considered.

(d) No consumer reporting agency shall provide or sell data or lists that include any information that in whole or in part was submitted in conjunction with an insurance inquiry about a consumers credit information or a request for a credit report or insurance score. Such information includes, but is not limited to, the expiration dates of an insurance policy or any other information that may identify time periods during which a consumers insurance may expire and the terms and conditions of the consumers insurance coverage.

(e) The restrictions provided in subsection (d) of this section do not apply to data or lists the consumer reporting agency supplies to the insurance [agent/producer] from whom information was received, the insurer on whose behalf such [agent/producer] acted, or such insurers affiliates or holding companies.

(f) Nothing in this section shall be construed to restrict any insurer from being able to obtain a claims history report or a motor vehicle report.
R.I. Gen. Laws § 27-10-6 — RI Code / Title 27 / Chapter 27-10 / Section 27-10-6
§ 27-10-6. Examination.
Status: in_force

(a) The department shall subject the applicant to a written examination as to the applicants competency to act as an insurance claim adjuster. The examination shall test the knowledge of the individual concerning the duties and responsibilities of an adjuster and the insurance laws and regulations of this state.

(b) The department may make arrangements, including contracting with an outside testing service, for administering examinations and collecting a nonrefundable fee for the examination.

(c) Each individual applying for an examination shall remit a nonrefundable fee as prescribed by the department.

(d) An individual who fails to appear for the examination as scheduled or fails to pass the examination shall reapply for an examination and remit all required fees and forms before being rescheduled for another examination.

(e) The department may accept successful completion of an examination administered by a federal entity in substitute for a state examination for the crop line of authority for company/independent adjusters.

(f) The department may also accept, in lieu of the written examination referred to in subsection (a) of this section, a certification issued by a national or state-based claims association with a program approved by the department, that includes a proctored exam of sufficient length and rigor to adequately determine the competence of the applicant and any other requirements set by the department of business regulation.
R.I. Gen. Laws § 27-5-28 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-28
§ 27-5-28. Maximum single risk insured.
Status: in_force

No company doing business under §§ 27-5-15  27-5-31 shall insure any larger amount upon any single risk than is permitted by law to a company possessing the same amount of capital irrespective of the fund provided for in this chapter.
R.I. Gen. Laws § 27-16-8 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-8
§ 27-16-8. Time allowed before default judgment.
Status: in_force

No plaintiff or complainant shall be entitled to a judgment by default, a judgment with leave to prove damages, or a judgment pro confesso under §§ 27-16-6 and 27-16-7 until the expiration of thirty (30) days from the date of the filing of the affidavit of compliance.
R.I. Gen. Laws § 27-33-5 — RI Code / Title 27 / Chapter 27-33 / Section 27-33-5
§ 27-33-5. Reimbursement of the secretary.
Status: in_force

The fund shall reimburse the secretary in an amount up to five percent (5%) of the aggregate property insurance premiums earned in this state during the calendar year immediately preceding the calendar year, with respect to which the secretary paid losses on lines of insurance reinsured by him or her in this state during that year, and for which he or she claims reimbursement from the fund in accordance with the act.
R.I. Gen. Laws § 27-9-37 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-37
§ 27-9-37. Reports on examinations  Hearing and filing.
Status: in_force

The commissioner shall prepare a report of any examination referred to in § 27-9-36 and shall, within a reasonable time following completion of that report, furnish each rating organization, advisory organization, or group, association, or other organization examined with a copy of it. Any rating organization, advisory organization, or group, association, or other organization may, within thirty (30) days after the receipt of a copy of the report, request the commissioner for a hearing, which shall be held by the commissioner upon ten (10) days written notice to the rating organization, advisory organization, group, association, or other organization. Following the hearing the commissioner may affirm, modify, or withdraw the commissioners report. Any report, or modification of a report, shall be filed following the hearing in the office of the commissioner as a public record, or if no hearing is requested within the period of thirty (30) days, the report shall be filed at the expiration of that period.
R.I. Gen. Laws § 27-46-1 — RI Code / Title 27 / Chapter 27-46 / Section 27-46-1
§ 27-46-1. Purpose.
Status: in_force

The purpose of this chapter is to regulate the formation and/or operation of risk retention groups and purchasing groups in this state formed pursuant to the provisions of 15 U.S.C. § 3901 et seq., to the extent permitted by that law.
R.I. Gen. Laws § 27-1-21 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-21
§ 27-1-21. Failure to deliver property or records to receiver.
Status: in_force

If the president, secretary, treasurer, agent, or servant of any insurance company that is enjoined as provided in this chapter, or any other person upon being required, neglects or refuses to deliver to the receiver or receivers of the corporation, who may be appointed by virtue of this chapter, evidences of debt, goods, effects, books, papers, and other evidences of property of every description belonging to the corporation as may be in his or her possession or under his or her control, he or she shall be fined not exceeding ten thousand dollars ($10,000) or be imprisoned not exceeding three (3) years, or be both fined and imprisoned at the discretion of the court.
R.I. Gen. Laws § 27-44-11 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-11
§ 27-44-11. Rating organizations  Permitted activity.
Status: in_force

Any rating organization, in addition to other activities not prohibited, is authorized to:

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

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

(3) Prepare, distribute, and file rates and supplementary rate information;

(4) Distribute information that is filed with the director and open to public inspection;

(5) Conduct research and on-site inspections in order to prepare classifications of public fire defenses;

(6) Consult with public officials regarding public fire protection as it would affect members, subscribers, and others;

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

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

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

(10) Collect, compile, and distribute past and current prices of individual insurers if that information is made available to the general public; and

(11) Furnish any other services related to those enumerated in this section.
R.I. Gen. Laws § 27-83-3 — RI Code / Title 27 / Chapter 27-83 / Section 27-83-3
§ 27-83-3. Disclosures. [Effective January 1, 2026.]
Status: in_force

(a) A pet insurer transacting pet insurance shall disclose the following to consumers:

(1) If the policy excludes coverage due to any of the following:

(i) A preexisting condition;

(ii) A hereditary disorder;

(iii) A congenital anomaly or disorder; or

(iv) A chronic condition;

(2) If the policy includes any other exclusions, the following statement: Other exclusions may apply. Please refer to the exclusions section of the policy for more information.;

(3) Any policy provision that limits coverage through a waiting or affiliation period, a deductible, coinsurance, or an annual or lifetime policy limit;

(4) Whether the pet insurer reduces coverage or increases premiums based on the insureds claim history, the age of the covered pet, or a change in the geographic location of the insured; and

(5) If the underwriting company differs from the brand name used to market and sell the product.

(b) Right to examine and return the policy.

(1) Unless the insured has filed a claim under the pet insurance policy, pet insurance applicants shall have the right to examine and return the policy, certificate, or rider to the company or an agent/insurance producer of the company within fifteen (15) days of its receipt and to have the premium refunded if, after examination of the policy, certificate, or rider, the applicant is not satisfied for any reason.

(2) Pet insurance policies, certificates, and riders shall have a notice prominently printed on the first page or attached thereto including specific instructions to accomplish a return. The following free look statement or language substantially similar shall be included:

You have fifteen (15) days from the day you receive this policy, certificate, or rider to review it, and return it to the company if you decide not to keep it. You do not have to tell the company why you are returning it. If you decide not to keep it, simply return it to the company at its administrative office, or you may return it to the agent/insurance producer that you bought it from as long as you have not filed a claim. You must return it within fifteen (15) days of the day you first received it. The company will refund the full amount of any premium paid within thirty (30) days after it receives the returned policy, certificate, or rider. The premium refund will be sent directly to the person who paid it. The policy, certificate, or rider will be void as if it had never been issued.

(c) A pet insurer shall clearly disclose a summary description of the basis or formula on which the pet insurer determines claim payments under a pet insurance policy within the policy, prior to policy issuance, and through a clear and conspicuous link on the main page of the pet insurers or pet insurers program administrators website.

(d) A pet insurer that uses a benefit schedule to determine claim payment under a pet insurance policy shall do both of the following:

(1) Clearly disclose the applicable benefit schedule in the policy; and

(2) Disclose all benefit schedules used by the pet insurer under its pet insurance policies through a clear and conspicuous link on the main page of the pet insurers or pet insurers program administrators website.

(e) A pet insurer that determines claim payments under a pet insurance policy based on usual and customary fees, or any other reimbursement limitation based on prevailing veterinary service provider charges, shall do both of the following:

(1) Include a usual and customary fee limitation provision in the policy that clearly describes the pet insurers basis for determining usual and customary fees and how that basis is applied in calculating claim payments; and

(2) Disclose the pet insurers basis for determining usual and customary fees through a clear and conspicuous link on the main page of the pet insurers or pet insurers program administrators website.

(f) If any medical examination by a licensed veterinarian is required to effectuate coverage, the pet insurer shall clearly and conspicuously disclose the required aspects of the examination prior to purchase and disclose that examination documentation may result in a preexisting condition exclusion.

(g) Waiting periods, and the requirements applicable to them, shall be clearly and prominently disclosed to consumers prior to the policy purchase.

(h) The pet insurer shall include a summary of all policy provisions required in subsections (a) through (g) of this section, inclusive, in a separate document titled Insurer Disclosure of Important Policy Provisions.

(i) The pet insurer shall post the Insurer Disclosure of Important Policy Provisions document required in subsection (h) of this section through a clear and conspicuous link on the main page of the pet insurers or pet insurers program administrators website.

(j) In connection with the issuance of a new pet insurance policy, the pet insurer shall provide the consumer with a copy of the Insurer Disclosure of Important Policy Provisions document required pursuant to subsection (h) of this section in at least twelve-point (12) type when the policy is delivered.

(k) At the time a pet insurance policy is issued or delivered to a policyholder, the pet insurer shall include a written disclosure with the following information, printed in twelve-point (12) boldface type:

(1) The address and customer service telephone number of the pet insurer or the agent or broker of record.

(2) If the policy was issued or delivered by an agent or broker, a statement advising the policyholder to contact the broker or agent for assistance.

(l) The disclosures required in this section shall be in addition to any other disclosures required by law or regulation.
R.I. Gen. Laws § 27-9-50 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-50
§ 27-9-50. Severability.
Status: in_force

If any section, subsection, subdivision, paragraph, sentence, or clause of this chapter is held invalid or unconstitutional, that decision shall not affect the remaining portions of this chapter.
R.I. Gen. Laws § 27-6-12 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-12
§ 27-6-12. Effective date of inland marine rates.
Status: in_force

Specific inland marine rates on risks specially rated by a rating organization shall become effective when filed and shall be deemed to meet the requirements of this chapter until such time as the commissioner reviews the filing and so long after this as the filing remains in effect.
R.I. Gen. Laws § 27-12-2 — RI Code / Title 27 / Chapter 27-12 / Section 27-12-2
§ 27-12-2. Publication of abstracts of reports.
Status: in_force

The insurance commissioner shall annually publish for distribution an abstract of the statements filed in the commissioners office by all insurance companies as required by § 27-12-1. The expense of publishing and distributing those abstracts shall be paid by the insurance companies.
R.I. Gen. Laws § 27-7-3 — RI Code / Title 27 / Chapter 27-7 / Section 27-7-3
§ 27-7-3. Applicability.
Status: in_force

All policies described in this chapter shall be deemed to be made subject to the provisions of this chapter, and all provisions of policies inconsistent with this chapter shall be void.
R.I. Gen. Laws § 27-20-25 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-25
§ 27-20-25. Holding company systems.
Status: in_force

Except to the extent superseded by chapter 64 of this title, all of the provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter.
R.I. Gen. Laws § 27-20-20 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-20
§ 27-20-20. Coverage for infertility.
Status: in_force

(a) Any nonprofit medical 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 the 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 medical 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 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 § 27-41-13.3 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-13.3
§ 27-41-13.3. Waiver, surplus notes, and risk-based capital requirements.
Status: in_force

(a) The director may waive any of the net worth or total adjusted capital requirements, or both, as set forth in § 27-41-13.1 or § 27-41-13.2, whenever satisfied that the health maintenance organization has sufficient net worth or total adjusted capital, or both, and an adequate history of generating net income to ensure its financial viability for the next year, or its performance and obligations are guaranteed by an organization with sufficient net worth and an adequate history of generating net income, or the assets of the health maintenance organization or its contracts with insurers, hospital or medical service corporations, governments, or other organizations are sufficient to reasonably assure the performance of its obligations; provided, however, that in no event shall the net worth requirement be less than two million five hundred thousand dollars ($2,500,000).

(b) Surplus notes. (1) In determining net worth, no debt is considered fully subordinated unless the subordination clause is in a form acceptable to the director. Any interest obligation relating to the repayment of any subordinated debt must be similarly subordinated. (2) The interest expenses relating to the repayment of any fully subordinated debt are considered covered expenses. (3) Any debt incurred by a note meeting the requirements of this section, and otherwise acceptable to the director, is not considered a liability and is recorded as equity.

(c) In addition to the net worth and capital requirements of §§ 27-41-13.1 through 27-41-13.3, all requirements of chapter 4.7 of this title shall apply to health maintenance organizations.
R.I. Gen. Laws § 27-6-24 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-24
§ 27-6-24. Admission of and services to subscribers.
Status: in_force

Subject to rules and regulations that have been approved by the commissioner as reasonable, each rating organization shall permit any insurer, not a member, to be a subscriber to its rating services for any kind of insurance, or subdivision or class of risk or a part or combination of it, for which it is authorized to act as a rating organization. Notice of proposed changes in the rules and regulations shall be given to subscribers. Each rating organization shall furnish its rating services without discrimination to its members and subscribers. The reasonableness of any rule or regulation in its application to subscribers, or the refusal of any rating organization to admit an insurer as a subscriber, shall, at the request of any subscriber or any affected insurer, be reviewed by the commissioner at a hearing held upon at least ten (10) days written notice to the rating organization and to the subscriber or insurer. If the commissioner finds that the rule or regulation is unreasonable in its application to subscribers, the commissioner shall order that the rule or regulation shall not be applicable to subscribers. If the rating organization fails to grant or reject an insurers application for subscribership within thirty (30) days after it was made, the insurer may request a review by the commissioner as if the application had been rejected. If the commissioner finds that the insurer has been refused admittance to the rating organization as a subscriber without justification, the commissioner shall order the rating organization to admit the insurer as a subscriber. If the commissioner finds that the action of the rating organization was justified, the commissioner shall make an order affirming its action.
R.I. Gen. Laws § 27-52-6 — RI Code / Title 27 / Chapter 27-52 / Section 27-52-6
§ 27-52-6. Duties of insurers utilizing the services of a reinsurance intermediary broker.
Status: in_force

(a) An insurer shall not engage the services of any person, firm, association, or corporation to act as a RB on its behalf unless that person is licensed as required by this chapter.

(b) An insurer may not employ an individual who is employed by a RB with which it transacts business, unless that RB is under common control with the insurer and subject to the Insurance Holding Company Systems Act, chapter 35 of this title.

(c) The insurer shall annually obtain a copy of statements of the financial condition of each RB with which it transacts business.
R.I. Gen. Laws § 27-1-13 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-13
§ 27-1-13. Citation for forfeiture of charter for unsafe practices.
Status: in_force

The superior court, upon complaint in writing from the insurance commissioner under oath setting forth that, in the commissioners opinion, any insurance company has forfeited its charter at law, or is managing its concerns in a manner that the public or those having funds in its custody are in danger of being defrauded, or the continued operation of its business would be hazardous to the public or its policyholders, or has become insolvent, shall issue a citation to the company, directed to and to be served on the president, secretary, or treasurer of the company by leaving an attested copy at the office or usual place of business of the company, commanding the president, secretary, or treasurer personally to appear before the court on a day and in a place to be mentioned in the citation, then and there under oath to show cause, if they have any, why the company should not be enjoined from further exercising the powers and franchises conferred by its charter and why the charter should not be forfeited.
R.I. Gen. Laws § 27-10-1.2 — RI Code / Title 27 / Chapter 27-10 / Section 27-10-1.2
§ 27-10-1.2. License required.
Status: in_force

(a) A person shall not act or hold themself out as a public, company, or independent adjuster in this state unless the person is licensed in accordance with this chapter.

(b) A person licensed as a public adjuster shall not misrepresent to a claimant that the person is an adjuster representing an insurer in any capacity, including acting as an employee of the insurer or acting as an independent adjuster.
R.I. Gen. Laws § 27-17-26 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-26
§ 27-17-26. Judicial review of orders and decisions of commissioner.
Status: in_force

Any final order or decision of the commissioner shall be subject to review by petition filed within twenty (20) days after notice of it at the instance of any party in interest in the superior court for the counties of Providence and Bristol, and the matter shall be heard de novo in the superior court and decisions on issues of fact shall be in accordance with the preponderance of the evidence presented there. The court shall determine whether the order or decision of the commissioner shall be stayed pending the review. The court may, in disposing of the issue before it, modify, affirm, or reverse the order or decision of the commissioner in whole or in part. Appeal may be taken from the decision of the superior court to the supreme court, and the appeal shall follow the course of equity.
R.I. Gen. Laws § 27-81-7 — RI Code / Title 27 / Chapter 27-81 / Section 27-81-7
§ 27-81-7. Telemedicine data reporting.
Status: in_force

Each health insurer shall collect and provide to the office of the health insurance commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data reflecting its telemedicine policies, practices, and experience. OHIC shall provide this information and data to the general assembly on or before January 1, 2022, and on or before each January 1 thereafter.
R.I. Gen. Laws § 27-29-4.7 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-4.7
§ 27-29-4.7. Additional unfair methods of competition.
Status: in_force

(a) In addition to those listed in § 27-29-4 the following are also defined as unfair methods of competition and unfair and deceptive acts or practices in the business of insurance:

(1) Twisting. Knowingly making any misleading representations or incomplete or fraudulent comparisons or fraudulent material omissions of or with respect to any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance in another insurer.

(2) Churning. The practice whereby policy values in an existing life insurance policy or annuity contract, including, but not limited to, cash, loan values, or dividend values, and in any riders to that policy or contract, are directly or indirectly used to purchase another insurance policy or annuity contract with that same insurer for the purpose of earning additional premiums, fees, commissions, or other compensation:

(i) Without an objectively reasonable basis for believing that the replacement or extraction will result in an actual and demonstrable benefit to the policyholder; or

(ii) In a fashion that is fraudulent, deceptive, or otherwise misleading or that involves a deceptive omission; or

(iii) When the applicant is not informed that the policy values, including cash values, dividends, and other assets of the existing policy or contract will be reduced, forfeited, or used in the purchase of the replacing or additional policy or contract, if this is the case; or

(iv) Without informing the applicant that the replacing or additional policy or contract will not be a paid-up policy or that additional premiums will be due or that a new contestable period will apply and explaining the impact of these differences, if this is the case.

(b) Each insurer shall comply with subsections (a)(2)(iii) and (a)(2)(iv) of this section by disclosing to the applicant at the time of the offer if, how, and the extent to which the policy or contract values (including cash value, dividends, and other assets) of a previously issued policy or contract will be used to purchase a replacing or additional policy or contract with the same insurer. The disclosure must include the premium, the death benefit of the proposed replacing or additional policy, and the date on which the policy values of the existing policy or contract will be insufficient to pay the premiums of the replacing or additional policy or contract.

(c) Each insurer shall adopt written procedures sufficient to reasonably avoid twisting and churning of policies or contracts that it has issued, and failure to adopt written procedures sufficient to reasonably avoid twisting and churning shall be an unfair method of competition and an unfair or deceptive act or practice.
R.I. Gen. Laws § 27-11-3 — RI Code / Title 27 / Chapter 27-11 / Section 27-11-3
§ 27-11-3. Maximum investment in real property.
Status: in_force

No real property shall be purchased, leased, held, or improved under this chapter if the cost or value of the property, or the cost of the improvements on it, or all of them on the date of the purchase, lease, or acquisition, plus the book value on the date of all real property held by the company, exceeds twenty percent (20%) of its assets.
R.I. Gen. Laws § 27-9-4_27-9-4 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-4_27-9-4
§ 27-9-4. Considerations in making of rates  Cancellation of policy. [Effective until January 1, 2026.]27-9-4. Considerations in making of rates  Cancellation of policy. [Effective January 1, 2026.]
Status: in_force

(a) All rates shall be made in accordance with the following provisions:

(1)(i) Due consideration shall be given to past and prospective loss experience within and outside this state, to catastrophe hazards, if any, 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 countrywide and those specially applicable to this state, and to all other relevant factors within and outside this state; provided, that no consideration shall be given to:

(A) Any loss or incident involving a bus driver, while in the course of the bus drivers employment for the Rhode Island public transit authority or private or municipal school bus companies, in establishing or maintaining that drivers rate respecting the operation of a personal motor vehicle or vehicles;

(B) Any loss or incident involving a law enforcement officer, while in the course of the law enforcement officers employment for the state, city, town police departments, or federal law enforcement agency, in establishing or maintaining that drivers rate respecting the operation of a personal motor vehicle or vehicles; and

(C) Any loss or incident involving a commercial vehicle driver, while in the course of the commercial vehicle drivers employment, in establishing or maintaining that drivers rate respecting the operation of a personal motor vehicle(s);

(ii) It shall be the responsibility of a commercial vehicle driver to provide the commercial vehicle drivers insurance company with proof that the loss or incident took place in the course of employment while operating a commercial vehicle. For the purposes of this section, a commercial vehicle shall be a motor vehicle with a gross weight in excess of ten thousand pounds (10,000 lbs.) or a motor vehicle used for public livery;

(2) The systems of expense provisions included in the rates for use by any insurer or group of insurers may differ from those of other insurers or groups of insurers to reflect the requirements of the operating methods of any insurer or group with respect to any kind of insurance, or with respect to any subdivision or combination of insurance for which subdivision or combination separate expense provisions are applicable;

(3) Risks may be grouped by classifications for the establishment of rates and minimum premiums;

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

(5) For any policy written, delivered, or renewed on or after January 1, 2025, in establishing or maintaining an insureds rate or classification respecting the operation of a personal motor vehicle, widowed persons shall not be treated differently than persons in a marriage; and

(6) In establishing or maintaining an insureds rate or classification respecting the operation of a personal motor vehicle, any insured sixty-five (65) years of age or older, who meets the criteria set forth in this section and has not had any chargeable accidents or moving violations within three (3) years preceding the establishment of the rate of insurance or classification, shall not be penalized solely by reason of his or her age.

(b) No insurance company shall fail to renew a private passenger automobile policy because of a loss occurrence only, unless a chargeable loss occurrence of three thousand dollars ($3,000) or more than two (2) nonchargeable loss occurrences, involving the insured, have taken place within the annual policy year.

(c)(1) No insurance company shall fail to renew a private passenger automobile policy solely because the insured has attained the age of sixty-five (65) years or older.

(2) Whenever the commissioner of insurance shall have reason to believe that any insurance company has refused to renew a private passenger automobile policy solely because the applicant has reached the age of sixty-five (65) years or older, the commissioner shall notify the company that it may be in violation of this section and in the commissioners discretion the commissioner may require a hearing to determine whether or not the company has actually been engaged in the practice stated in this subsection. Any hearing held under this section shall in all respects comply with the hearing procedure provided in the Administrative Procedures Act, chapter 35 of title 42.

(3) If after the hearing the commissioner shall determine that the company has engaged in the practice of systematically failing to renew private passenger automobile policies because of the advanced age of the insured, the commissioner shall reduce the commissioners findings to writing and shall issue and cause to be served upon the company an order to cease and desist from engaging in those practices. After the issuance of the cease and desist order, if the commissioner finds that the company has continued to engage in those practices, the commissioner shall impose upon the company a fine not to exceed the amount of one thousand dollars ($1,000) for each separate violation.

(4) Any company aggrieved by any order or decision of the commissioner of insurance may appeal the order and decision to the superior court of Providence in accordance with the Administrative Procedures Act, chapter 35 of title 42.

(d) No insurance group, carrier, or company in establishing any premium surcharge or penalty relative to a specific motor vehicle policy, shall consider any accident or any claim where any insured covered by that policy is fifty percent (50%) or less at fault.

(e) No insurance group, carrier, or company shall assess any premium surcharge against any insured covered by a motor vehicle policy where a property damage claim payment is less than three thousand dollars ($3,000).

(f) No insurance group, carrier, or company shall refuse to issue motor vehicle liability insurance, impose a surcharge, or otherwise increase the rate for a motor vehicle policy solely because the applicant is a volunteer driver. Volunteer driver is defined as a person who provides services without compensation to a nonprofit agency or charitable organization.
R.I. Gen. Laws § 27-17-27 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-27
§ 27-17-27. Severability.
Status: in_force

In the event any section, part, or provisions of this chapter is held to be illegal, that section, part, or provision shall not affect any other section, part, or provision of the chapter, but the remaining sections, parts, and provisions shall be and remain in full force and effect.
R.I. Gen. Laws § 27-44-10 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-10
§ 27-44-10. Insurers and rating and advisory organizations  Prohibited activity.
Status: in_force

(a) No insurer or rating or advisory organization shall attempt to monopolize or combine or conspire with any other person to monopolize an insurance market.

(b)(1) No insurer shall agree with any other insurer or with any rating or advisory organization to adhere to or to use any rate, rating plan, rating schedule, rating rule, policy or bond forms, rate classifications, rate territories, underwriting rules, surveys, inspections, or similar materials, except as needed to develop statistical plans permitted by this chapter. Notwithstanding the foregoing, nothing contained in this chapter shall apply to any pools.

(2) The fact that two (2) or more insurers, whether or not members or subscribers of a rating organization, use consistently or intermittently, the same rates, rating plans, rating schedules, rating rules, policy or bond forms, rate classifications, rate territories, underwriting rules, surveys or inspections, or similar materials is not sufficient in itself to support a finding that an agreement exists, and may be used only for the purpose of supplementing or explaining other evidence of the existence of an agreement.

(3) Two (2) or more insurers having a common ownership or operating in this state under common management or control may act in concert between or among themselves with respect to any matters pertaining to those activities authorized in this chapter as if they constituted a single insurer.

(c) No insurer or rating or advisory organization shall make any arrangement with any other insurer, rating or advisory organization, or other person that has the purpose or effect of restraining trade unreasonably or of substantially lessening competition in the business of insurance.

(d) No advisory organization shall engage in any unfair or unreasonable practice. If after a hearing the director finds that any activity or practice of an advisory organization is unfair, unreasonable, or inconsistent with the requirements of this chapter, the director shall specify the finding in an order requiring the discontinuance of the activity or practice.
R.I. Gen. Laws § 27-20-5.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-5.1
§ 27-20-5.1. 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 § 27-18-34 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-34
§ 27-18-34. Health insurance contracts  Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.
Status: in_force

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

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

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

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

(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations, and health maintenance organizations shall insure that all participating primary care provider certified registered nurse practitioners are included on any publicly accessible list of participating providers for the respective organization.

(f) 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 § 27-10-3 — RI Code / Title 27 / Chapter 27-10 / Section 27-10-3
§ 27-10-3. Issuance of license.
Status: in_force

(a) The insurance commissioner may issue to any person a license to act as either a public adjuster; company adjuster; or independent adjuster once that person files an application in a format prescribed by the department and declares under penalty of suspension, revocation, or refusal of the license that the statements made in the application are true, correct, and complete to the best of the individuals knowledge and belief. Before approving the application, the department shall find that the individual:

(1) Is at least eighteen (18) years of age;

(2) Is eligible to designate this state as the individuals home state;

(3) Is trustworthy, reliable, and of good reputation, evidence of which shall be determined by the department;

(4) Has not committed any act that is a ground for probation, suspension, revocation, or refusal of a professional license as set forth in § 27-10-12;

(5) Has successfully passed the examination for the line(s) of authority for which the person has applied;

(6) Has paid a fee of two hundred fifty dollars ($250).

(b) A Rhode Island resident business entity acting as an insurance adjuster may elect to obtain an insurance adjusters license. Application shall be made using the uniform business entity application. Prior to approving the application, the insurance commissioner shall find both of the following:

(1) The business entity has paid the appropriate fees.

(2) The business entity has designated a licensed adjuster responsible for the business entitys compliance with the insurance laws and rules of this state.

(c) The department may require any documents reasonably necessary to verify the information contained in the application.
R.I. Gen. Laws § 27-2-27 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-27
§ 27-2-27. Appeal from revocation or suspension.
Status: in_force

A company aggrieved by a revocation or suspension of its license may, within thirty (30) days from the effective date of the revocation or suspension, file a petition in the superior court for the county of Providence for a review of that action of the insurance commissioner. The court shall summarily hear and determine the question whether the ground for revocation or suspension specified in the notice of the insurance commissioner exists and may make any appropriate order or decree. If the order or decree is adverse to the petitioning company it may within twenty (20) days from the issuing of the order or decree appeal to the supreme court; in case of an appeal the revocation or suspension of the license of the company shall continue in full force until the final determination of the question by the supreme court, unless vacated by the insurance commissioner during the pendency of the appeal.
R.I. Gen. Laws § 27-18-83 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-83
§ 27-18-83. Healthcare provider credentialing.
Status: repealed

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(ii) Financial incentives for persons enrolled in the plan to use the participating providers and procedures provided for by the health plan.
R.I. Gen. Laws § 27-29-14 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-14
§ 27-29-14. Confidentiality of insurance information.
Status: in_force

No insurance company, authorized or licensed to do business in the state of Rhode Island, that obtains insurance information through any residual market (mechanism), including, but not limited to, the assigned risk plans Joint Underwriting Association, including, but not limited to, the name of the insured, the policy expiration date, the amount of insurance coverage, the policy number, the name of the insurance company or the amount of the insurance premium, shall without the permission of the producer of record use that information for marketing or soliciting so as to eliminate the participation of the producer of record and shall be prohibited from selling or transferring that information to any third party for those purposes, without the consent of the producer of record; provided, that nothing contained in this section shall be deemed to prohibit an insurance company from offering voluntary market coverage as provided for in the rules of any automobile insurance residual market mechanism or to prohibit a workers compensation insurance company from sharing the name of the insured with a nonprofit medical service corporation or a nonprofit hospital service corporation.
R.I. Gen. Laws § 27-5-3.9 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-3.9
§ 27-5-3.9. Vacant property.
Status: in_force

No residential property insurance policy shall exclude coverage for vandalism or malicious mischief unless the dwelling has been vacant for more than sixty (60) consecutive days immediately before the loss.
R.I. Gen. Laws § 27-50-11 — RI Code / Title 27 / Chapter 27-50 / Section 27-50-11
§ 27-50-11. Administrative procedures.
Status: in_force

The commissioner may promulgate rules and regulations necessary to effectuate the purposes of this chapter.
R.I. Gen. Laws § 27-71-7 — RI Code / Title 27 / Chapter 27-71 / Section 27-71-7
§ 27-71-7. Protocols for targeted market conduct examinations.
Status: in_force

(a) When the commissioner identifies through market analysis a pattern of conduct or practice by an insurer which requires further investigation, and less intrusive market conduct actions identified in § 27-71-5(b) are not appropriate, the commissioner has the discretion to conduct targeted, market conduct examinations in accordance with the NAIC Market Conduct Uniform Examination Procedures and the Market Regulation Handbook (or procedures, adopted by regulation, that are substantially similar to the foregoing NAIC products).

(b) If the insurer to be examined is not a domestic insurer, the commissioner may communicate with and may coordinate the examination with the insurance commissioner of the state in which the insurer is organized.

(c) Concomitant with the notification requirements established in subsection (e) of this section, the commissioner shall post notification on the NAIC Examination Tracking System, or comparable NAIC product as determined by the commissioner, that a market conduct examination has been scheduled.

(d) The commissioner may not conduct a comprehensive market conduct examination more frequently than once every three (3) years. The commissioner may decide not to conduct a comprehensive market conduct examination based on market analysis.

(e)(1) Prior to commencement of a targeted on-site market conduct examination, market conduct surveillance personnel shall prepare a work plan and proposed budget. Such proposed budget, which shall be reasonable for the scope of the examination, and work plan shall be provided to the company under examination.

(2) Market conduct examinations shall, to the extent feasible, utilize desk examinations and data requests prior to a targeted on-site examination.

(3) Market conduct examinations shall be conducted in accordance with the provisions set forth in the NAIC Market Regulation Handbook and the NAIC Market Conduct Uniform Examinations Procedures (or procedures, adopted by regulation, that are substantially similar to the foregoing NAIC products).

(4) Prior to the conclusion of a market conduct examination, the individual among the market conduct surveillance personnel who is designated as the examiner-in-charge shall schedule an exit conference with the insurer.

(f) Announcement of the examination shall be sent to the insurer and posted on the NAICs Examination Tracking System (or comparable NAIC product, as determined by the commissioner) as soon as possible but in no case later than sixty (60) days before the estimated commencement of the examination, unless extraordinary circumstances indicating a risk to consumers require immediate action. Such announcement to the insurer shall contain:

(1) The name and address of the insurer(s) being examined;

(2) The name and contact information of the examiner-in-charge;

(3) The reason(s) for and the scope of the targeted examination;

(4) The date the examination is scheduled to begin;

(5) Identification of any non-insurance department personnel who will assist in the examination, if known at the time the notice is prepared;

(6) A time estimate for the examination;

(7) A budget and work plan for the examination and identification of reasonable and necessary costs and fees that will be included in the bill, if the cost of the examination is billed to the company; and

(8) A request for the insurer to name its examination coordinator.

(g) If a targeted examination is expanded beyond the reasons provided to the insurer in the notice of the examination required under this section, the commissioner shall provide written notice to the insurer, explaining the extent of the expansion and the reasons for the expansion. The department shall provide a revised work plan to the insurer before the beginning of any significantly expanded examination, unless extraordinary circumstances indicating a risk to consumers require immediate action.

(h) The commissioner shall conduct a pre-examination conference with the insurer examination coordinator and key personnel to clarify expectations thirty (30) days prior to commencement of the examination.

(i) The department shall use the NAIC Standard Data Request (or comparable product, adopted by regulation, that is substantially similar to the foregoing NAIC product).

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

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

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

(j)(1) The commissioner shall adhere to the following timeline, unless a mutual agreement is reached with the insurer to modify the timeline:

(i) The commissioner shall deliver the draft report to the insurer within sixty (60) days of the completion of the examination. Completion of the examination shall be defined as the date the commissioner confirms in writing that the examination is completed.

(ii) The insurer must respond with written comments within thirty (30) days of receipt of the draft report.

(iii) The department shall make a good faith effort to resolve issues and prepare a final report within thirty (30) days of receipt of the insurers written comments, unless a mutual agreement is reached to extend the deadline. The commissioner may make corrections and other changes, as appropriate.

(iv) The insurer shall, within thirty (30) days, of receipt of the final report, file a written response to all comments and recommendations contained in the report. The response shall include a written plan of how and when the comments and recommendations contained in the examination report will be corrected and/or implemented. For each comment and recommendation, the response must include an implementation date and a completion date for each corrective action. In lieu of these requirements, the company may submit a rebuttal to any comment or recommendation contained in the examination report. An additional thirty (30) days shall be allowed if agreed to by the commissioner and the insurer.

(2) The final written and electronic publicly available market conduct report shall include the insurers written response and any agreed-to corrections or changes. The response may be included either as an appendix or in the text of the examination reports. References to specific individuals by name shall be limited to an acknowledgement of their involvement in the conduct of the examination.

(k)(1) Upon adoption of the examination report pursuant to § 27-13.1-5(c)  (f), the commissioner shall continue to hold the content of the examination report as private and confidential for a period of thirty (30) days, except to the extent provided in subsection (k)(2) of this section. During this time, the report shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private action. Thereafter, the commissioner shall open the report for public inspection, provided no court of competent jurisdiction has stayed its publication. This section may not be construed to limit the commissioners authority to use any final or preliminary market conduct examination report, and examiner or company work papers or other documents, or any other information discovered or developed during the course of an examination in the furtherance of any legal or regulatory action that the commissioner, in the commissioners sole discretion may deem appropriate.

(2) Nothing contained in this chapter shall prevent or be construed as preventing the commissioner from disclosing the content of an examination report, preliminary examination report or results, or any matter relating thereto, to the insurance department of this or any other state or agency of the federal government at any time, provided the agency or office receiving the report or matters relating thereto agrees to hold it confidential and in a manner consistent with this chapter.

(l) The insurer may appeal the order adopting the examination report in accordance with the procedures set forth in § 27-13.1-5(d) and the administrative procedures act, chapter 35 of title 42.
R.I. Gen. Laws § 27-41-100 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-100
§ 27-41-100. Acute mental health crisis mobile response and stabilization services. [Effective January 1, 2026.]
Status: in_force

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

(1) Aggression;

(2) Self-injury;

(3) Trauma;

(4) Acute depression/anxiety;

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

(6) Extreme parent/child conflict.

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

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

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

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

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

(9) Other limited benefit policies.
R.I. Gen. Laws § 27-43-2 — RI Code / Title 27 / Chapter 27-43 / Section 27-43-2
§ 27-43-2. Incorporation of captive insurance companies in this state.
Status: in_force

(a) A subsidiary captive insurance company shall be incorporated as a stock insurance company with its capital divided into shares and held by the stockholders.

(b) An association captive insurance company or an industrial insured captive insurance company may be:

(1) Incorporated as a stock insurance company with its capital divided into shares and held by the stockholders; or

(2) Incorporated as a mutual insurance company without capital stock, the governing body of which is elected by the member organizations of its association; or

(3) Organized as a reciprocal insurer in accordance with chapter 17 of this title.

(c) A captive insurance company that is formed as a corporation shall have not less than three (3) incorporators of whom not less than two (2) shall be residents of this state.

(d)(1) In the case of a captive insurance company formed as a corporation, before the articles of association are transmitted to the secretary of state, the incorporators shall petition the commissioner to issue a certificate setting forth his or her finding that the establishment and maintenance of the proposed corporation will promote the general good of the state. In arriving at the finding, the commissioner shall consider:

(i) The character, reputation, financial responsibility, insurance experience, and business qualifications of the incorporators and the proposed officers and directors;

(ii) The sources and availability of its capital; and

(iii) Other financial and business matters that the commissioner deems advisable.

(2) In the case of a captive insurance company formed as a reciprocal insurer, the organizers shall petition the commissioner to issue a certificate setting forth the commissioners finding that the establishment and maintenance of the proposed association will promote the general good of the state. In arriving at that finding, the commissioner shall consider:

(i) The character, reputation, financial responsibility, insurance experience, and business qualifications of the organizers and the attorney in fact;

(ii) The sources and availability of its capital; and

(iii) Other financial and business matters that the commissioner shall deem advisable.

(e) The articles of association, the certificate, and the organization fee shall be transmitted to the secretary of state, who shall then record both the articles of incorporation and the certificate.

(f) The capital stock of a captive insurance company incorporated as a stock insurance company shall be issued at not less than par value, and all capital insurance companies shall have the minimum capital provided in §27-43-4.

(g)(1) In the case of a captive insurance company formed as a corporation in this state, at least one of the members of the board of directors of a captive insurance company incorporated in this state shall be a resident of this state.

(2) In the case of a captive insurance company formed as a reciprocal insurer in this state, at least one of the members of the subscribers advisory committee shall be a resident of this state.

(h) Every captive insurance company referenced within this subsection has the powers contained in this chapter, and is subject to the provisions of this chapter, chapter 1 of this title, and chapter 1.2 of title 7; provided, that insofar as the provisions of this chapter are inconsistent with the provisions of chapter 1 of this title or chapter 1.2 of title 7, the provisions of this chapter are controlling.

(i) Captive insurance companies formed as corporations under the provisions of this chapter have the privileges and are subject to the provisions of the general corporation law and the applicable provisions contained in this chapter. In the event of conflict between the provisions of the general corporation law and the provisions of this chapter, this chapter controls.

(j) Captive insurance companies formed as reciprocal insurers under the provisions of this chapter have all the privileges and are subject to all the obligations imposed by chapter 17 of this title in addition to the applicable provisions of this chapter. In the event of a conflict between the provisions of chapter 17 and the provisions of this chapter, this chapter controls. To the extent that chapter 17 also subjects a reciprocal insurer to the other provisions of this title, these other provisions are not applicable to a reciprocal insurer formed under this chapter unless these provisions are expressly made applicable to these captive insurance companies by this chapter.

(k) The articles of incorporation or bylaws of a captive insurance company formed as a corporation may authorize a quorum of a board of directors to consist of no fewer than one third ( ) of the fixed or a majority of the prescribed number of directors as determined by the charter or the bylaws of the corporation or by §7-1.2-802.

(l) The subscribers agreement or other organizing document of a captive insurance company formed as a reciprocal insurer may authorize a quorum of a subscribers advisory committee to consist of no less than one third ( 1 / 3 ) of the number of its members.
R.I. Gen. Laws § 27-57-3 — RI Code / Title 27 / Chapter 27-57 / Section 27-57-3
§ 27-57-3. Certain liens not affected.
Status: in_force

Nothing in this chapter affects the validity or priority of liens or written notices of healthcare providers, attorney fees, holders of security interests, or the assignment of rights under §40-6-9 which may exist. Funds subject to liens, written notices, or security interests shall be paid to the lien or interest holder.

[See §12-1-15 of the General Laws.]
R.I. Gen. Laws § 27-9-52 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-52
§ 27-9-52. Assessment for costs of rate filings, review, and pricing.
Status: in_force

The director of the department of business regulation may appoint actuaries and any other required administrative personnel to assist the director in the performance of the directors duties relating to the evaluation of rate filings, reviews, and pricing procedures of insurers; the actuaries and other administrative personnel shall serve under the direction of the director and shall be removable at the directors pleasure. The director is authorized to enter into contracts with consultants for the purpose of studying rate filings, reviews, and pricing procedures of insurers. Insurance companies doing insurance in this state shall be assessed according to a schedule of their direct writings of insurance in this state to pay for the compensation of the actuaries, consultants, and other administrative personnel retained hereunder. This assessment shall comply with the provisions pursuant to of his or her duties
R.I. Gen. Laws § 27-41-77 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-77
§ 27-41-77. Coverage for individual participating in approved clinical trials.
Status: repealed

(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) Assures 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 maintenance organization offering group or individual health insurance coverage provides coverage to a qualified individual, it:

(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 is participating in a clinical trial, nothing in subsection (b)(1) shall be construed as preventing a health maintenance organization 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 maintenance organization 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 maintenance organizations coverage with respect to clinical trials.

(c) The requirements of this section shall be in addition to the requirements of §§27-41-41  27-41-41.3 [repealed].

(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 § 27-36-2 — RI Code / Title 27 / Chapter 27-36 / Section 27-36-2
§ 27-36-2. Annual assessments of insurance companies.
Status: in_force

(a) The director of the department of business regulation shall make an annual assessment against each insurance company, those corporations and other entities subject to this title and chapter 62 of title 42, hereafter referred to as a company, for payment of all reasonable expenditures incurred by the attorney general in representation at insurance rate hearings for matters involving insurance regulation. The assessments shall be in amounts annually determined and certified by the attorney general to the director of the department of business regulation as sufficient reimbursement for the general expenditures of the attorney general to fulfill the attorney generals obligations under this chapter. The general expenditures shall be proportionately assessed by the director of the department of business regulation against each company. In addition, actual reasonable costs for experts, such as but not limited to actuaries and economists, and other specific costs incurred by the attorney general related to insurance rate hearings, whether or not a public hearing has been held or the rate review has proceeded through a final decision by the department of business regulation or office of the health insurance commissioner, shall be billed directly by the attorney general to the company that initiated the filing.

(b) The company billed for these specific costs shall make payment to the attorney general by forwarding a check, payable to the service provider, to the chief of the insurance advocacy unit of the attorney generals office within sixty (60) days of the date invoiced. Assessments made pursuant to this section may be credited to the normal operating costs of each company and shall be deposited as general revenue.
R.I. Gen. Laws § 27-25-19 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-19
§ 27-25-19. The benefit contract.
Status: in_force

(a) Every society authorized to do business in this state shall issue to each owner of a benefit contract a certificate specifying the amount of benefits provided by the contract. The certificate, together with any riders or endorsements attached to it, the laws of the society, the application for membership, the application for insurance and declaration of insurability, if any, signed by the applicant, and all amendments to each, shall constitute the benefit contract, as of the date of issuance, between the society and the owner, and the certificate shall state this. A copy of the application for insurance and declaration of insurability, if any, shall be endorsed upon or attached to the certificate. All statements on the application shall be representations and not warranties. Any waiver of this provision shall be void.

(b) Any changes, additions, or amendments to the laws of the society duly made or enacted subsequent to the issuance of the certificate, shall bind the owner and the beneficiaries, and shall govern and control the benefit contract in all respects the same as though those changes, additions, or amendments had been made prior to and were in force at the time of the application for insurance, except that no change, addition, or amendment shall destroy or diminish benefits that the society contracted to give the owner as of the date of issuance.

(c) Any person upon whose life a benefit contract is issued prior to attaining the age of majority shall be bound by the terms of the application and certificate and by all the laws and rules of the society to the same extent as though the age of majority had been attained at the time of application.

(d) A society shall provide in its laws that if its reserves as to all or any class of certificates become impaired its board of directors or corresponding body may require that there shall be paid by the owner to the society the amount of the owners equitable proportion of the deficiency as ascertained by its board, and that if the payment is not made either: (1) It shall stand as an indebtedness against the certificate and draw interest not to exceed the rate specified for certificate loans under the certificates; or (2) In lieu of or in combination with subsection (d)(1), the owner may accept a proportionate reduction in benefits under the certificate. The society may specify the manner of the election and which alternative is to be presumed if no election is made.

(e) Copies of any of the documents mentioned in this section, certified by the secretary or corresponding officer of the society, shall be received in evidence of the terms and conditions of the documents.

(f) No certificate shall be delivered or issued for delivery in this state unless a copy of the form has been filed with the commissioner of insurance in the manner provided for like policies issued by life insurers in this state. Every life, accident, health, or disability insurance certificate and every annuity certificate shall meet the standard contract provision requirements not inconsistent with this chapter for like policies issued by life insurers in this state, except that a society may provide for a grace period for the payment of premiums of one full month in its certificate. The certificate shall also contain a provision stating the amount of premiums payable under the certificate and a provision reciting or setting forth the substance of any sections of the societys laws or rules in force at the time of issuance of the certificate that, if violated, will result in the termination or reduction of benefits payable under the certificate. If the laws of the society provide for expulsion or suspension of a member, the certificate shall also contain a provision that any member so expelled or suspended, except for nonpayment of a premium or within the contestable period for material misrepresentations in the application for membership or insurance, shall have the privilege of maintaining the certificate in force by continuing payment of the required premium.

(g) Benefit contracts issued on the lives of persons below the societys minimum age for adult membership may provide for the transfer of control or ownership to the insured at an age specified in the certificate. A society may require approval of an application for membership in order to effect this transfer, and may provide in all other respects for the regulation, government, and control of the certificates and all of the rights, obligations, and liabilities incident to and connected with the certificates. Ownership rights prior to the transfer shall be specified in the certificate.

(h) A society may specify the terms and conditions on which benefit contracts may be assigned.
R.I. Gen. Laws § 27-19-11 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-11
§ 27-19-11. Investment standards.
Status: in_force

(a) All nonprofit hospital service corporations shall protect the interests of subscribers by promoting company solvency and financial strength through the application of investment standards that facilitate a reasonable balance of the following objectives:

(1) To preserve principal;

(2) To assure reasonable diversification as to type of investment, issuer, and credit quality; and

(3) To allow the nonprofit hospital service corporation to allocate investments in a manner consistent with principles of prudent investment management to achieve an adequate return so that obligations to subscribers are adequately met and financial strength is sufficient to cover reasonably foreseeable contingencies.

(b) All investments, including, but not limited to, those referred to in this chapter, shall be made and held in accordance with the objectives in subsection (a) of this section subject to the limitations set forth in this chapter and in regulations promulgated pursuant to this chapter. Investments not conforming to this chapter and any regulations promulgated pursuant to this chapter shall not be considered admitted assets.
R.I. Gen. Laws § 27-6-28 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-28
§ 27-6-28. Actuarial and technical services furnished by rating organizations.
Status: in_force

Any rating organization may subscribe for or purchase actuarial, technical, or other services, and those services shall be available to all members and subscribers without discrimination.
R.I. Gen. Laws § 27-2-6 — RI Code / Title 27 / Chapter 27-2 / Section 27-2-6
§ 27-2-6. Certificate of deposit for benefit of policyholders.
Status: in_force

No insurance company, association, or society incorporated by or organized under the laws of any other state or government shall make within this state any contract of insurance unless it has deposited securities created by the laws of the United States, or by or under laws of the state in which the company, association, or society is located or in other safe stocks or securities, the market value of which at all times shall be at least one hundred thousand dollars ($100,000) which investments are deposited with the insurance commissioner, auditor, comptroller, or chief financial officer of the state by whose laws the company is incorporated, or where the association or society is located or has its principal office and place of business, and the insurance commissioner of this state is furnished with the certificate of the commissioner, auditor, comptroller, or chief financial officer, under his or her hand and official seal, that he or she, as the commissioner, auditor, comptroller, or chief financial officer of the state holds in trust and on deposit for the benefit of all policyholders of the company, association, or society, voluntary or otherwise, the previously mentioned securities. The certificate shall embrace the items of this security held, and shall state that he or she is satisfied that the securities are worth one hundred thousand dollars ($100,000); provided, that no company of any foreign country shall make any contract of insurance with any person in this state unless the company, if a stock company, has two million dollars ($2,000,000) paid-in capital stock and four million dollars ($4,000,000) surplus, or if a mutual company, it has net assets over all liabilities in the amount of not less than six million dollars ($6,000,000), and one million dollars ($1,000,000) is invested in stocks created by the laws of the United States, or under the laws of some state of the United States, the market value of which at all times shall be at least one million dollars ($1,000,000), and which shall have made a deposit with the insurance commissioner of this state or with the proper officer of some other state of the United States of not less than two million dollars ($2,000,000) in securities which shall at all times have a market value of at least two million dollars ($2,000,000), in trust for the benefit of its policyholders in the United States, and the general treasurer of this state is furnished with the certificate of the commissioner, auditor, comptroller, or chief financial officer, under his or her hand and official seal, if the deposit be made in another state, that he or she as the commissioner, auditor, comptroller, or chief financial officer of the state holds in trust and on deposit for the benefit of all policyholders of the company, association, or society, voluntary or otherwise, in the United States, the previously mentioned securities; the certificate shall embrace the items of this security held, and shall state that he or she is satisfied that the securities are worth two million dollars ($2,000,000). Nothing contained in this section shall be so construed as to apply to foreign insurance companies licensed prior to June 1, 1978.
R.I. Gen. Laws § 27-70-4 — RI Code / Title 27 / Chapter 27-70 / Section 27-70-4
§ 27-70-4. Regulatory oversight.
Status: in_force

The director of the department of labor and training shall have the authority to promulgate rules and regulations for the implementation and administration of this chapter.
R.I. Gen. Laws § 27-61-1 — RI Code / Title 27 / Chapter 27-61 / Section 27-61-1
§ 27-61-1. Short title.
Status: in_force

This chapter may be cited as the Unfair Discrimination Against Subjects of Abuse in Life Insurance Act.
R.I. Gen. Laws § 27-9-5 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-5
§ 27-9-5. Uniformity among insurers.
Status: in_force

Except to the extent necessary to meet the provisions of § 27-9-4(a)(4), uniformity among insurers in any matter within the scope of § 27-9-4 is neither required nor prohibited.
R.I. Gen. Laws § 27-17-9 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-9
§ 27-17-9. Contingent reserve.
Status: in_force

In addition to the reserves provided for in §§ 27-17-7 and 27-17-10, there shall also be maintained at all times by the exchange, as assets, a contingent reserve in cash or securities as stated in § 27-17-7 of not less than the amount of minimum capital required of a stock insurance company incorporated under the law of any other state of the United States to do the kind or kinds of insurance that the exchange is authorized to write under § 27-17-1.
R.I. Gen. Laws § 27-6-25 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-25
§ 27-6-25. Regulation by rating organizations of payments by insurers to policyholders or members.
Status: in_force

No rating organization shall adopt any rule the effect of which would be to prohibit or regulate the payment of dividends, savings, or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members, or subscribers.
R.I. Gen. Laws § 27-29-13.1 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-13.1
§ 27-29-13.1. Late payment of premium.
Status: in_force

An insurer may levy and collect a maximum fee or charge of ten dollars ($10.00) for any late payment of premium by a policyholder for any property, casualty, fire and marine or liability policy of insurance. A late fee may not be imposed unless payment is received more than five (5) business days following the date payment is due.
R.I. Gen. Laws § 27-6-1 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-1
§ 27-6-1. Purpose.
Status: in_force

The purpose of this chapter is to promote the public welfare by regulating insurance rates to the end that they shall not be excessive, inadequate, or unfairly discriminatory, and to authorize and regulate cooperative action among insurers in ratemaking and in other matters within the scope of this chapter. Nothing in this chapter is intended to prohibit or discourage reasonable competition, or to prohibit or encourage, except to the extent necessary to accomplish the purpose of this section, uniformity in insurance rates, rating systems, or rating plans or practices. This chapter shall be liberally interpreted to carry into effect the provisions of this section.
R.I. Gen. Laws § 27-25-30 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-30
§ 27-25-30. Injunction  Liquidation  Receivership of domestic society.
Status: in_force

(a) When the commissioner of insurance upon investigation finds that a domestic society:

(1) Has exceeded its powers;

(2) Has failed to comply with any provision of this chapter;

(3) Is not fulfilling its contracts in good faith;

(4) Has a membership of less than four hundred (400) after an existence of one year or more; or

(5) Is conducting business fraudulently or in a manner hazardous to its members, creditors, the public, or the business; the commissioner shall notify the society of the deficiency or deficiencies and state in writing the reasons for his or her dissatisfaction. The commissioner shall at once issue a written notice to the society requiring that the existing deficiency or deficiencies be corrected. After the notice, the society shall have a thirty-day (30) period in which to comply with the commissioners request for correction, and, if the society fails to comply, the commissioner shall notify the society of the findings of noncompliance and require the society to show cause on a named date why it should not be enjoined from carrying on any business until the violation(s) complained of shall have been corrected, or why an action in quo warranto should not be commenced against the society.

(b) If on that date the society does not present good and sufficient reasons why it should not be enjoined or why the action should not be commenced, the commissioner of insurance may present the facts relating to the action to the attorney general who shall, if he or she deems the circumstances warrant, commence an action to enjoin the society from transacting business or in quo warranto.

(c) The court shall upon commencement of the action notify the officers of the society of a hearing. If after a full hearing it appears that the society should be enjoined or liquidated or a receiver appointed, the court shall enter the necessary order. No enjoined society shall have the authority to do business until:

(1) The commissioner of insurance finds that the violation(s) complained of has been corrected;

(2) The costs of the action shall have been paid by the society if the court finds that the society was in default as charged;

(3) The court has dissolved its injunction; and

(4) The commissioner of insurance has reinstated the certificate of authority.

(d) If the court orders the society liquidated, it shall be enjoined from carrying on any further business, where the receiver of the society shall proceed at once to take possession of the books, papers, money, and other assets of the society and, under the direction of the court, proceed to close the affairs of the society and to distribute its funds to those entitled to the funds.

(e) No action under this section shall be recognized in any court of this state unless brought by the attorney general upon request of the commissioner of insurance. Whenever a receiver is to be appointed for a domestic society, the court shall appoint the commissioner of insurance as the receiver.

(f) The provisions of this section relating to hearing by the commissioner of insurance, action by the attorney general at the request of the commissioner of insurance, hearing by the court, injunction, and receivership shall be applicable to a society that shall voluntarily determine to discontinue business.
R.I. Gen. Laws § 27-20-22 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-22
§ 27-20-22. Discontinuance of coverage  Chronic disabilities.
Status: in_force

No nonprofit medical service corporation subject to the provisions of this chapter shall discontinue reimbursement or providing services for the covered healthcare services of chronic disabilities unless the patient has exhausted benefits to which he or she is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period, provided notice of the discontinuation is sent to subscribers who have been reimbursed for or utilized those services in the past three (3) years. The notice shall be mailed at least sixty (60) days prior to the beginning of the open enrollment period. For the purposes of this section, chronic disability means an impairment or illness that is likely to continue indefinitely.
R.I. Gen. Laws § 27-1-30 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-30
§ 27-1-30. Liability of directors, officers, and shareholders.
Status: in_force

For the purpose of preventing the unfair use of information that may have been obtained by a beneficial owner, director, or officer by reason of their relationship to the company, any profit realized by them from any purchase and sale, or any sale and purchase, of any equity security of the company within any period of less than six (6) months, unless the security was acquired in good faith in connection with a debt previously contracted, shall inure to and be recoverable by the company, irrespective of any intention on the part of the beneficial owner, director, or officer in entering into a transaction of holding the security purchased or of not repurchasing the security sold for a period exceeding six (6) months. An action to recover profit may be instituted in any court of competent jurisdiction by the company, or by the owner of any security of the company in the name and on behalf of the company if the company fails or refuses to bring the action within sixty (60) days after request or fails diligently to prosecute the action, but no action shall be brought more than two (2) years after the date the profit was realized. This section shall not be construed to cover any transaction where the beneficial owner was not the beneficial owner, both at the time of the purchase and sale, or the sale and purchase, of the security involved, or any transaction or transactions that the commissioner by rules and regulations may exempt as not comprehended within the purpose of this section.
R.I. Gen. Laws § 27-58-8 — RI Code / Title 27 / Chapter 27-58 / Section 27-58-8
§ 27-58-8. Sales force.
Status: in_force

Solicitation for the purchase or sale of insurance by a financial institution shall be conducted only by persons whose responsibilities do not include loan transactions or other transactions involving the extension of credit, or the taking of deposits. For the purposes of this section, solicitation does not include signage on the premises.
R.I. Gen. Laws § 27-41-12 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-12
§ 27-41-12. Investments.
Status: in_force

With the exception of investments made in accordance with §27-41-5(a)(1) and (a)(2) and §27-41-5(b), the investable funds of a health maintenance organization may be invested in the following investments and any other investments that the director authorizes by regulation:

(1)(i) Governmental securities. Obligations of the United States. In bonds, notes, certificates, bills, or other obligations, or any part of the obligation, issued, assumed, insured, or guaranteed in whole or in part by the United States;

(ii)(A) Obligations of agencies and instrumentalities of the United States. In bonds, notes, certificates, bills, or other obligations, or any part of the obligations, issued, assumed, insured, or guaranteed in whole or in part, directly or indirectly, by any agency or instrumentality of the United States, now or after this established, expressly including in this section, without limiting the generality of the foregoing, the following:

(I) Federal national mortgage association;

(II) Public housing association;

(III) Federal land banks;

(IV) Federal home loan banks;

(V) Federal intermediate credit banks; and

(VI) Banks for cooperatives;

(B) As used in this subsection, the phrase any agency or instrumentality of the United States shall include any persons, agents, agencies, subagents or subagencies, divisions, banks, corporations, commissioners, commissions, administrators, administrations, bureaus, boards, or other instrumentalities established by, or under the authority of, the President or the Congress of the United States or any agency or instrumentality of the President or the Congress, or to whom the authority to issue, insure, or guarantee stocks, bonds, securities, or other obligations has been delegated by the United States or any agency or instrumentality of the United States;

(2) State and municipal securities. The following securities are permitted investments for a health maintenance organization provided that: (A) These securities on the date of purchase are eligible for amortization in accordance with rules and guidelines of the securities valuation office of the National Association of Insurance Commissioners; (B) These securities, on the date of purchase, have a rating of at least an A as established by Moodys Investors Service, Inc. In the event that the Moodys bond ratings are no longer published by Moodys Investors Service, Inc., or in the event that the director determines that the Moodys bond ratings as published by Moodys Investors Service, Inc., are no longer appropriate for the determination of state and municipal bond investments, then an alternative method for the determination of permissible state and municipal bond investments, which is adopted by regulation promulgated by the director, may be established:

(i) Obligations of the state of Rhode Island. In bonds, notes, certificates, or other obligations issued, assumed, insured, or guaranteed, as to payment of principal and interest, in whole by the state of Rhode Island;

(ii) Obligations of other states and territories. In bonds, notes, certificates, or other obligations issued, assumed, insured, or guaranteed, as to payment of principal and interest in whole by any other state or territory of the United States, including the territory designated as the commonwealth of Puerto Rico;

(iii) Obligations of political subdivisions of the state of Rhode Island. In bonds, notes, certificates, or other obligations issued, assumed, or guaranteed, as to payment of principal and interest by any county, city, town, incorporated village, district, department, agency, commission, authority, or other political subdivision of the state of Rhode Island; and

(iv) Obligations of political subdivisions of other states. In bonds, notes, certificates, or other obligations issued, assumed, or guaranteed, as to payment of principal and interest by any county, city, town, incorporated village, district, department, agency, commission, authority, or other political subdivision of any other state of the United States;

(3) Deposits in banks and trust companies. Those deposits must be in insured financial institutions that are members of the Federal Reserve System or eligible to act as reserve agents as defined in §19-3-12;

(4) Commercial paper. In commercial paper purchased in the open market maturing in twelve (12) months or less of an individual, firm, or corporation whose business is principally in the United States, provided:

(i) That the paper carries one of the top three (3) ratings of a recognized credit agency satisfactory to the director of business regulation;

(ii) That the paper ninety (90) days prior to maturity would qualify as eligible for rediscount with a federal reserve bank; and

(iii) That a recent statement of assets, liabilities, and operations duly certified by a certified public accountant showing a satisfactory credit position is on file with the health maintenance organization; and

(5) Other bonds. Bonds, except those of a parent, provided that:

(i) Those bonds on the date of purchase are eligible for amortization in accordance with rules and guidelines of the securities valuation office of the National Association of Insurance Commissioners; and

(ii) Those bonds on the date of purchase have a rating of at least an A, as established by Moodys Investors Service, Inc.
R.I. Gen. Laws § 27-20-23.2 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-23.2
§ 27-20-23.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.
Status: in_force

(a) Definitions. As used herein:

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

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

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

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

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

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

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

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

(2) The product must be nationally available.

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

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

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

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

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

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

(6) The department of health shall exercise oversight and enforcement of this section.
R.I. Gen. Laws § 27-50-15 — RI Code / Title 27 / Chapter 27-50 / Section 27-50-15
§ 27-50-15. Restoration of terminated coverage.
Status: in_force

The director may promulgate regulations to require small employer carriers, as a condition of transacting business with small employers in this state after July 13, 2000, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier on or after July 1, 2000. The director may prescribe any terms for the reissue of coverage that the director finds are reasonable and necessary to provide continuity of coverage to small employers.
R.I. Gen. Laws § 27-61-2 — RI Code / Title 27 / Chapter 27-61 / Section 27-61-2
§ 27-61-2. Definitions.
Status: in_force

For the purposes of this chapter:

(1) Abuse means the occurrence of one or more of the following acts by a current or former family member, household member, intimate partner, or caretaker:

(i) Attempting to cause or intentionally, knowingly, or recklessly causing another person bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault, or involuntary sexual intercourse;

(ii) Knowingly engaging in a course of conduct or repeatedly committing acts toward another person including following the person or minor child without proper authority, under circumstances that place the person or minor child in reasonable fear of bodily injury or physical harm;

(iii) Subjecting another person to false imprisonment; or

(iv) Attempting to cause or intentionally, knowingly, or recklessly causing damage to property so as to intimidate or attempt to control the behavior of another person.

(2) Abuse-related medical condition means a medical condition sustained by a subject of abuse that arises in whole or part out of an act or pattern of abuse.

(3) Abuse status means the fact or perception that a person is, has been, or may be a subject of abuse, irrespective of whether the person has sustained abuse-related medical conditions.

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

(5) Insured means the person whose life is covered under an insurance policy.

(6) Insurer means a person or other legal entity engaged in the business of insurance in this state, including agents, brokers, adjusters, or third-party administrators.

(7) Policy or certificate means a contract of insurance or annuity issued, proposed for issuance, or intended for issuance by an insurer, including endorsements or riders.

(8) Subject of abuse means a person against whom an act of abuse has been directed; who has current or prior injuries, illnesses, or disorders that resulted from abuse; or who seeks, may have sought, or had reason to seek medical or psychological treatment for abuse or protection, court-ordered protection, or shelter from abuse.
R.I. Gen. Laws § 27-20-50 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-50
§ 27-20-50. Coverage for early intervention services.
Status: in_force

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

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

(c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
R.I. Gen. Laws § 27-77-5 — RI Code / Title 27 / Chapter 27-77 / Section 27-77-5
§ 27-77-5. ORSA summary report.
Status: in_force

(a) Upon the commissioners request, and no more than once each year, an insurer shall submit to the commissioner an ORSA summary report or any combination of reports that together contain the information described in the ORSA guidance manual, applicable to the insurer and/or the insurance group of which it is a member. Notwithstanding any request from the commissioner, if the insurer is a member of an insurance group, the insurer shall submit the report(s) required by this subsection if the commissioner is the lead state commissioner of the insurance group as determined by the procedures within the financial analysis handbook adopted by the NAIC.

(b) The report(s) shall include a signature of the insurer or insurance groups chief risk officer or other executive having responsibility for the oversight of the insurers enterprise risk management process attesting to the best of his or her belief and knowledge that the insurer applies the enterprise risk management process described in the ORSA summary report and that a copy of the report has been provided to the insurers board of directors or the appropriate committee thereof.

(c) An insurer may comply with subsection (a) by providing the most recent and substantially similar report(s) provided by the insurer or another member of an insurance group of which the insurer is a member to the commissioner of another state or to a supervisor or regulator of a foreign jurisdiction, if that report provides information that is comparable to the information described in the ORSA guidance manual. Any such report in a language other than English must be accompanied by a translation of that report into the English language.
R.I. Gen. Laws § 27-44-22 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-22
§ 27-44-22. Severability.
Status: in_force

If any provisions of this chapter, or the application of the provisions to any person or circumstances, are held invalid, the remainder of the chapter, and the application of the provisions to persons or circumstances other than those to which it is held invalid, shall not be affected by that invalidity.
R.I. Gen. Laws § 27-20-6.2 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-6.2
§ 27-20-6.2. Filing of policy forms.
Status: in_force

(a) A nonprofit medical 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 § 27-29-4.5 — RI Code / Title 27 / Chapter 27-29 / Section 27-29-4.5
§ 27-29-4.5. Penalty.
Status: in_force

An insurers failure to comply with any requirement of § 27-29-4.4, or any rule or regulation promulgated by the department of business regulation shall result in a fine in a sum of up to five thousand dollars ($5,000).
R.I. Gen. Laws § 27-6-20 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-20
§ 27-6-20. Hearings on application by persons aggrieved by filings  Order terminating filing  Removal of discrimination.
Status: in_force

(a) Any person or organization aggrieved with respect to any rate or filing that is in effect may make written application to the commissioner for a hearing; provided, that the insurer or rating organization that uses the rate or made the filing shall not be authorized to proceed under this section. This application shall specify the grounds to be relied upon by the applicant. If the commissioner shall find that the application is made in good faith, that the applicant would be aggrieved if the applicants grounds are established, and that these grounds justify holding a hearing, the commissioner shall, within thirty (30) days after receipt of the application, hold a hearing upon not less than ten (10) days written notice to the applicant and to every insurer and rating organization that uses the rate or made the filing; provided, if a public hearing had been held concerning the rate or filing before it became effective, no hearing shall be held pursuant to this section unless the commissioner shall find that there has been a substantial change of circumstances since that hearing.

(b) If, after the hearing, the commissioner finds that the rate or filing does not meet the requirements of this chapter, the commissioner shall issue an order specifying in what respects the commissioner finds that the rate or filing fails to meet the requirements of this chapter, and stating when, within a reasonable period after this, the rate shall no longer be used or the filing shall be deemed no longer effective. This order shall not affect any contract or policy made or issued prior to the expiration of the period set forth in the order. If the commissioner finds that an unfair discrimination exists in the application of a rate or filing to an individual risk the commissioner may, after a hearing held on like notice to the insurer affected and to any rating organization that made the filing, issue an order that the unfair discrimination be removed. Copies of any order issued under this section shall be sent to every affected insurer and rating organization.
R.I. Gen. Laws § 27-6-21 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-21
§ 27-6-21. Competitive rates as evidence of fairness  Profit as evidence of adequacy.
Status: in_force

If the insurer making or issuing a contract or policy at a rate or premium less than that provided by any filing, at any hearing held pursuant to §§ 27-6-17  27-6-22, or pursuant to § 27-6-16, shows to the satisfaction of the commissioner that the rate or premium was used in good faith to meet an equally low or lower net cost to the insured of a competitor, that showing shall be prima facie evidence that the rate or premium used is not unfairly discriminatory, and if the insurer using the rate or premium shall show to the satisfaction of the commissioner that it is writing that kind or class of insurance at a profit, that showing shall be prima facie evidence that the rate or premium used is not inadequate.
R.I. Gen. Laws § 27-41-22 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-22
§ 27-41-22. Statutory construction and relationship to other laws.
Status: in_force

(a) Except as otherwise provided in this chapter, provisions of chapters 19, 20, 20.1, and 20.2 of this title shall not be applicable to any health maintenance organization granted a license under this chapter. This provision shall not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws or the hospital or medical service corporation laws of this state except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.

(b) Solicitation of enrollees by a health maintenance organization granted a license, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.

(c) Any health maintenance organization authorized under this chapter shall not be deemed to be practicing a profession, and may employ, or contract with, any licensed health professional to deliver professional services.

(d) No section of chapter 15 of title 23, the Health Care Certificate of Need Act, shall be abridged by this chapter.

(e) All information relating to a subscribers healthcare history, diagnosis, condition, treatment, or evaluation shall be considered confidential healthcare information and shall not be released or transferred except under the safeguards established by chapter 37.3 of title 5, the Confidentiality of Health Care Information Act.

(f) The provisions of chapter 19.1 of this title, relating to extended medical benefits, shall be construed to apply to enrollees of health maintenance organizations.

(g) Any health maintenance organization authorized under this chapter shall be deemed to be an insurer, for the purposes of compliance with chapter 17 of title 44.
R.I. Gen. Laws § 27-25-41 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-41
§ 27-25-41. Payment of benefits other than insurance benefits.
Status: in_force

(a) A society may pay benefits, other than insurance benefits, to its members from any special account or fund maintained for that purpose; provided, that if the benefits are of a nature that they could constitute benefits within the class of insurance set forth in this chapter, a society making the payments may not:

(1) Make any separate charge for the payments;

(2) Issue any certificate, policy, or other document promising the payments;

(3) Provide in its constitution, laws, or any other document that the payments may be received by the member as a matter of right; or

(4) Advertise the payments as insurance or as payments to which the member has any right.

(b) The society shall maintain a separate accounting of all disbursements made under this section and report them in its annual statement.
R.I. Gen. Laws § 27-17-25 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-25
§ 27-17-25. Hearings on rules and decisions of commissioner.
Status: in_force

Any party in interest aggrieved by any order or decision of the commissioner or by any rule or regulation adopted and promulgated by the commissioner may, within thirty (30) days after notice of it to other known parties in interest, make written request to the commissioner for a hearing. Within twenty (20) days after receipt of the written request, the commissioner shall hear the party or parties and shall give not less than ten (10) days written notice of the time and place of the hearing. Within fifteen (15) days after the hearing, the commissioner shall affirm, reverse, or modify the commissioners previous action, specifying the commissioners reasons for the action. Pending the hearing and decision on the hearing, the commissioner may suspend or postpone the effective date of the commissioners previous action. At any hearing before the commissioner, observance of formal rules of pleading or evidence shall not be required.
R.I. Gen. Laws § 27-9-8 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-8
§ 27-9-8. Filings by advisory organizations.
Status: in_force

(a) An insurer may satisfy its obligation to make filings by becoming a member of, or a subscriber to, a licensed advisory organization that makes filings, and by authorizing the director to accept those filings on its behalf; provided, that nothing contained in this chapter shall be construed as requiring any insurer to become a member of, or a subscriber to, any advisory organization.

(b) Every advisory organization shall file with the director for approval all prospective loss costs, provisions for special assessments, and all supplementary rating information and every change or amendment or modification of any of these proposed for use in this state. These filings shall be subject to the provisions of chapter 7.1 of this title, relating to workers compensation insurance.
R.I. Gen. Laws § 27-35-5 — RI Code / Title 27 / Chapter 27-35 / Section 27-35-5
§ 27-35-5. Examination.
Status: in_force

(a) Power of commissioner. Subject to the limitation contained in this section and in addition to the powers the commissioner has under other sections of this title relating to the examination of insurers, the commissioner shall have the power to examine any insurer registered under § 27-35-3 and its affiliates to ascertain the financial condition of the insurer, including the enterprise risk to the insurer by the ultimate controlling party, or by any entity or combination of entities within the insurance holding company system, or by the insurance holding company system on a consolidated basis.

(b) Access to books and records. (1) The commissioner may order any insurer registered under § 27-35-3 to produce records, books, or other information papers in the possession of the insurer or its affiliates as are reasonably necessary to determine compliance with this chapter. (2) To determine compliance with this chapter, the commissioner may order any insurer registered under § 27-35-3 to produce information not in the possession of the insurer if the insurer can obtain access to such information pursuant to contractual relationships, statutory obligations, or other method. In the event the insurer cannot obtain the information requested by the commissioner, the insurer shall provide the commissioner a detailed explanation of the reason that the insurer cannot obtain the information and the identity of the holder of information. Whenever it appears to the commissioner that the detailed explanation is without merit, the commissioner may require, after notice and hearing, the insurer to pay a penalty for each days delay, or may suspend or revoke the insurers license.

(c) Use of consultants. The commissioner may retain at the registered insurers expense attorneys, actuaries, accountants, and other experts not otherwise a part of the commissioners staff as shall be reasonably necessary to assist in the conduct of the examination under subsection (a) of this section. Any persons so retained shall be under the direction and control of the commissioner and shall act in a purely advisory capacity.

(d) Expenses. Each registered insurer producing for examination records, books, and papers pursuant to subsection (a) of this section shall be liable for and shall pay the expense of the examination in accordance with applicable laws of this state.

(e) Compelling production. In the event the insurer fails to comply with an order, the commissioner shall have the power to examine the affiliates to obtain the information. The commissioner shall also have the power to issue subpoenas, to administer oaths, and to examine under oath any person for purposes of determining compliance with this section. Upon the failure or refusal of any person to obey a subpoena, the commissioner may petition a court of competent jurisdiction, and upon proper showing, the court may enter an order compelling the witness to appear and testify or produce documentary evidence. Failure to obey the court order shall be punishable as contempt of court. Every person shall be obliged to attend as a witness at the place specified in the subpoena, when subpoenaed, anywhere within the state. He or she shall be entitled to the same fees and mileage, if claimed, as a witness in superior court of this state, which fees, mileage, and actual expense, if any, necessarily incurred in securing the attendance of witnesses, and their testimony, shall be itemized and charged against, and be paid by, the company being examined.
R.I. Gen. Laws § 27-44-20 — RI Code / Title 27 / Chapter 27-44 / Section 27-44-20
§ 27-44-20. Hearings.
Status: in_force

Any hearing conducted pursuant to this chapter shall be held in accordance with the Administrative Procedures Act (APA), chapter 35 of title 42, to the extent that the APA does not conflict with any provision of law contained in this chapter.
R.I. Gen. Laws § 27-6-13 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-13
§ 27-6-13. Suspension or modification of requirements  Examinations as to fairness.
Status: in_force

Under the rules and regulations that the commissioner shall adopt, the commissioner may, by written order, suspend or modify the requirement of filing as to any kind of insurance, or subdivision or combination of it, or as to classes of risks, the rates for which cannot practicably be filed before they are used. Those orders, rules, and regulations shall be made known to insurers and rating organizations affected by them. The commissioner may make an examination as the commissioner may deem advisable to ascertain whether any rates affected by an order meet the standards set forth in § 27-6-4(2).
R.I. Gen. Laws § 27-18-65 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-65
§ 27-18-65. Post-payment audits.
Status: in_force

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

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

(c) For the purposes of this section, healthcare provider means an individual clinician, either in practice independently or in a group, who provides healthcare services, and any healthcare facility, as defined in § 27-18-1.1, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner as identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.

(d) Except for those contracts where the health insurer or plan has the right to unilaterally amend the terms of the contract, the parties shall be able to negotiate contract terms that allow for different time frames than are prescribed herein.
R.I. Gen. Laws § 27-18-16 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-16
§ 27-18-16. False statements in application.
Status: in_force

The falsity of any statement in the application for any policy covered by this chapter may not bar the right to recovery under the policy unless the false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.
R.I. Gen. Laws § 27-19-56 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-56
§ 27-19-56. Post-payment audits.
Status: in_force

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

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

(c) For the purposes of this section, healthcare provider means an individual clinician, either in practice independently or in a group, who provides healthcare services, and any healthcare facility, as defined in § 27-18-1.1, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.

(d) Except for those contracts where the health insurer or plan has the right to unilaterally amend the terms of the contract, the parties shall be able to negotiate contract terms that allow for different time frames than are prescribed herein.
R.I. Gen. Laws § 27-77-1 — RI Code / Title 27 / Chapter 27-77 / Section 27-77-1
§ 27-77-1. Purpose and scope.
Status: in_force

The purpose of this chapter is to provide the requirements for maintaining a risk management framework, and completing an own risk and solvency assessment (ORSA) and provide guidance and instructions for filing an ORSA summary report with the insurance commissioner of this state.

The requirements of this chapter shall apply to all insurers domiciled in this state unless exempt pursuant to §27-77-6.

The general assembly finds and declares that the ORSA summary report will contain confidential and sensitive information related to an insurer or insurance groups identification of risks material and relevant to the insurer or insurance group filing the report. This information will include proprietary and trade secret information that has the potential for harm and competitive disadvantage to the insurer or insurance group if the information is made public. It is the intent of this general assembly that the ORSA summary report shall be a confidential document filed with the commissioner; that the ORSA summary report will be shared only as stated herein and to assist the commissioner in the performance of his or her duties; and that in no event shall the ORSA summary report be subject to public disclosure.
R.I. Gen. Laws § 27-10-11 — RI Code / Title 27 / Chapter 27-10 / Section 27-10-11
§ 27-10-11. Penalty for violations.
Status: in_force

Any person who acts as an adjuster, other than for life and accident and health insurance, without holding a current, valid license as provided in this chapter, or shall act in any manner in the negotiation of any insurance claim agreement in violation of any provision of this chapter shall be punished by an order to cease and desist such practices and fine or other penalty in accordance with the standards of § 42-14-16.
R.I. Gen. Laws § 27-16-6 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-6
§ 27-16-6. Service of process on commissioner.
Status: in_force

(a) Service of process shall be made by delivering to and leaving with the insurance commissioner, or some person in apparent charge of the commissioners office, two (2) copies of the process and the payment to the commissioner of any fees prescribed by law. The insurance commissioner shall mail by registered mail one of the copies of the process to the defendant at its last known principal place of business, and shall keep a record of all process served upon the defendant.

(b) The service of process is sufficient, provided notice of the service and a copy of the process are sent within ten (10) days thereafter by registered mail by the plaintiff or the plaintiffs attorney to the defendant at its last known principal place of business, 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 § 27-19-67 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-67
§ 27-19-67. 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 § 27-16-3 — RI Code / Title 27 / Chapter 27-16 / Section 27-16-3
§ 27-16-3. Short title.
Status: in_force

Sections 27-16-3  27-16-14 may be cited as the Unauthorized Insurers Process Act.
R.I. Gen. Laws § 27-20-17 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-17
§ 27-20-17. Mammograms and pap smears  Coverage mandated.
Status: in_force

(a) Subscribers to any nonprofit medical service plan shall be afforded coverage under the plan for mammograms and pap smears, in accordance with guidelines established by the American Cancer Society.

(b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit medical service plan shall be afforded coverage for:

(1) Two (2) paid screening mammograms per year when recommended by a physician for women who have been treated for breast cancer within the last five (5) years or who are at high risk of developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple first-degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia; and

(2) Any screening deemed medically necessary for proper breast cancer screening in accordance with applicable American College of Radiology guidelines including, but not limited to, magnetic resonance imaging, ultrasound, or molecular breast imaging for any person who has received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue.
R.I. Gen. Laws § 27-4-30 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-30
§ 27-4-30. Unintentional policy lapse.
Status: in_force

(a) Each insurer that delivers, or issues for delivery, an individual life insurance policy in this state on or after January 1, 2017, shall notify an applicant, in writing at the time of application for such policy, of such applicants right to designate a third party to receive notice of cancellation of the policy based on nonpayment of premium. The applicant may make such designation at the time of application for such policy, or at any time such policy is in force, by submitting a written notice to the insurer containing the name and address of the third-party designee.

(b) The insurers transmission to the third-party designee of a copy of a notice of cancellation based on nonpayment of premium shall be in addition to the transmission of the original notice to the policyholder. The copy of the notice of cancellation transmitted to the third party shall be governed by the same law and policy provisions that govern the notice being transmitted to the policyholder.

(c) The designation of a third party shall not constitute acceptance of any liability on the part of the third party or insurer for services provided to the policyholder.
R.I. Gen. Laws § 27-6-38 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-38
§ 27-6-38. Unlawful practices of joint underwriters or reinsurers.
Status: in_force

If, after a hearing, the commissioner finds that any activity or practice of any group, association, or other organization of joint underwriters or insurers is unfair or unreasonable or inconsistent with the provisions of this chapter, the commissioner may issue a written order specifying in what respects that activity or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, and requiring the discontinuance of that activity or practice.
R.I. Gen. Laws § 27-51-2 — RI Code / Title 27 / Chapter 27-51 / Section 27-51-2
§ 27-51-2. Definitions.
Status: in_force

As used in this chapter:

(1) Actuary means a person who is a member in good standing of the American Academy of Actuaries.

(2) Insurer means any person, firm, association, or corporation duly licensed in this state as an insurance company pursuant to this title.

(3)(i) Managing general agent (MGA) means any person, firm, association, or corporation who or that negotiates and binds ceding reinsurance contracts on behalf of an insurer or manages all or part of the insurance business of an insurer, including the management of a separate division, department, or underwriting office, and acts as an agent for the insurer whether known as a managing general agent, manager, or other similar term, who or that, with or without the authority, either separately or together with affiliates, produces, directly or indirectly, and underwrites an amount of gross direct written premium equal to or more than five percent (5%) of the policyholder surplus as reported in the last annual statement of the insurer in any one quarter or year together with one or more of the following: (A) Adjusts or pays claims in excess of an amount determined by the insurance commissioner or (B) Negotiates reinsurance on behalf of the insurer.

(ii) Notwithstanding subsection (3)(i) of this section, the following persons shall not be considered as MGAs for the purposes of this chapter:

(A) An employee of the insurer;

(B) A U.S. manager of the United States branch of an alien insurer;

(C) An underwriting manager who or that, pursuant to contract, manages all or part of the insurance operations of the insurer, is under common control with the insurer, subject to the holding company regulatory act, and whose compensation is not based on the volume of premiums written without regard to the profitability of the business written; and

(D) An attorney-in-fact authorized by and acting for the subscribers of a reciprocal insurer or interinsurance exchange under powers of attorney.

(4) Producer means insurance producer as defined in chapter 2.4 of this title.

(5) Underwrite means the authority to accept or reject risk on behalf of the insurer.
R.I. Gen. Laws § 27-4-7 — RI Code / Title 27 / Chapter 27-4 / Section 27-4-7
§ 27-4-7. Privilege against self-incrimination.
Status: repealed

No person shall be excused from attending and testifying or producing any books, papers, or other documents, before any court or magistrate, upon any investigation, proceeding, or trial for a violation of any of the provisions of § 27-4-6 [repealed], upon the ground or for the reason that the testimony or evidence, documentary or otherwise, required of that person may tend to convict the person of a crime or subject the person to a penalty or forfeiture. No person shall be prosecuted or subjected to any penalty or forfeiture for or on account of any transaction, matter, or thing concerning which that person may testify or produce evidence, documentary or otherwise, and no testimony given or produced shall be received against the person upon any criminal investigation or proceeding.
R.I. Gen. Laws § 27-25-9 — RI Code / Title 27 / Chapter 27-25 / Section 27-25-9
§ 27-25-9. Waiver.
Status: in_force

The laws of the society may provide that no subordinate body, nor any of its subordinate officers or members, shall have the power or authority to waive any of the provisions of the laws of the society. That provision shall be binding on the society and every member and beneficiary of a member.
R.I. Gen. Laws § 27-20-31.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-31.1
§ 27-20-31.1. Hysterectomy or myomectomy treatment.
Status: in_force

Commencing January 1, 2023, any insurer or healthcare plan, nonprofit health medical service plan, or nonprofit hospital service plan that provides coverage for obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health plan offered by a health insurance carrier or a health maintenance organization, shall provide coverage for a hysterectomy, myomectomy and laparoscopic removal of uterine fibroids, including uterine artery embolization, intraoperative ultrasound guidance and monitoring and radiofrequency ablation.
R.I. Gen. Laws § 27-18-23 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-23
§ 27-18-23. Severability.
Status: in_force

If any provision of this chapter, or the application of a provision to any person or circumstances, is held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those as to which it is held invalid, shall not be affected by that invalidity.
R.I. Gen. Laws § 27-20-29 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-29
§ 27-20-29. Mastectomy treatment.
Status: in_force

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

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

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

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

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

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

(d) [Deleted by P.L. 2018, ch. 114, § 3 and P.L. 2018, ch. 204, § 3].

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

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

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

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

(2) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
R.I. Gen. Laws § 27-46-11 — RI Code / Title 27 / Chapter 27-46 / Section 27-46-11
§ 27-46-11. Administrative and procedural authority regarding risk retention groups and purchasing groups.
Status: in_force

The commissioner is authorized to make use of any of the powers established under this title and any other pertinent section of law to enforce the laws of this state not specifically preempted by 15 U.S.C. § 3901 et seq., including the commissioners administrative authority to investigate, issue subpoenas, conduct depositions and hearings, issue orders, impose penalties, and seek injunctive relief. With regard to any investigation, administrative proceedings, or litigation, the commissioner can rely on the procedural laws of this state. Any injunctive authority of the commissioner, in regard to risk retention groups, shall be restricted by the requirement that any injunction be issued by a court of competent jurisdiction.
R.I. Gen. Laws § 27-41-79 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-79
§ 27-41-79. Emergency services.
Status: in_force

(a) As used in this section:

(1) Emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition: (i) Placing the health of the individual, or with respect to a pregnant woman her unborn child in serious jeopardy; (ii) Constituting a serious impairment to bodily functions; or (iii) Constituting a serious dysfunction of any bodily organ or part.

(2) Emergency services means, with respect to an emergency medical condition:

(i) A medical screening examination (as required under section 1867 of the Social Security Act, 42 U.S.C. §1395dd) that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate such emergency medical condition; and

(ii) Such further medical examination and treatment, to the extent they are within the capabilities of the staff and facilities available at the hospital, as are required under section 1867 of the Social Security Act (42 U.S.C. §1395dd) to stabilize the patient.

(3) Stabilize, with respect to an emergency medical condition has the meaning given in section 1867(e)(3) of the Social Security Act (42 U.S.C. §1395dd(e)(3)).

(b) If a health maintenance organization offering group health insurance coverage provides any benefits with respect to services in an emergency department of a hospital, it must cover emergency services consistent with the rules of this section.

(c) A health maintenance organization shall provide coverage for emergency services in the following manner:

(1) Without the need for any prior authorization determination, even if the emergency services are provided on an out-of-network basis;

(2) Without regard to whether the healthcare provider furnishing the emergency services is a participating network provider with respect to the services;

(3) If the emergency services are provided out of network, without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from in-network providers;

(4) If the emergency services are provided out of network, by complying with the cost-sharing requirements of subsection (d) of this section; and

(5) Without regard to any other term or condition of the coverage, other than:

(i) The exclusion of or coordination of benefits;

(ii) An affiliation or waiting period permitted under part 7 of federal ERISA, part A of title XXVII of the federal Public Health Service Act, or chapter 100 of the federal Internal Revenue Code; or

(iii) Applicable cost sharing.

(d)(1) Any cost-sharing requirement expressed as a copayment amount or coinsurance rate imposed with respect to a participant or beneficiary for out-of-network emergency services cannot exceed the cost-sharing requirement imposed with respect to a participant or beneficiary if the services were provided in-network; provided, however, that a participant or beneficiary may be required to pay, in addition to the in-network cost sharing, the excess of the amount the out-of-network provider charges over the amount the plan or health maintenance organization is required to pay under subsection (d)(1). A health maintenance organization complies with the requirements of this subsection (d) if it provides benefits with respect to an emergency service in an amount equal to the greatest of the three amounts specified in subsections (d)(1)(i), (d)(1)(ii), and (d)(1)(iii) of this section (which are adjusted for in-network cost-sharing requirements).

(i) The amount negotiated with in-network providers for the emergency service furnished, excluding any in-network copayment or coinsurance imposed with respect to the participant or beneficiary. If there is more than one amount negotiated with in-network providers for the emergency service, the amount described under this subsection (d)(1)(i) is the median of these amounts, excluding any in-network copayment or coinsurance imposed with respect to the participant or beneficiary. In determining the median described in the preceding sentence, the amount negotiated with each in-network provider is treated as a separate amount (even if the same amount is paid to more than one provider). If there is no per-service amount negotiated with in-network providers (such as under a capitation or other similar payment arrangement), the amount under this subsection (d)(1)(i) is disregarded.

(ii) The amount for the emergency service calculated using the same method the plan generally uses to determine payments for out-of-network services (such as the usual, customary, and reasonable amount), excluding any in-network copayment or coinsurance imposed with respect to the participant or beneficiary. The amount in this subsection (d)(1)(ii) is determined without reduction for out-of-network cost sharing that generally applies under the plan or health insurance coverage with respect to out-of-network services.

(iii) The amount that would be paid under Medicare (part A or part B of title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.) for the emergency service, excluding any in-network copayment or coinsurance imposed with respect to the participant or beneficiary.

(2) Any cost-sharing requirement other than a copayment or coinsurance requirement (such as a deductible or out-of-pocket maximum) may be imposed with respect to emergency services provided out of network if the cost-sharing requirement generally applies to out-of-network benefits. A deductible may be imposed with respect to out-of-network emergency services only as part of a deductible that generally applies to out-of-network benefits. If an out-of-pocket maximum generally applies to out-of-network benefits, that out-of-pocket maximum must apply to out-of-network emergency services.

(e) The provisions of this section apply for plan years beginning on or after September 23, 2010.

(f) 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.
R.I. Gen. Laws § 27-18-21 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-21
§ 27-18-21. Appeals from commissioner.
Status: in_force

Any order or decision of the commissioner under this chapter shall be subject to appeal to the superior court at the instance of any party in interest. The filing of the appeal shall operate as a stay of the order or decision until the court directs otherwise. The court may review all of the facts and, in disposing of the issue before it, may modify, affirm, or reverse the order or decision of the commissioner in whole or in part. Any person aggrieved by the decision or decree of the superior court may appeal to the supreme court on questions of law. The appeal shall follow the course of equity. Pending the determination of the appeal, all orders or decisions or decrees of either the commissioner or the superior court shall be stayed until the supreme court directs otherwise.
R.I. Gen. Laws § 27-66-6 — RI Code / Title 27 / Chapter 27-66 / Section 27-66-6
§ 27-66-6. Initial application  Conversions.
Status: in_force

(a) No person shall engage in a conversion involving the establishment, maintenance, or operation of a health insurance corporation, health maintenance organization, nonprofit hospital service corporation, or nonprofit medical service corporation, without prior approval of the department of business regulation. The transacting parties shall file an initial application in accordance with subsection (b) of this section which shall, at a minimum, include the following information with respect to each transacting party and to the proposed new health insurance corporation, health maintenance organization, nonprofit hospital service corporation, or nonprofit medical service corporation:

(1) A detailed summary of the proposed conversion;

(2) Names, addresses, and phone numbers of the transacting parties;

(3) Name, address, phone number, and occupation of all officers, members of the board of directors, trustees, executive and senior level management including for each position, current persons and persons holding the position during the past three (3) years;

(4) Articles of incorporation and certificate of incorporation;

(5) Bylaws and organizational charts;

(6) Organizational structure for existing transacting parties and each partner, affiliate, parent, subsidiary, or related corporate entity in which the acquiror has a twenty percent (20%) or greater ownership interest;

(7) Conflict of interest statements, policies, and procedures;

(8) Names, addresses, and phone numbers of professional consultants engaged in connection with the proposed conversion;

(9) Copies of audited income statements, balance sheets, and other financial statements for the past three (3) years and to the extent they have been made public, audited interim financial statements and income statements together with a detailed description of the financing structure of the proposed conversion including equity contribution, debt restructuring, stock issuance, partnership interests, stock offerings, and the like;

(10) A detailed description as each relates to the proposed transaction for equipment leases, insurance, regulatory compliance, tax status, pending litigation or pending regulatory citations, pension plan descriptions and employee benefits, assessments and organizational goals;

(11) Copies of reports analyzing the proposed conversion during the past three (3) years including, but not limited to, reports by appraisers, accountants, investment bankers, actuaries, and other experts;

(12) A description of the manner in which the price was determined including which methods of valuation and what data were used, and the names and addresses of persons preparing these documents, and this information is deemed to be proprietary;

(13) The name and mailing address of all facilities in which the acquiror maintains an ownership interest or controlling interest or operating authority;

(14) A list of pending or adjudicated citations, violations, or charges against the facilities listed in subsection (a)(13) of this section brought by any governmental agency within the past three (3) years and the status or disposition of each matter with regard to its operation;

(15) The names of persons currently holding a position as an officer, director, or senior level management who will or will not maintain any position with the new health insurance corporation, health maintenance organization, nonprofit hospital service corporation, or nonprofit medical service corporation and whether this person will receive any salary, severance stock offering, or any financial gain, current or deferred, as a result of or in relation to the proposed conversion;

(16) Current, signed original conflict of interest forms from all officers, directors, trustees, senior management, chairpersons, or department chairpersons on a form acceptable to the attorney general;

(17) Any other material that the department of business regulation deems relevant to its investigation;

(18) A detailed description of real estate owned or leased including title reports for land owned and lease agreements concerning the proposed conversion;

(19) Copies of all documents related to: (i) Identification of all charitable assets; (ii) Accounting of all charitable assets for the past three (3) years; and (iii) Distribution of the charitable assets including, but not limited to, endowments, restricted, unrestricted and specific purpose funds as each relates to the proposed transaction;

(20) A description of the plan as to how the new health insurance corporation, health maintenance organization, nonprofit hospital service corporation, or nonprofit medical service corporation will provide community benefits and continued access to health insurance during the first three (3) years of operation;

(21) Copies of documents or description of any proposed plan for any entity to be created for charitable assets, including but not limited to, endowments, restricted, unrestricted and specific purpose funds, the proposed articles of incorporation, bylaws, mission statement, program agenda, method of appointment of board members, qualifications of board members, duties of board members, and conflict of interest policies;

(22) The application shall also include a complete statement of performance during the preceding one year with regard to the terms and conditions of approval of conversion and each projection, plan, or description submitted as part of the application for any conversion completed under any application;

(23) Copies of all NCQA (National Council on Quality Assurance) reports and profiles and all NAIC (National Association of Insurance Commissioners) reports issued during the past five (5) years.

(b) Two (2) copies of the initial application shall be provided to the department of business regulation and the department of attorney general simultaneously by United States mail, certified, return receipt requested.

(c) Except for information determined by the department of business regulation in accordance with § 27-66-23 to be confidential and/or proprietary, the initial application, supporting documentation, and the attorney generals report shall be considered public records and shall be available for inspection upon request.
R.I. Gen. Laws § 27-18-26 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-26
§ 27-18-26. Physical examinations by insurance company.
Status: in_force

Any applicant for accident and/or sickness insurance with any company organized or doing business within this state shall be provided, upon request, any and all medical reports by a physician or other medical personnel that were performed at the request or direction of the company. The reports shall only be provided to a physician of the applicants choice whether the applicant receives a rating or rejection from a company, and the provisions of this section shall also apply to medical examinations performed pursuant to applications for an increase in insurance coverage.
R.I. Gen. Laws § 27-19-73 — RI Code / Title 27 / Chapter 27-19 / Section 27-19-73
§ 27-19-73. Opioid antagonists.
Status: in_force

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended, or renewed in this state on or after January 1, 2017, shall provide coverage for at least one generic opioid antagonist and device. Prior authorization may be required for non-generic forms of opioid antagonists and devices.

(b) As used in this section:

Opioid antagonist means naloxone hydrochloride and any other drug approved by the United States Food and Drug Administration for the treatment of opioid overdose.

(c) The coverage mandated by this section shall include generic opioid antagonists prescribed or dispensed via standing order or collaborative-practice agreement intended for use on patients other than the insured. Prior authorization may be required for non-generic forms of opioid antagonists and devices.
R.I. Gen. Laws § 27-20-25.1 — RI Code / Title 27 / Chapter 27-20 / Section 27-20-25.1
§ 27-20-25.1. No derogation of attorney general.
Status: in_force

No provision of this chapter shall derogate from the common law or statutory authority of the attorney general nor shall any provision be construed as a limitation on the common law or statutory authority of the attorney general, including the authority to investigate at any time charitable assets for the purpose of determining and ascertaining whether they are being administered in accordance with law and with the terms and purposes of the charity.
R.I. Gen. Laws § 27-18-33.2 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-33.2
§ 27-18-33.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies.
Status: in_force

(a) Definitions. As used herein:

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

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

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

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

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

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

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

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

(2) The product must be nationally available.

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

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

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

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

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

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

(6) The department of health shall exercise oversight and enforcement of this section.
R.I. Gen. Laws § 27-41-93 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-93
§ 27-41-93. 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 § 27-30-9 — RI Code / Title 27 / Chapter 27-30 / Section 27-30-9
§ 27-30-9. Issuance of policies.
Status: in_force

All policies of consumer credit insurance shall be delivered or issued for delivery in this state only by an insurer authorized to engage in the business of insurance thereto, and shall be issued only through holders of licenses or authorizations issued by the commissioner.
R.I. Gen. Laws § 27-50-19 — RI Code / Title 27 / Chapter 27-50 / Section 27-50-19
§ 27-50-19. Essential health benefits.
Status: repealed

(a) The following words and phrases as used in this section have the following meanings consistent with federal law and regulations adopted thereunder, as long as they remain in effect. If such authorities are determined by the commissioner to no longer be in effect, the laws and regulations in effect as of the date immediately prior to their legislative repeal or their being declared invalid or nullified by federal judicial or executive branch action, as identified by the commissioner shall govern, unless a different meaning is required by the context:

(1) Essential health benefits means the following general categories, and the services covered within those categories as defined pursuant to the processes described in 42 U.S.C. § 18022 and implementing regulations and guidance:

(i) Ambulatory patient services;

(ii) Emergency services;

(iii) Hospitalization;

(iv) Maternity and newborn care;

(v) Mental health and substance use disorder services, including behavioral health treatment;

(vi) Prescription drugs;

(vii) Rehabilitative and habilitative services and devices;

(viii) Laboratory services;

(ix) Preventive services, wellness services, and chronic disease management; and

(x) Pediatric services, including oral and vision care.

(2) Preventive services means those services described in 42 U.S.C. § 300gg-13 and implementing regulations and guidance.

(b) If any provision of the federal Patient Protection and Affordable Care Act and implementing regulations relating to coverage for essential health benefits and/or for preventive services without cost sharing are determined by the commissioner to have been repealed or to have been declared invalid or nullified by the final judgment of a federal judicial branch applicable to the state or by executive or administrative action, which shall be deemed to include an action of the federal executive or judicial branch that nullifies the effectiveness of the obligation to provide coverage without cost sharing for a meaningful range of preventive services substantially similar to those preventive services required under 42 U.S.C. § 300gg-13 as of January 1, 2023, then the following shall apply:

(1) A health insurance policy, subscriber contract, or health plan offered, issued, renewed, issued for delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant to this title and/or chapter shall provide coverage of at least the essential health benefits categories set forth in this section, and shall further provide coverage of preventive services from in-network providers without applying any copayments, deductibles, coinsurance, or other cost sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance, including existing exemptions, in effect as of the date immediately prior to their repeal, revocation, or nullification, as set forth above.

(2) To the extent that the U.S. Preventive Services Taskforce revises its recommendations with respect to grade A or B preventive services, or other expert advisory panel designated in 42 U.S.C. § 300gg-13 similarly provides new or revised recommendations, the office of health insurance commissioner shall have the authority to issue guidance clarifying the services that shall qualify as preventive services under this section, consistent with said recommendations and in accordance with the processes as had been described by the version of 42 U.S.C. § 300gg-13(b) and related regulations and guidance in effect as of the date immediately prior to their repeal, revocation, or nullification, as set forth above.

(c) If a health insurance policy, subscriber contract, or health plan offered, issued, renewed, issued for delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant to this title and/or chapter, was not subject to the requirements described in subsection (b) of this section prior to their repeal, revocation, or nullification, then such policy, contract, or plan shall remain so exempt and the provisions of this section shall not apply.
R.I. Gen. Laws § 27-17-5 — RI Code / Title 27 / Chapter 27-17 / Section 27-17-5
§ 27-17-5. Service of process.
Status: in_force

Concurrently with the filing of the declaration provided for by the terms of § 27-17-4, the attorney shall file with the commissioner an instrument in writing duly executed by the attorney for the subscribers, conditioned that upon the issuance of the certificate of authority provided for in § 27-17-6, an action may be brought in any county in which the cause of action arises or where the claimant resides, and service of process may be had upon the commissioner in all suits in this state arising out of any policies, contracts, or agreements issued, which service shall be valid and binding upon all subscribers exchanging at any time reciprocal or interinsurance contracts through the attorney. Three (3) copies of the process shall be served, and the commissioner shall file one copy in the commissioners office, forward one copy to the attorney, and return one copy with the commissioners admission of service. Service of process may also be had upon all subscribers by serving the attorney at the office. Service of process shall not be had upon subscribers or any of them in any suit or proceeding in this state, except in the manner provided in this section, and any suit or other proceeding may be begun and prosecuted or defended by them under the name or designation adopted by them. A service fee of five dollars ($5.00) shall accompany each service and be paid to the commissioner.
R.I. Gen. Laws § 27-18-32 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-32
§ 27-18-32. Discontinuance of coverage  Chronic disabilities.
Status: in_force

Notwithstanding the provisions of § 27-18-19, no group health insurer shall discontinue reimbursement or providing services for covered healthcare services for chronic disabilities, unless the patient has exhausted benefits to which the patient is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period provided notice of the discontinuation of the services is sent to subscribers who have been reimbursed for or utilized the services in the past three (3) years. The notice shall be mailed at least sixty (60) days prior to the beginning of the open enrollment period. For the purposes of this section, chronic disability means an impairment or illness that is likely to continue indefinitely.
R.I. Gen. Laws § 27-6-39 — RI Code / Title 27 / Chapter 27-6 / Section 27-6-39
§ 27-6-39. Examination of rating and advisory organizations and underwriting and reinsurance groups.
Status: in_force

The commissioner shall, at least once in five (5) years, make or cause to be made an examination of each rating organization licensed in this state as provided in § 27-6-23 and the commissioner may, as often as the commissioner may deem it expedient, make or cause to be made an examination of each advisory organization referred to in § 27-6-33 and of each group, association, or other organization referred to in § 27-6-37. The total cost of those examinations shall be borne by the examined organization and shall be one hundred fifty percent (150%) of the total salaries paid to the examining personnel of the banking and insurance division engaged in those examinations less any salary reimbursements and shall be paid to the insurance commissioner to and for the use of the state. This assessment shall be in addition to any taxes and fees payable to the state. The officers, manager, agents, and employees of the rating organization, advisory organization, or group, association, or other organization may be examined at any time under oath and shall exhibit all books, records, accounts, documents, or agreements governing its method of operation. In lieu of any examination the commissioner may accept the report of an examination made by the insurance supervisory official of another state, pursuant to the laws of that state.
R.I. Gen. Laws § 27-71-2 — RI Code / Title 27 / Chapter 27-71 / Section 27-71-2
§ 27-71-2. Purpose  Legislative intent.
Status: in_force

(a) The purpose of this chapter is to establish a framework for insurance market conduct actions, including:

(1) Processes and systems for identifying, assessing, and prioritizing market conduct problems that have an adverse impact on consumers, policyholders, and claimants;

(2) Market conduct actions by a commissioner to substantiate such market conduct problems and a means to remedy market conduct problems; and

(3) Procedures to communicate and coordinate market conduct actions among states to foster the most efficient and effective use of resources.

(b) This chapter does not apply to entities regulated by the office of health insurance commissioner under chapter 14.5 of title 42 (The Rhode Island Healthcare Reform Act of 2004  Health Insurance Oversight) or any insurer licensed only in the state of Rhode Island.
R.I. Gen. Laws § 27-5-10 — RI Code / Title 27 / Chapter 27-5 / Section 27-5-10
§ 27-5-10. Penalty for nonconforming policy  Validity.
Status: in_force

Any insurance company or insurance producer who shall make, issue, or deliver a policy of fire insurance in willful violation of §§ 27-5-1  27-5-9, or any part of those sections, shall forfeit for each offense not less than fifty dollars ($50.00) nor more than two hundred dollars ($200); but the policy shall be binding upon the company issuing it.
R.I. Gen. Laws § 27-18-55 — RI Code / Title 27 / Chapter 27-18 / Section 27-18-55
§ 27-18-55. Acupuncture services.
Status: in_force

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

(b) For the purposes of this section:

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

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

(c) It shall remain within the sole discretion of the accident and sickness insurer as to which doctor of acupuncture it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer; provided, that no accident and sickness insurer may be required to pay for duplicative services actually rendered by a doctor of acupuncture and any other healthcare provider. Nothing contained in this section shall preclude the accident and sickness insurer from conducting managed care, medical necessity, or utilization review.
R.I. Gen. Laws § 27-41-59 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-59
§ 27-41-59. FDA approved prescription contraceptive drugs and devices.
Status: in_force

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

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

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

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

(e) Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time.
R.I. Gen. Laws § 27-9-30 — RI Code / Title 27 / Chapter 27-9 / Section 27-9-30
§ 27-9-30. Advisory organization defined.
Status: in_force

Every group, association, or other organization of insurers, whether located within or outside 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 § 27-41-70 — RI Code / Title 27 / Chapter 27-41 / Section 27-41-70
§ 27-41-70. Tobacco cessation programs.
Status: in_force

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

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

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

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

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

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

(9) Other limited benefit policies.
R.I. Gen. Laws § 27-1-44 — RI Code / Title 27 / Chapter 27-1 / Section 27-1-44
§ 27-1-44. Prohibition on the pledging of stock.
Status: in_force

No domestic insurance company, and no holding company as defined in § 27-35-1(6), shall pledge its own stock, or any stock of any domestic insurance company subsidiary, without the prior written consent of the director of business regulation. The provisions of this section shall not apply to any of these pledges in effect prior to August 5, 1996.
R.I. Gen. Laws § 27-74-5 — RI Code / Title 27 / Chapter 27-74 / Section 27-74-5
§ 27-74-5. Registration requirements.
Status: in_force

(a) Before doing business in or from this state as a discount medical plan organization, a person shall obtain a certificate of registration from the commissioner to operate as a discount medical plan organization.

(b) Each application for a certificate of registration to operate as a discount medical plan organization:

(1) Shall be in a form prescribed by the commissioner and verified by an officer or authorized representative of the applicant;

(2) Shall be accompanied by a fee of two hundred fifty dollars ($250) payable to the State of Rhode Island;

(3) Shall include information on whether:

(i) A previous application for a certificate of registration, license, or permit to operate as a medical discount plan has been denied, revoked, suspended, or terminated for cause in any jurisdiction (including Rhode Island); and

(ii) The applicant is under investigation for or the subject of any pending action or has been found in violation of a statute or regulation in any jurisdiction (including Rhode Island) within the previous five (5) years;

(4) Shall include information, as the commissioner may require, that permits the commissioner, after reviewing all of the information submitted pursuant to this subsection, to make a determination that the applicant:

(i) Is financially responsible;

(ii) Has adequate expertise or experience to operate a discount medical plan organization; and

(iii) Is of good character.

(c) After the receipt of an application filed pursuant to this section, the commissioner shall review the application and notify the applicant of any deficiencies in the application.

(d) Within ninety (90) days after the date of receipt of a completed application, the commissioner shall:

(1) Issue a certificate of registration if the commissioner is satisfied that the applicant has met the requirements of this chapter and any regulations promulgated thereunder; or

(2) Disapprove the application and state the ground(s) for disapproval. The commissioner shall notify the applicant in writing specifically stating the ground(s) for the disapproval. Upon such notification, the applicant may, within thirty (30) days, request a hearing on the matter to be conducted in accordance with the Administrative Procedures Act, chapter 35 of title 42.

(e) Prior to issuance of a certificate of registration by the commissioner, each discount medical plan organization shall establish an Internet website in order to conform to the requirements of § 27-74-9(f).

(f) A registration is effective for two (2) years, unless prior to its expiration it is renewed in accordance with this section or suspended or revoked. At least ninety (90) days before a certificate of registration expires, the discount medical plan organization shall submit a renewal application form and the renewal fee. The commissioner shall renew the certificate of registration of each holder that meets the requirements of this chapter and any regulations promulgated thereunder and pays the renewal fee. The renewal application shall be substantially the same as an original application and the renewal fee shall be two hundred fifty dollars ($250) payable to the State of Rhode Island.

(g) The commissioner may suspend the authority of a discount medical plan organization to enroll new members or refuse to renew or revoke a discount medical plan organizations certificate of registration if the commissioner finds that any of the following conditions exist:

(1) The discount medical plan organization is not operating in compliance with this chapter and any regulations promulgated thereunder;

(2) The discount medical plan organization has advertised, merchandised, or attempted to merchandise its services in such a manner as to misrepresent its services or capacity for service or has engaged in deceptive, misleading, or unfair practices with respect to advertising or merchandising;

(3) The discount medical plan organization is not fulfilling its obligations as a discount medical plan organization; or

(4) The continued operation of the discount medical plan organization would be hazardous to its members.

(h) If the commissioner has cause to believe that grounds for the nonrenewal, suspension, or revocation of a certificate of registration exist, the commissioner shall notify the discount medical plan organization in writing specifically stating the ground(s) for the refusal to renew or suspension or revocation. Upon such notification, the discount medical plan may, within thirty (30) days, request a hearing on the matter to be conducted in accordance with the Administrative Procedures Act, chapter 35 of title 42.

(i) When the certificate of registration of a discount medical plan organization is nonrenewed, surrendered, or revoked, the discount medical plan organization shall proceed, immediately following the effective date of the order of revocation or, in the case of a nonrenewal, the date of expiration of the certificate of registration, to wind up its affairs transacted under the certificate of registration. The discount medical plan organization shall not engage in any further advertising, solicitation, collecting of fees, or renewal of contracts. The commissioner may, in his or her sole discretion and upon a showing of good cause, in the case of a registration of a discount medical plan organization that has been revoked or nonrenewed by the commissioner, allow the discount medical plan organization to continue to operate under any conditions and restrictions established by the commissioner, pending the outcome of a hearing requested pursuant to subsection (h) of this section.

(j) The commissioner shall, in an order suspending the authority of the discount medical plan organization to enroll new members, specify the period during which the suspension is to be in effect and the conditions, if any, that must be met by the discount medical plan organization prior to reinstatement of its certificate of registration to enroll members. The commissioner may rescind or modify the order of suspension prior to the expiration of the suspension period. The certificate of registration of a discount medical plan organization shall not be reinstated unless requested by the discount medical plan organization. The commissioner shall not grant the request for reinstatement if the commissioner finds that the circumstances for which the suspension occurred still exist or are likely to recur.

(k) In lieu of suspending or revoking a discount medical plan organizations certificate of registration, whenever the discount medical plan organization has been found to have violated any provision of this chapter, the commissioner may:

(1) Issue and cause to be served upon the organization charged with the violation a copy of the findings and an order requiring the organization to immediately cease and desist from engaging in the act or practice that constitutes the violation; and

(2) Impose any penalty provided for under § 42-14-16.

( l ) Each registered discount medical plan organization shall notify the commissioner immediately whenever the discount medical plan organizations certificate of registration, or other form of authority, to operate as a discount medical plan organization in another jurisdiction is suspended, revoked, or nonrenewed in that state.

(m) A provider who provides discounts to his or her own patients without any cost or fee of any kind to the patient is not required to obtain and maintain a certificate of registration under this chapter as a discount medical plan organization.